Integrating Sustainable Development Goals into Maternal Healthcare: A Mixed-Methods Study from Botswana

The Sustainable Development Goals (SDGs), particularly Goal 3 on health and well-being, offer a framework for improving maternal health. In Botswana, progress in reducing maternal mortality has plateaued, requiring an examination of how SDG principles are applied within the maternal healthcare system. This study assessed the integration of SDG targets into Botswana's maternal healthcare policies and frontline service delivery. It aimed to identify barriers and facilitators to this integration from the perspectives of healthcare providers and policymakers. A sequential explanatory mixed-methods design was used. A document analysis of national maternal health policies was conducted first. This was followed by a cross-sectional survey of midwives and obstetricians from selected healthcare facilities. Finally, in-depth interviews and focus group discussions were held with a purposive sample of survey respondents and key policymakers. Policy documents showed high-level alignment with SDG 3, but implementation was inconsistent. The survey indicated that only 38% of frontline providers had received formal training on SDG-related protocols. Qualitative data identified three key barriers: fragmented health information systems, resource constraints favouring acute care over preventative SDG-aligned programmes, and insufficient interdisciplinary collaboration. A significant gap exists between the formal adoption of SDG targets in policy and their practical application in maternal healthcare delivery in Botswana. Systemic and operational challenges hinder effective integration. To strengthen integration, we recommend: 1) developing standardised SDG-focused training for maternal health providers; 2) revising monitoring frameworks to include specific SDG indicators; and 3) fostering stronger linkages between maternal health services and community-based programmes addressing wider SDG determinants like poverty and education. Sustainable Development Goals, maternal health, health policy, health systems, Botswana, sub-Saharan Africa This study provides evidence on the operational challenges of implementing global health goals within a national maternal healthcare system, offering practical insights for policymakers and health managers in similar settings.