The world of foreign aid is at a crossroads. Changes at USAID have reignited a debate on the unpredictable nature of humanitarian support. While emergency food relief has resumed in Lebanon, Syria, Somalia, Jordan, Iraq, and Ecuador, crucial assistance for nations including Afghanistan and Yemen remains on hold. These changes hint at an emerging US model that favours emergency support over long-term, sustainable involvement.

Yet this moment reveals a deeper truth: the need for a fundamental rethink of how we deliver development and humanitarian aid. What’s required now is smarter aid – support that not only responds to immediate crises but builds the foundations for lasting progress. Nowhere is this clearer than in the fight to improve maternal healthcare in the world’s most fragile regions.

Every day, thousands of women risk their lives to bring new life into the world. Consider this – in 2023, the World Health Organization reported 260,000 maternal deaths, with a staggering 92 percent of these in low- and lower-middle-income countries. With smarter aid, focused on prevention, access, and local capacity-building, the tragic reality is that most of these deaths are preventable.

In wealthier countries, childbirth is typically safe, supported by trained health professionals and emergency care when needed. However, in sub-Saharan Africa, only 60 percent of births are attended by skilled health personnel. According to UNICEF, across Asia, under-five mortality remains alarmingly high in several countries, driven largely by conflict, poverty, and weak health systems. South Asia alone accounts for 26 percent of global under-five deaths, even though its under-five mortality rate has declined by 72 percent since 1990.

The contrast is even starker in conflict-affected areas: in Afghanistan, for example, nearly half of all births lack skilled attendance, and basic emergency obstetric care is scarce. Without access to trained providers, routine complications – like postpartum haemorrhage or obstructed labour – quickly become life-threatening emergencies.

Women in remote areas, especially those trapped in poverty, confront insurmountable obstacles in their quest for healthcare. In many regions, the nearest facilities are agonisingly out of reach – a crisis most acute in areas prioritised by the Sustainable Development Goals, such as sub-Saharan Africa and Southern Asia, where a severe shortage of skilled providers and critical supplies exacerbates an already desperate situation.

Picture a soon-to-be mother in a distant village of rural Afghanistan or Pakistan, unsure if she will ever reach a safe place to give birth. She walks for hours over rough terrain to a field hospital, knowing that if complications arise, her chances of survival are slim. This is not an abstract example – it is the daily reality for millions of women across the world. Those who survive the gruelling journey to the hospital often find themselves sharing a bed with another patient, or their premature babies sharing incubators – if they exist at all.

The result? In Afghanistan, a woman dies every two hours from pregnancy-related complications.

In the clinics we have seen, the outcome for expectant mothers depends to a large degree on whether the clinic has the necessary supplies, trained staff, and equipment to provide immediate care.

Smarter aid makes this difference – it ensures these life-saving resources are in place before emergencies happen, and that the right trainings and technologies are made available for training midwives. Midwives trained in neonatal resuscitation and infection prevention can address the nearly 40 percent of under-five deaths occurring in the first month of life, with the highest risk in the first week.

This is the promise of smarter aid: not just emergency relief, but targeted investments that systematically break down the barriers between mothers and life-saving care.

Consider, for example, the UAE’s plan to establish ten state-of-the-art maternity and paediatric centres across Afghanistan’s most vulnerable provinces – Nangarhar, Balkh, Herat, Ghazni, Paktika, Paktia, Kandahar, and Helmand. These centres are designed not as temporary fixes, but as lasting pillars of maternal and child health, offering safe deliveries, comprehensive prenatal and postnatal care, emergency interventions, and vaccination programmes.

The impact is transformative. These facilities will directly benefit 115,000 women and indirectly support over 727,000 people. But the gains go far beyond healthcare: healthy mothers nurture healthy families, fuelling stronger, more resilient communities. Already, the centres have created dozens of local jobs, stabilising fragile economies,  and reinforcing the social fabric.

This approach has proven its worth before. Beginning in the 1940s, Sri Lanka introduced a nationwide network of polyclinics, many in rural areas, that evolved into community-based maternity and child-care centres staffed by trained midwives and public-health nurses. Maternal mortality there plummeted from over 500 per 100,000 live births in the 1950s to just 60 per 100,000 today.

When aid supports local solutions, trains healthcare workers, and fortifies supply chains, it builds resilience that endures long after the emergency passes. Over the past two decades, maternal mortality rates worldwide have declined, yet far too many gains remain fragile. Progress can be reversed if attention wanes or funding dries up. Maternal health challenges aren’t solved overnight; they demand long-term commitment, predictable investment, and partnerships that place local communities at the heart of the solution.

In this context, philanthropy must step up. Not as a stopgap but as a driving force for lasting change. As aid budgets become more uncertain and institutional support more short term, philanthropic investment can offer the predictable, long-term backing needed to sustain progress. The greatest impact comes when funding goes beyond immediate services to strengthen systems: supporting local organisations, training midwives, improving supply chains, and ensuring no mother or newborn is left behind when political priorities shift.

Philanthropy is uniquely placed to take the long view, to fund what others overlook, to back solutions that build resilience, and to partner directly with frontline communities. When coordinated with governments and humanitarian actors, it can unlock sustainable, scalable results.

Healthcare workers continue to remind us that every healthy mother sets in motion a ripple effect. Saving a single life strengthens families, supports economic growth, and creates brighter futures for entire communities. This is the essence of smarter aid. Building economies, strengthening societies, and laying the groundwork for lasting resilience. Creating solutions that endure long after the headlines fade.

Over the past two decades, global maternal and under-five mortality rates have declined dramatically, yet gains in many fragile settings remain precarious. The risk of reversal is real if funding dries up or focus shifts away from long-term capacity building. Maternal health challenges are not solved overnight - they demand sustained commitment, predictable investment, and community-driven partnerships.

Imagine a world where no mother fears childbirth and every child enjoys a healthy start - this future is within reach if we choose to build it through smart, proactive investments in maternal health.