By Sara E Casey*, Kathleen T Mitchell, Immaculée Mulamba Amisi, Martin Migombano Haliza, Blandine Aveledi, Prince Kalenga and Judy Austin

Corresponding author: Sara E Casey This email address is being protected from spambots. You need JavaScript enabled to view it.

Abstract

Background: Prolonged exposure to war has severely impacted the provision of health services in the Democratic Republic of the Congo (DRC). Health infrastructure has been destroyed, health workers have fled and government support to health care services has been made difficult by ongoing conflict. Poor reproductive health (RH) indicators illustrate the effect that the prolonged crisis in DRC has had on the on the reproductive health (RH) of Congolese women. In 2007, with support from the RAISE Initiative, the International Rescue Committee (IRC) and CARE conducted baseline assessments of public hospitals to evaluate their capacities to meet the RH needs of the local populations and to determine availability, utilization and quality of RH services including emergency obstetric care (EmOC) and family planning (FP).

Methods: Data were collected from facility assessments at nine general referral hospitals in five provinces in the DRC during March, April and November 2007. Interviews, observation and clinical record review were used to assess the general infrastructure, EmOC and FP services provided, and the infection prevention environment in each of the facilities.

Results: None of the nine hospitals met the criteria for classification as an EmOC facility (either basic or comprehensive). Most facilities lacked any FP services. Shortage of trained staff, essential supplies and medicines and poor infection prevention practices were consistently documented. All facilities had poor systems for routine monitoring of RH services, especially with regard to EmOC.

Conclusions: Women's lives can be saved and their well-being improved with functioning RH services. As the DRC stabilizes, IRC and CARE in partnership with the local Ministry of Health and other service provision partners are improving RH services by: 1) providing necessary equipment and renovations to health facilities; 2) improving supply management systems; 3) providing comprehensive competency-based training for health providers in RH and infection prevention; 4) improving referral systems to the hospitals; 5) advocating for changes in national RH policies and protocols; and 6) providing technical assistance for monitoring and evaluation of key RH indicators. Together, these initiatives will improve the quality and accessibility of RH services in the DRC - services which are urgently needed and to which Congolese women are entitled by international human rights law.

The electronic version of this article is the complete one and can be found online at: http://www.conflictandhealth.com/content/3/1/12

By Lydia Smith

When Siwar gave birth to her fifth child in Za'atari refugee camp in northwest Jordan, she had to deliver her daughter alone.

'There are many difficulties here and I had to deliver the baby by myself,' she said. 'When I delivered my other daughter back in Syria, I was surrounded by family, relatives, sisters-in-law and my sisters.'

Siwar's story is far from unusual. She is one of the estimated 1.5 billion people living in countries affected by conflict, fragility and large-scale violence. Women and children disproportionately account for 75% of those displaced by conflict, and 20% of women are of reproductive age. One in five will be pregnant.

More than half of maternal deaths worldwide occur in fragile states, many of them affected by conflict and recurring natural disasters. Women die because they give birth without a midwife or skilled health provider on hand and because they do not have access to emergency obstetric services. Others are unable to travel to health facilities – which may or may not exist.

For 20 years, reproductive health has been considered a basic human right. But during the chaos of armed conflict and other humanitarian emergencies, a high price is exacted on women's health – a problem which the Royal College of Obstetricians and Gynaecologists (RCOG) argues needs to be given greater attention by health workers inside and outside crisis zones...

Go to: http://www.ibtimes.co.uk/worst-place-be-mother-why-we-need-address-childbirth-conflict-zones-1458885

From Reproductive Health Response in Conflict Consortium. As a part of Columbia University's Averting Maternal Death and Disability (AMDD) Program, the Reproductive Health Response in Conflict (RHRC) Consortium implemented 12 pilot emergency obstetric care (EmOC) projects in the following nine countries: Bosnia, Kenya, Liberia, Pakistan, Sierra Leone, Southern Sudan, Tanzania, Thailand and Uganda.

Prior to designing the individual project interventions, the RHRC Consortium EmOC technical advisor and field staff conducted assessments to document EmOC activities in those conflict-affected settings and design pilot projects to address critical needs. The assessments were conducted in 2001, except for those in Pakistan and Uganda, which were completed in 2002.

The goal of the project was to avert maternal death and disability among approximately 40,500 women from conflict-affected populations and the purpose was to establish or improve Basic and Comprehensive EmOC services at health centers and hospitals responding to the emergency obstetric needs of refugees and others of reproductive age living within and around the refugee communities....

Go to: http://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&ved=0CC8QFjAC&url=http%3A%2F%2Fwomensrefugeecommission.org%2Fresources%2Freproductive-health%2F144-emergency-obstetric-care-critical-need-among-populations-affected-by-conflict%2Ffile&ei=Etc7VMjiEKjY7AbamIHwBQ&usg=AFQjCNEc84YYrVBRLV3FTwhObLCAKPgOcg&sig2=2gOCFkkzQzWaCIJ_WLqL0A