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Meeting needs for reproductive health services in post-conflict environments: CARE's Family Planning Project in the Democratic Republic of the Congo
Voices from the Village: Improving Lives through CARE’s Sexual and Reproductive Health Programs - No 1
Catherine Toth
Cooperative for Assistance and Relief Everywhere (CARE)
May 2007
SARPN acknowledges CARE as a source of this document: www.care.org
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Introduction
"The armed men came," remembers Lukumu Yandangi, a peer educator in CARE’s Family Planning Project in southern Maniema province. "They destroyed everything – they raped, they killed. They totally upended life as we knew life. Farmers couldn’t farm, our children couldn’t go to school." During the DRC’s chaotic war,1 Yandangi’s village was attacked by the Mayi Mayi, the national army, the police and various militias, including the Interahamwe. "And we never really understood," he says, "what the rebellion was about."
Yandangi and millions of other Congolese emerged from the war with far less than the little they originally had. Similarly, state services, including the healthcare system, were bankrupt: the war, with its pillage and destruction, had finished off what 35 prior years of government neglect and corruption had begun. By 2001, maternal mortality in the DRC had reached an outrageous 1,289 deaths per 100,000 live births,2 and child mortality stood at 243 per 1,000 live births in rural areas.3 Remote, nearly inaccessible and severely affected by war, Maniema ranked as the poorest province in the DRC.4
In late 2002, as the government and rebel factions edged toward a peace accord, CARE arrived in southern Maniema and, with funding from ECHO (the European Commission’s humanitarian aid branch), launched an emergency program to restart the health care system in 10 health zones across this isolated region.5 The program provided training to health workers in basic curative and preventive services, rehabilitated and reequipped certain facilities, and reinstated logistics for essential medical supplies.
Yet the original ECHO program did not include reproductive health services. Using data collected during a study of morbidity and mortality in two of Maniema’s health zones, CARE persuaded ECHO to fund certain services – prenatal care, safe deliveries, obstetric emergency referrals and, eventually, family planning and modern contraceptive methods – in the top-tier health facilities in southern Maniema. Convinced of the value of reproductive health services in post-conflict Congo, ECHO then went on to add these services to all its emergency health programs in the country.
Footnotes:
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Often defined as two wars: 1996-1997 and 1998-2002. Note that horrific violence against civilians continues in northwest DRC at the hands of militias that did not sign the 2002 peace accords.
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According to the DRC government’s Programme National de la Santй Reproductive, pre-war maternal mortality rates varied from 550 to 870 deaths per 100,000 live births between 1982 and 1991. See http://www.minisanterdc.cd/leministere/pnsr.htm.
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UNICEF. “Enquкte nationale sur la situation des enfants et des femmes MICS2/2001, Rapport d’analyse.”
http://www.childinfo.org/MICS2/newreports/drc/mics2%20rapport%20final%20.pdf. 2002.
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CARE DRC. “Integrated Baseline Survey, Kasongo Health Program.” 2005.
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A health zone is a government-mandated administrative division.
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