Dem. Republic of the Congo
After nearly four decades of war and conflict, people living in the Democratic Republic of the Congo (DRC) face numerous barriers to accessing quality reproductive health services. Due to its vast size and poorly developed road and communication systems, family planning, maternal health, and other basic health services are extremely limited or altogether unavailable. Family planning helps prevent maternal morbidity and mortality, as well as assisting women and men to have the number of children they desire. Poor maternal health care has resulted in high maternal mortality, as well as the occurrence of obstetric fistula, a hole in the birth canal that results in chronic leakage of urine or feces, often caused by obstructed labor. Traumatic fistula—the same condition, but inflicted by sexual violence—is also common, due to the prevalence of gender-based violence in the DRC.
With women at the center of our mission in the DRC, EngenderHealth has a two-pronged approach to addressing the reproductive health needs of poor and marginalized communities there. Since 2008, EngenderHealth has worked to improve the quality of and access to fistula care services in the DRC. From 2008 to 2013, we partnered with seven health centers and hospitals to train 44 doctors and 242 nurses in fistula repair surgery and 802 doctors and nurses in fistula counseling and follow-up care. Our work also included the improvement of emergency obstetric care and outreach to rural clinics, to ensure that women in need of medical attention were referred to the hospitals for repair.
Today, EngenderHealth continues to address fistula in the DRC with the Fistula Care Plus project. As our work expands, we are better able to address the backlog of women living with obstetric or traumatic fistula. We are also increasing the integration of family planning services with fistula and maternal health services as a key component of fistula prevention.
In a country with a high total fertility rate (6.6 lifetime births per woman) and high unmet need for family planning (25% of married women of reproductive age in Kinshasa), there are also significant gaps in access to contraception. From 2013 to 2018, EngenderHealth’s Expand Family Planning Project (ExpandFP) supported the Ministry of Health in building capacity, improving quality, and expanding access to family planning services in five health zones of Kinshasa, a province with both urban and periurban areas and more than 10 million inhabitants. Over the duration of the project, ExpandFP supported training for nearly 200 individual providers, supervisors, and other staff to improve facilities’ capacity to offer quality family planning services. Through multiple service approaches, the project supported the provision of nearly 100,000 contraceptive services to women. ExpandFP also conducted two research studies. The first explored client perceptions of full, free, and informed choice in different service delivery modalities, in DRC, Tanzania, and Uganda. The second explored and provided evidence for establishing an internal hospital-based referral system to increase access to family planning in the extended perinatal period and simultaneously examined the effects of providing free contraceptives to clients on family planning counseling and uptake.