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When Prosper Mbumba married, he expected to have only two children. But one had to be a son. Four daughters later, he and his wife were still trying.

Mbumba was eager to produce a male heir according to the customary demands of his Luba people in Congo.

“In my tribe, in my culture, that was like an insult, having only daughters,” the human rights activist said. “I should do my best to get more children, expecting to have a boy.”

He and his wife, Régine Ntumba, said they were relieved when the first of two sons was born. Mbumba, sitting with his wife in an open-air bar in the Congolese capital of Kinshasa, described finally feeling a “little satisfied.”

Ntumba, a housewife, said she was “very happy to learn that finally I have a boy.”

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This is part of a series on maternal mortality in sub-Saharan Africa, which has the world’s fastest-growing population and accounts for 70% of global maternal deaths. Around 180,000 pregnancy deaths are recorded every year across the continent.

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Africa has the world’s fastest-growing population. But many of those births occur in conditions that would be challenging anywhere in the world, from the lack of medical workers on hand to limited resources for managing complicated births, especially in rural areas. Africa accounts for 70% of global maternal deaths, according to the World Health Organization, even as those deaths have been declining.

The Associated Press is exploring why so many African women continue to die in childbirth. The reasons exist before pregnancy, including difficulties in obtaining contraception. And now some of the continent’s most prominent donors, especially the United States under the Trump administration, are sharply pulling back on the assistance that helps to keep mothers and babies safe.

Families ‘ keep trying’ for boys, putting some women at risk

Complicating the risks for women in many parts of sub-Saharan Africa is the pressure — heaped more on women than men — to produce male heirs to perpetuate clan lines.

Because daughters often marry men from different clans or tribes, sons are seen as necessary to sustain their forefathers’ legacies. The belief is so entrenched that many women accept it as justified, even if repeated pregnancies endanger their health.

Congo has one of the highest fertility rates anywhere in the world, at 5.9 children per woman, according to United Nations figures. The rate is largely fueled by cultural considerations that favor early marriage and large families, in addition to inadequate access to contraception.

The quest for male heirs is woven into a societal fabric that exposes many women to unwanted childbearing, said Patrick Djemo, a physician who leads MSI Reproductive Choices in Congo.

The organization provides counseling, contraception and safe, legally permissible abortions to women in seven of the country’s 26 provinces. Many clients are married, but others are young women who want to postpone childbearing.

“A lot of pressure is exerted on couples, and, as you know, mostly it is the woman who is blamed for giving birth to a girl,” Djemo said. Men often seek to block their partners from using family planning by asserting their right to make decisions, he said.

Roughly 29% of Congolese women of reproductive age cite an “unmet need” for family planning, whether to space births or to stop having kids, according to the U.N. Population Fund.

Congolese authorities sought to rectify that in a five-year strategic plan aiming to provide “access to affordable, quality family planning services” to all women of childbearing age by 2026.

But it remains an enormous task in a country the size of Western Europe, with poor infrastructure and armed rebellion in the east.

A woman in labor pleads to know the gender

Annie Tshiamala, the head of an association of Congolese midwives, she said she encounters too many women desperate to have sons.

She still remembers the day over three decades ago when a woman, bloodied in a difficult labor while having her ninth baby, asked whether it was a boy or a girl. The woman, in her 40s, had eight girls and was desperate.

Tshiamala, not wanting to disappoint the mother, didn’t respond, but a colleague said it was another girl.

“And she was disappointed. She said, ‘Oh, my Lord. Why?’”

The woman later confided that her marriage was in danger because she had not produced a son.

Tshiamala said she herself had been pressured by her mother-in-law, who wanted more than the four sons she has. Backed by her husband, she refused.

One man threatens to get a girlfriend if no son is born

Even today in Congo’s capital, educated women face pressure over the lack of a son.

“When you don’t have boys, you are not worth respect,” Gloria Masanka, a radio presenter with Congo’s national broadcaster, said of her in-laws’ family. She said that with girls, there is fear of losing the family name.

Masanka, the mother of two young daughters, has been married for a decade. She said the couple would be happier if they had a son, even though she has miscarried twice and her blood pressure rises dangerously during pregnancy.

There has been pressure and family disputes. Her husband, she said, has even been “bold” enough to suggest he would get a girlfriend in pursuit of a male heir.

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For more on Africa and development: https://apnews.com/hub/africa-pulse

The Associated Press receives financial support for global health and development coverage in Africa from the Gates Foundation. The AP is solely responsible for all content. Find AP’s standards for working with philanthropies, a list of supporters and funded coverage areas at AP.org.