South Sudan: Offering help in one of the hardest places to be a woman

 

YIDA, South Sudan—The sounds of children are everywhere.   As I walk around the Yida refugee camp in South Sudan, children pour out of each thatched dwelling.  Spotting me, they call out “khawathja,” their word for  “foreigner.”   And it’s not a trick of the eye,  these epic crowds of kids:  The Sudanese refugees living here at Yida tell me that it’s normal for a woman to give birth to twelve or more children.

But there is no such thing as bed rest here for pregnant women.  Expectant mothers are still responsible for gathering firewood and water for their families: traditional “women’s jobs” which often involve carrying heavy loads for many miles.  It’s no wonder that miscarriages are common. A midwife I met the other day -- a woman who is knowledgeable about family planning -- tells me that she has been pregnant 17 times, but has only given birth to 10 children.

 

Making my way through the throng to the camp’s newly-built Women and Girl’s Wellness Center, I can’t help but think about Yida’s youngest mothers-to-be.

 

We refer to them as women,  but often they are teenagers -- girls as young as 14 who will be married and begin to reproduce as soon as they are biologically able. Frequently girls here are given as wives in exchange for money or other things their families need to survive.  During my conversation with the midwife, she introduced me to one of these girls: a 14-year-old I’ll call Lilian who had just been married to an older man. The midwife shook her head as she told me, “It is not okay, but it is what the men of the family tell them to do.”  

 

Lilian was quite shy around the khawathja, but softly told us that she does not know what it will mean for her to be married.  Some of her contemporaries are clearer about their future.  As one once explained to me, “If you start having babies when you are young, you can have as many as 15 or 17 before your body gives up.” 

 

As my thoughts drift back to the 14-year-old bride, I wonder about what life holds for her: how soon she will be pregnant, the ability of her yet-to-be-matured body to carry a pregnancy -- and her ability to safely deliver a healthy child. One out of every 50 women who gives birth in South Sudan dies in the process. In fact, a woman here  is 85 times more likely to die in childbirth than a woman in the United States.

 

The IRC is working with local communities to help reduce this appalling maternal mortality rate – the highest in the world.  

 

During a recent focus group discussion with women and men in Yida, I was confronted with confused faces and silence when I asked what people in the camp are doing to avoid or delay pregnancy.  Except for those who have traveled to the larger cities in Sudan or South Sudan, knowledge and use of family planning in the camp is alarmingly rare.  One woman laughed as she told me she cannot escape her own fertility. “It’s a cycle we are in. We want to have a healthy life and a solid future … but we do not know how to get out of the cycle.”    

 

Knowledge and acceptance of family planning is starting to grow among both men and women here, however.   In a culture where a husband makes many important decisions for his wife about her health, I was pleased to hear an older man tell me that the use of birth control pills and injections is no longer taboo. “Bring the information to the people” he said, “and they will use it to start living in better ways.”

 

At the Women and Girl’s Wellness Center, the IRC provides camp residents with health education and a range of reproductive health services.   These include family planning methods and counseling, health care during pregnancy, delivery assistance and post-natal care, testing and treatment for sexually transmitted diseases, and clinical care for survivors of sexual assault.  The IRC is also training midwives and establishing a system for recently arrived refugees to be referred for care.  

 

As I watch women come and go from the center, I have high hopes that they leave with everything they need to manage their fertility, safely carry and deliver their babies, and secure healthy lives for themselves and their children.