BACKGROUND:
Reducing maternal and neonatal mortality remains a critical challenge in Burkina Faso, where national indicators remain far below SDG targets, and a security crisis has closed around 350 health facilities, depriving nearly 4 million people of regular care. Thus, Village Midwives (VMs) were reinstated as part of an emergency plan to provide essential obstetric services in the insecure regions.

METHODS:
From August 2024 to February 2025, a sequential mixed-methods study was conducted across four severely affected regions. It integrated quantitative secondary data from all affected health districts with qualitative data from focus groups and individual interviews with VMs, health workers, partners, and beneficiaries. Analysis used descriptive statistics (R, Python) and thematic analysis (QDA Miner). Ethical approval and consent were secured.

RESULTS:
From 2022 to 2024, VMs performed 47,180 deliveries. In the Sahel region, their contribution peaked, accounting for 43% of all deliveries in 2023. District coverage varied from 100% in the North and Sahel to 83.3% in Centre-Nord and Boucle du Mouhoun. However, VM training rates were highly disparate (92% in Kaya vs. 0% in Sebba) and NGO-dependent. Severe equipment shortages forced the use of improvised materials such as plastic bags as gloves. Despite this, qualitative results show that VMs as indispensable and reliable providers, who reduce delays in access to care through their proximity and rapid referrals to health facilities. Low absolute numbers of maternal deaths (≤7 per year) were recorded among VM-assisted births, with none in Centre-Nord. Data gaps hinder a conclusive statistical analysis of mortality impact.

CONCLUSIONS:
Village Midwives are an essential emergency response component in conflict-affected Burkina Faso. To optimize their impact, their role requires formal integration into the health system, supported by standardized training, a reliable equipment supply chain, and strengthened data reporting mechanisms.