Unmet obstetric needs in secondary and tertiary hospitals in Lubumbashi, Democratic Republic of Congo: a mixed-methods study

Background The need for obstetric care is defined by health conditions that require appropriate medical management. Limited literature in the Democratic Republic of Congo (DRC) using the unmet obstetric needs (UON) approach prompted this study. We aimed to assess the coverage of UON in the city of Lubumbashi, estimate the magnitude of unmet obstetric needs, identify factors associated with maternal mortality, and explore stakeholders’ awareness of the UON approach. Methods We conducted a mixed-methods cross-sectional analytical and phenomenological study in 12 health facilities in Lubumbashi. A total of 444 women were included in the quantitative analysis, and 30 semi-structured interviews were conducted with key stakeholders. Results An overall deficit of 88% in major obstetric interventions (MOIs) was observed. The deficit was markedly lower at the university clinics (1.1%) and Sendwe Hospital (33%) compared with an average deficit of 93.1% across the 10 secondary-level hospitals. Caesarean section was associated with higher odds of maternal death aOR=1.42(95% CI:1.21-1.72), whereas blood transfusion and referral to a higher level of care appeared to be protective factors. Qualitative findings revealed limited awareness among healthcare providers regarding the UON approach. Conclusions This study highlights a substantial burden of unmet obstetric needs in Lubumbashi, particularly in secondary-level facilities, alongside persistent maternal mortality largely driven by haemorrhagic complications. Strengthening emergency obstetric care capacity at secondary-level facilities, improving referral systems, and integrating UON indicators into routine health information systems should be prioritised to reduce preventable maternal deaths.