An Ethnographic Study of Sustainable Healthcare: Maternal Medicine and Resourcefulness in the Democratic Republic of Congo

Maternal healthcare provision in the Democratic Republic of Congo (DRC) is challenged by profound resource constraints. This creates a critical context for examining how sustainable practices are enacted within maternal medicine, beyond theoretical models of development. This study aimed to ethnographically explore the concept of sustainable healthcare as practised in maternal medicine in the DRC. Its primary objective was to document and analyse the everyday resourcefulness of healthcare providers and communities in maintaining care delivery. An ethnographic study was conducted at a rural maternal health clinic and its surrounding community in the DRC. Data were collected via prolonged participant observation, in-depth interviews with midwives, nurses, traditional birth attendants, and recently delivered women, and analysis of material artefacts used in care. Findings reveal that sustainability is fundamentally underpinned by adaptive resourcefulness. A dominant theme was the systematic reuse and repurposing of material objects, such as the sterilisation and repeated use of single-use items. Care protocols were consistently adapted to available resources, prioritising essential, life-saving interventions. Sustainable maternal healthcare in this context is a dynamic, pragmatic practice of continual adaptation and maximisation of existing resources, rather than an externally imposed ideal. It is deeply embedded in the daily labour and ingenuity of local actors. Sustainable development initiatives in African maternal health should prioritise supporting and enhancing existing local systems of resourcefulness. This includes investing in robust, reusable equipment and flexible training that acknowledges and builds upon contextual realities. Maternal health, sustainability, resourcefulness, ethnography, Democratic Republic of Congo, midwifery. This study provides a grounded, empirical account of sustainable healthcare in practice, contributing a nuanced perspective from the DRC to African obstetric and gynaecological literature.