AFRICA: "Grace Under Fire" Film Documents Women's Health Crisis in Continent

Dr. Grace Kodindo speaks from the heart as well as her experience as an obstetrician in Africa as she describes the dangers women face in conflict zones, where reproductive and maternal health care is severely lacking and where rape is often used as a weapon of war.

Kodindo, a physician from Chad -- home to thousands of displaced persons fleeing conflict in neighboring countries like Sudan -- previewed a documentary film at the State Department June 2 that highlighted the trials women face in eastern Democratic Republic of the Congo (DRC), where mothers are often obliged to give birth under difficult conditions as they flee rampaging militias.

She told her State Department audience: "We need more focus on the human rights of displaced people" and "Reproductive health care for women is a human right."

Kodindo was joined at the special screening of the 27-minute film, Grace Under Fire, by Under Secretary of State for Democracy and Global Affairs Maria Otero, Assistant Secretary of State for Population, Refugees and Migration Eric Schwartz and U.S. Agency for International Development (USAID) Senior Deputy Assistant Administrator for Democracy, Conflict and Humanitarian Assistance Susan Reichle.

The film was produced by the Reproductive Health Access, Information and Services in Emergencies (RAISE) Initiative of Columbia University, the U.N. Population Fund (UNFPA), Marie Stopes International, a nongovernmental organization (NGO) focusing on sexual and reproductive health, and the Television Trust for the Environment (TVE).

Under Secretary Otero said she was inspired by the film and "heroes" like Kodindo who are working to bring attention to reproductive and maternal health care issues worldwide. She said President Obama's Global Health Initiative has "women and children at its core" and that the Obama administration has renewed funding for the U.N. Population Fund, including $55 million in 2010.

Noting that 75 percent of the 60 million people displaced by some form of conflict or natural disaster worldwide are women and children -- 25 percent of these women are of reproductive age and one in five is likely to be pregnant -- Otero said, "Violence and displacement don't stop women giving birth, even while on the run ... [which] puts women and girls at increased risk of maternal death, reproductive health problems and gender-based violence."

The United States is "engaging with governments around the world," Otero said, "particularly with what we're calling priority governments, for example the DRC, to ensure that the health and human rights of women are protected and addressed."

USAID's Reichle said that since 2000, USAID has worked with 10,000 rape survivors in the DRC alone, and that USAID, over the last 45 years, has worked with 27 million women in 60 countries on reproductive health issues.

At the beginning of the film, Kodindo said, "I was not emotionally prepared to talk to the women" in the villages and bare-bones health clinics with whom she met in north Kivu in eastern DRC.

The film states that although women generally have a dismal one-in-three chance of dying in childbirth in some parts of Africa because of a lack of reproductive and maternal health care, those odds are increased significantly in a war zone like eastern Congo, where 5.5 million people have been killed and 2.1 million displaced in the past 10 years.

The documentary displayed in heartbreaking detail the trials and tribulations of girls and women in the Congo, many of them rape survivors who were forced to give birth in the bush or in understocked clinics with few drugs and no available sterile equipment. In addition, 58 of 60 women waiting outside a clinic in Ritsoro in the DRC told Kodindo their husbands had abandoned them because of the social stigma associated with their having been raped, or from a fear of contracting a sexually transmitted disease.

Citing "widespread and continued gender inequality" in the DRC, Assistant Secretary Schwartz said the film "powerfully demonstrates" the continued vulnerability of women and girls and the need to have proper reproductive and sexual health care in all humanitarian settings.

Following the film, Kodindo joined a panel discussion on reproductive health care that included Schwartz; Sarah Craven, UNFPA's Washington office chief; Dr. Boubacar Toure, regional health adviser for the International Rescue Committee in the DRC; and Clarence Massaquoi, regional director for the Christian charity PMU-Liberia (PMU stands for Pentecostal Mission Unlimited).

The DRC government is mindful of the problem of systemic sexual violence, said Toure. It enacted a law in 2006 against sexual violence "but it needs to be reinforced." Unfortunately, the DRC, which is larger than western Europe, has few roads and its eastern provinces are more than 1,000 miles from the capital, Kinshasa, and are dominated by warring militias intent on robbing the region's rich mineral and forest resources.

Massaquoi interjected a positive note in the discussion, saying, "In the past year, we've reduced maternal death significantly" in Liberia. While the task ahead is still "enormous," he said, "the way forward is investing in local organizations."

Assistant Secretary Schwartz closed the event by thanking panel participants for their dedication to this important cause and by pledging the U.S. government's continued commitment to work in partnership with other governments, NGOs, donors, and health care practitioners to improve the provision of vital sexual and reproductive health care and services to underserved populations, especially those in conflict-affected settings worldwide.

Schwartz emphasized that providing "sexual and reproductive health care must be a front-line priority in complex emergency settings, and should be planned for and implemented along with other lifesaving interventions in emergencies, such as water and sanitation, shelter and nutrition."