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Not All That Bleeds is Ebola – how the DRC outbreak impacts reproductive health

Introduction: The 10th outbreak of Ebola Virus Disease (EVD) in the Democratic Republic of the Congo (DRC) started in August 2018 and has taken place in the conflict-affected provinces of North-Kivu and Ituri.  There have been over 3300 cases and 2200 deaths in this outbreak, 56% of which have been among women and girls.  Learning from the West African EVD outbreak tells us that such epidemics have a negative impact across the health system, and that sexual and reproductive health (SRH) services are generally disrupted leading to negative outcomes for women, men, girls and boys.  To document the impacts of this outbreak on SRH services, the IRC undertook a programme assessment from October – December 2019, with the aim of developing concrete recommendations for improving SRH service provision and access during the current outbreak and for future outbreaks.

Methods: This assessment was conducted in Goma, Butembo, Katwa, Kalunguta and Beni health zones of North-Kivu, DRC.  A total of 120 individuals were interviewed, 85 women and 35 men, either in focus groups, individual interviews or through targeted questions by email.  The participants were selected purposively to ensure a mix of women, pregnant women and men from the community, health workers, EVD response workers, Tradi-practiciens and representatives from the Ministry of Health and Non-Governmental Organisations.  A total of six routine health facilities were visited, of which three were assessed for their SRH preparedness, and one Ebola Treatment Centre (ETC) was visited. Routine SRH service indicators from the health information management system were mapped against EVD case counts in the four health zones where the qualitative data collection took place.

Findings: The EVD outbreak has had an impact on the provision of, and access to, SRH services in the affected health zones across all priority activities of the Minimum Initial Service Package (MISP) for Reproductive Health in Crises:

1. Coordination of the MISP

2. Prevention of Sexual Violence and Care of Survivors

3. Reduce transmission of HIV/sexually transmitted infections (STIs)

4. Prevent excess maternal and newborn morbidity and mortality

5. Prevention of unintended pregnancy

6. Plan for comprehensive SRH services.

7. Additional priority activity – Safe Abortion Care (SAC).

Recommendations (more specifics found in the assessment):

1. Sexual and reproductive health needs and services are to be embedded in the EVD response from the outset.

2. Reduce delays at every stage of the patient journey, particularly for women experiencing obstetric complications, including complications from abortion.

3. Support individuals and communities to mitigate SRH risks posed during and after EVD epidemic:

4. Formulate SRH guidelines for the EVD context involving experts in all relevant fields.

Available documents & links