The impact of conflict is rarely seen through the prism of reproductive health. Yet women and girls routinely face sexual and gender-based violence during war and its aftermath, maternal mortality is endemic in conflict-affected areas and amplifying women’s voices is critical to removing risks to their well-being.
A few years ago, a woman in her sixties outside Banda Aceh in Indonesia told me about the rape and other torture she had endured during the conflict between the Free Aceh Movement and the government. Beyond the psychological trauma, her body still suffered from enduring physical pain. Many years on, while the open conflict had ended, she still had not received comprehensive health care and support. Instead, like too many survivors of physical and sexual violence, she was left in a vicious circle of isolation, carrying the burden of stigma and shame.
In war and its immediate aftermath, it is easy to forget those who are voiceless or invisible in the public space. Yet, countless reports show that time and again women and adolescent girls are at higher risk of sexual and gender-based violence during and after conflict – putting at risk their reproductive health.
- With health infrastructure destroyed and information about sexual and reproductive health missing, they may also face a higher risk of dying due to pregnancy-related complications.
- Yet, the number of women and girls dying during pregnancy or childbirth is often high in conflict-affected areas, while many suffer from chronic illnesses.
Over half of the world’s maternal deaths occur in countries torn apart by armed violence and in fragile states. In Afghanistan, despite years of international aid, the maternal mortality ratio is still at 396 deaths per 100,000 live births or, according to recent studies, possibly twice as high. We have called, among other measures, for an expansion and improvement of gender-sensitive aspects of aid programs in all Boko Haram-affected areas. For women living in conflict-affected environments, childbirth can be a particularly dangerous and traumatic experience.
Many have to give birth unassisted and in unsanitary conditions, increasing the likelihood of trauma, long-lasting physical illness, and death. In South Sudan, a country devastated by years of war, at least one woman in 28 is likely to die from a pregnancy-related cause. In fragile and conflict-affected environments, where only 65 per cent of births are attended by skilled health professionals, unassisted birth remains one of the main drivers of maternal mortality. Unable to access safe abortion services, many women also resort to unsafe and potentially life-threatening methods to terminate their pregnancies.
We must recognise the challenge of preventable maternal deaths in conflict-affected areas, and provide adequate sexual and reproductive health information and services to women and girls of all ages.