“It’s only by God’s grace that you survive pregnancy.” This statement, made by a 19-year-old girl in the Democratic Republic of the Congo (DRC), illustrates the incredible situation of women in sub-Saharan Africa with little or no access to reproductive health care. The statistics are staggering: every year, approximately half a million women around the world die from pregnancy related causes. More than half are in sub-Saharan Africa, almost all are in impoverished countries, and most deaths are avoidable. Think about the women in your life – how many people do you know who have needed an emergency C-section because the baby was breach or the labor was taking too long? Issues like obstructed labor and post-partum hemorrhage occur with women everywhere. In developed countries, they lead to scary moments and extra medical care.  In the developing world, they often lead to death.

Dire as this situation is throughout the developing world, it is much worse in areas of conflict. Here, women are subjected to the additional burdens of violence and displacement. Emergency response to conflict areas usually consists of extremely basic supplies – food, clean water, sometimes first aid and shelter. But reproductive health services are just as important.

Yesterday I went to a film screening in DC to watch BBC Documentary “Grace Under Fire”, which focuses on Dr. Grace Kodindo, a Chadian Ob/Gyn who travels to the DRC to observe the special needs of women in conflict areas. The film was followed by a panel and Q&A featuring Dr. Kodindo, Mr. Clarence Massaquoi of Liberia, and Dr. Bouba Touré of the DRC. The film was fantastic and the information I learned was staggering. You can watch an excerpt of the film on YouTube, as it was televised on BBC.

The need for reproductive health services in conflict areas is greater than that in peaceful areas for a number of reasons. First and foremost, sexual violence and rape are used as a weapon of war in many areas, particularly in the DRC.  Women going to work on their fields or to gather firewood or water are frequently captured by soldiers or armed militia and violently gang raped. Immediate care is vital, as the administration of Post-Exposure Prophylaxis (PEP) greatly reduces the chances of HIV transmission, and Emergency Contraception (EC) greatly reduces the chances of a pregnancy resulting from the rape. Doses of simple antibiotics also treat the victim for Gonorrhea, Chlamydia, or other sexually transmitted infections (STIs) she may have gotten from her attacker(s). Without rapid treatment, she is at a very high risk for any and all of these issues.

Second, what health care infrastructure may have previously existed is often destroyed in conflict. Buildings are burned, medicines and supplies are stolen or destroyed, and doctors and nurses often flee with the rest of the population. Those that stay can only do so much without basic supplies like antibiotics, clean needles, disinfectant, and latex gloves.

Third, conflict makes it more dangerous and difficult to travel to anywhere health care may still be available. If there are central areas where clinics are still equipped and functioning, it is often too far or too treacherous to get there.

A number of relatively simple and cost-effective interventions exist but are in short supply. One is more PEP kits and EC for post-rape treatment. Another is emergency birth kits, containing such simple supplies as a plastic sheet, gloves, and a clean razor to cut the umbilical cord after birth if a woman is unable to deliver in a clinic (tetanus caused by cutting the umbilical cord with an unclean instrument is a common cause of newborn death). A third is stocking makeshift hospitals with other basic supplies like gloves, clean needles, and antibiotics. More long-term interventions include training skilled birth attendants and educating communities about simple ways they can make their pregnancies safer. The long-term availability of birth control is extremely important so that families can limit and space their pregnancies. Education is also needed to combat stigma relating to rape, as many women avoid treatment hoping that they can keep the incidence of their rape a secret. It is common for a husband to leave his wife after she has been raped. In the film, when Dr. Kodindo asks a group of 60 rape victims in the DRC how many of their husbands had left them as a result of their being raped, 58 answered positively.

What can we do to help? A grad student in the audience asked the panel what they thought the role of students is and should be.  They answered unanimously that advocacy and awareness are essential, and that students can work on their own campuses to bring these issues to the attention of the developed world. The panelists themselves spoke this week in front of the State Department, pushing the importance of Sexual and Reproductive Health and Rights. We as young people, perhaps unable to personally go to the DRC to deliver supplies and assist with childbirth, can urge our representatives to co-sponsor and pass the Global MOMS Act, H.R. 5268. Introduced in May by Rep. Lois Capps (D-CA), the bill requires the President to develop a strategy to reduce mortality and improve maternal, newborn, and child health. It also increases collaboration among the relevant agencies and departments of the US government working toward the UN Millenium Development Goals, especially goals 4 and 5. Urge your representative to co-sponsor the bill through the CARE website.  You can also check out Astarte, an organization which sponsored the film screening and focuses specifically on reproductive health care in conflict areas

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