THE TARPAULIN ROOF had barely been nailed down when the maternity clinic in the Bidibidi refugee settlement in northern Uganda welcomed its first patient. A woman who had fled violence in South Sudan arrived at the International Rescue Committee (IRC) temporary health center in labor.
The makeshift structure was equipped and staffed to ensure a safe delivery of her baby. In many ways, it was largely uneventful – the same procedure that was being undertaken at maternity hospitals everywhere from Kampala to Brussels, New York, or Tokyo. But the truth is, if that mother hadn’t made it from South Sudan to Uganda, the story could have ended differently: Her delivery could have resulted in death or disability.
Millions of women and girls currently don’t have access to the necessary care to ensure their maternal health. And in crisis, contraception can be just as important as services for pregnant women. Conflict-affected countries suffer from the worst health outcomes for women. Despite this reality, a global evaluation found that funding for reproductive health in conflict-affected countries is 57 percent lower than for non-conflict countries. And only 14 percent of appeals for reproductive health in emergencies included contraception.
The lack of access to reproductive health services is pervasive and unacceptable, but it is also an opportunity to be seized. We now have the chance to respond to the reproductive health needs of refugees and host communities that may have never before been met.
“At home, you bleed and there’s no medicine or products … Here there are injections, they will stitch you.”
In Uganda, the IRC has supported clinics and health workers to respond to the health needs of refugees fleeing from South Sudan. Since violence broke out again in Juba in 2016, more than 500,000 people have crossed the border into Uganda and settled in camps. Most are women and children.
They did not simply escape the potential violence of their country, but the life-threatening consequences of poor reproductive health services. Before arriving at the camp, many mothers were forced to deliver at home with little or no help from a professional. South Sudan has experienced a severe shortage of trained and skilled health workers, making it the world’s fifth highest in maternal mortality. Upon arriving in Uganda, the prospects for safe delivery changed dramatically. The refugee camps introduced mothers to services previously non-existent in their home country.
Since August, 1,153 babies have been delivered in the refugee camp. Waiting rooms swell with women and children who are sick, need a checkup or are seeking advice from a health worker about issues like birth spacing or breastfeeding. For some, it was the first time they had accessed contraceptive services, met a skilled midwife or learned what to do if they experience bleeding during or after pregnancy.
“At home, you bleed and there’s no medicine or products,” one of the women waiting in the facility told the IRC. “Here, there are injections; they will stitch you.”
Many South Sudanese refugees had never heard of – let alone seen – an intrauterine device before. When healthcare workers told them these contraceptive methods were effective for at least several years and did not require a daily pill or regular clinic visits, they were eager to learn more. In December alone, more than 50 women in the camp received a birth control implant, which can prevent unintended pregnancies for up to four years. Hundreds more received other methods of contraception, including oral contraceptives, injectables, or an IUD.
These services are not just available for refugees. Ugandan women from nearby towns also come to the refugee camp to access contraceptives or deliver their babies. Last June, 102 local Ugandan women chose to deliver babies at the camp maternity ward in Kiryandango. They shared their experiences with other women and by the end of the year, the monthly deliveries had doubled to 237.
“Women see the importance because they compare now to what they had before. Pregnant women are feeling taken care of and supported at health centers,” Anthony, a community health worker helping at the maternity, told us,
“Services like family planning are economically better and less stressful for women,” Peter, a volunteer in the camp, said, adding. “The community is starting to realize this.”
Reproductive health services such as contraception, safe abortion care, emergency obstetric and newborn care are critical for all women, whether they find themselves at the heart of crisis, displacement or in a stable but poor setting. These services change lives.
The people of Uganda – both refugees and locals – are recognizing the advantages of reproductive health services and their right to access it. If attitudes on the ground can change so quickly, so can the attitudes of humanitarian organizations in other settings, toward the importance of reproductive health for women and girls.
