By Brenda Zulu in Accra, Ghana
One in 13 women in the Democratic Republic of Congo dies in pregnancy or childbirth. Every half an hour a woman dies of a pregnancy related case in Congo.
Health problems related to pregnancies and childbirth remain the leading cause of ill health and death for women of childbearing age worldwide. This is even worse in countries which have undergone an emergency or crisis.
Addressing unsafe abortion in emergency situations at the ‘Keeping Our Promise’ conference in Accra, Ghana, “Dr Wilma Doedens, Technical Advisor, Humanitarian Response Branch, United Nations Fund for Population Activities defined emergency as “serious disruption of the functioning of a society, causing widespread human, material, or environmental losses which exceed the ability of the affected society to cope using its own resources,”
In an emergency situation however, Dr Doedens said, the risk of sexual violence may increase during social instability and that lack of family planning services may increase risks associated with unwanted pregnancy.
“Malnutrition and epidemics increase risks of pregnancy complications and often the lack of access to emergency obstetric care increases risk of maternal death,”said Dr Doedens.
Testimonies of women survivors of war, also attending the conference clearly outlined the status of post rape and reproductive health care in the Congo.
One woman simply called Cilcily explained “We have had war for many years and nothing has changed. We have nothing now, I have six children. It is hard to feed everyone. We have one meal per day and only my sons go to school since I do not have enough money to take the girls as well. I have heard that women can stop getting pregnant but I don’t know how and no one has told me how. I wish I could stop. I don’t want to be pregnant anymore.”
In an interview, Dr Baubacar Toure, Reproductive Health Advisor, International Rescue Committee, outlined challenges to quality reproductive and post rape health care in Congo.
He said that in Congo, the average age of bearing children was 15 years as many girls were married off at that age.
He explained that lack of medicines, supplies and equipment is a frequent barrier to the hospitals ability to provide services to pregnant women. Many hospitals cannot provide the medication and supplies necessary to provide the very basic obstetric services, such as antibiotics, syringes and long gloves needed for certain procedures.
Similarly, the ability of the Congolese health system to offer family planning services and prevent infections is limited by the lack of essential supplies at health and hospitals. Contraceptives are for instance offered only in a limited number of hospitals.
Due to the war, there is lack of staff in the health centres and hospitals to perform emergency obstetric care as many of the health staff fled for their lives. It is estimated that Congo lacks approximately 42 000 health professionals. According to the DRCs national protocol, a general referral hospital with 100 beds serving a population of 100 000 should have at least three doctors, anaesthetist and 16 nurses.
Some hospitals are staffed with as little as one doctor and fewer than five nurses. Health workers are often not paid for months and many rural health workers migrate to cities or go to work for international agencies to seek employment with a regular salary.
Another barrier to proper reproductive health care is lack of female health staff i rural areas. Traditionally, Congolese women do not discuss reproductive health issues with men, even less when it comes to post rape health care. The scarcity of female rape health care medical staff throughout Congo is therefore problematic.
Sexual assault affects the reproductive health of survivors and their families. Unwanted pregnancies, damage to reproductive organs, sexual transmittable diseases and HIV are possible consequences of rape and sexual assaults. Without treatment and support, such consequences might affect the entire families.
Another female participant at the ‘keeping our promise’ conference attested to this. She said, “One day, at the age of 19, I was in bed asleep when I heard guns. The rebels had entered the village. I was so afraid, and I run with no belongings only the cloths I was wearing. I had to sleep in the bush for three days and on the fourth day I was kidnapped by an armed soldier who threatened me with death. He took me far away to the bushes and he raped me. After some weeks I found I was pregnant. I felt so ashamed but I could not keep the baby. I went and had an abortion. It was so painful and I still think about it everyday.”
Health facilities are often the first point of contact for rape survivors The physical injuries from sexual assault are one of the main reason survivors seek help.
In addition to the lack of staff, little commitment to continuing professional development and in service training is evident in the public sector, unless specifically funded by an external donor. Lack of training on newer, safer procedures was also a major challenge.
As health care professional are not consistently trained in the clinical care of survivors of sexual assault, when survivors report to health centers they are often not offered quality life saving care because it is simply unavailable.
This is complicated by ineffective referral systems which are critical to the accessibility of proper health services. Major obstacles to proper referrals are access to ambulances and means of communicating with a hospital that may have one. Roads are also often impassable to four wheel vehicles during the rainy season.
No comments:
Post a Comment