of pregnancies are unwanted in Kinshasa
Democratic Republic of Congo
Democratic Republic of Congo
of adolescent girls get pregnant before the age of 19
people are living with HIV in North Kivu
In Kinshasa, about half of all pregnancies are unwanted and across the country, one in four girls becomes pregnant for the first time before the age of 19. Access to contraception is illegal for minors and abortion is permitted only for medical purposes, but even in such cases access to abortion is not effective. About one in every 100 births causes the death of the mother. Despite this, adolescent sexual and reproductive health issues are politically and socio-culturally sensitive.
About one in every 100 births causes the death of the mother.
In the DRC, HIV affects 1.2% of the 15-49 age group. Prevalence is three times higher amongst women (1.6%) than amongst men of the same age (0.6%). This is due to a lack of knowledge about HIV, especially amongst young people, as well as the taboo in Congolese society surrounding the sexuality of teenagers outside marriage. As a result, young people are often judged, stigmatised, and even rejected when visiting health centres for problems related to their sexual and reproductive health. Thus, condom use is rare and most of the time they are unaware of their HIV status.
In two health zones in the megalopolis, Doctors of the World is working with teenagers to inform and raise awareness of sexual and reproductive health issues in a broad sense, and on the themes of unwanted pregnancy in particular, but also STIs including HIV, and gender-based violence. In this way, in collaboration with a national association, Doctors of the World is trying to improve access to family planning for young girls, to inform them about STIs, to offer care to those who have undergone an abortion or to take care of those who have suffered sexual violence.
Particular emphasis is placed on the links between community mobilisation frameworks (neighbourhoods, schools, youth clubs, etc.) and health centres to facilitate effective access to these services, enabling them to choose to have a child when and if they wish, and to reduce the risk of STI and HIV infection.
Doctors of the World also trains health personnel, in conjunction with the ministry, in an approach that is adapted to teenagers. Lastly, the association supports civil society to lobby authorities to legalise contraception for minors and abortion.
In June 2014, a law was presented to Parliament to promote free access to contraception for all women of child-bearing age. The Superior Court of Justice gave a favourable opinion.
“If you dare abort, you’ll die!” This was the response of the nurse Merlyne consulted when she learned she was pregnant. She didn’t want the child and neither did her fiancé. Merlyne thought she couldn’t get pregnant and wasn’t using any contraceptive because she lacked information about the different methods available. When her fiancé understood that she would not abort the pregnancy, he refused to take responsibility and left: on the day Merlyne gave birth, several months had already passed since she’d last heard from him.
Merlyne is now 20 years old and, although she is happy to have her little four-month-old girl Grady, she would have preferred to wait so that she could meet her daughter’s needs on her own. She and Grady are an extra burden for her parents. Merlyne does not want to hear about another pregnancy, but uses no method of contraception to avoid it. She is nevertheless determined to take the time to see her first child grow up and to realise her own dream of opening a hairdressing salon and securing her independence.
Tina was just 12 years old when she became pregnant for the first time. Too young to understand what was going on in her body, she did not realise what was happening to her until the sixth month. Her parents hesitated about terminating this early, unwanted pregnancy: they were too frightened that Tina might die. They preferred to ask the child’s father to take responsibility. Tina found herself forced by this unplanned pregnancy to continue her relationship with the man. Two other children followed in rapid succession but the couple’s life together deteriorated to such an extent that Tina had to ask the father of her children to leave. She has since found a new partner and now hopes to take time before having another baby and to decide on the best moment to do so. On the advice of a friend, she has had an implant inserted, which protects her for 5 years. But this has been done in secret, as she dares not speak to her partner about it for fear of his reaction.
The oldest is 12 and the youngest 2 months. The others are aged 10, 8 and 4 years. Their mother, Omba, is just 28 years old and already has 6 children. Her wish was for just two children but the pregnancies followed one after another. For this woman who has no access to family planning, each pregnancy is a curse. Even neighbouring women make fun of her when they see her fall pregnant so often. They have offered to help her get an abortion but Omba is too afraid of dying. Today Omba and her husband are both unemployed and live with the anxiety of not being able to feed their children properly. Only the four-year-old goes to school due to a lack of money. Omba went to a health centre where she was told about an implant that would give her 5 years’ protection against a further pregnancy. But to have it, she needed money which she does not have: all she has are her children.
Following an initial unwanted pregnancy at age 21, Audrey had three other pregnancies that followed just one year apart. The doctor had warned her of the risks this posed for her own health as well as that of her children, but Audrey was not well enough informed about methods of contraception and did not have the means to do anything about it. She decided to find out about family planning and to speak about it to her husband. Together they agreed to use condoms as a way of controlling future pregnancies: nine years then passed before the birth of their last child following a pregnancy which they had planned and wanted. At age 36, Audrey is mother to 5 children, aged 15, 11, 10, 9 and 9 months respectively. She is now convinced that planning births is a matter for couples and that it is together that the decision must be taken whether or not to have a child. Happily this is a view shared by her husband.
Irène had had a boyfriend for just a short time and so the news of her pregnancy came as a shock. They had had sex on only four occasions and she didn’t think she could get pregnant so quickly. Neither her parents nor the school had explained to her why and how to protect herself. For this brilliant 19-year-old student in her final year of studies, pregnancy meant the end of her schooling. She did not even dare to speak about the unwanted pregnancy to her boyfriend who had already threatened several times that he would leave her if she got pregnant. She first tried every way of getting an abortion but it needed money which she didn’t have. When at last she resolved to tell the truth, her boyfriend quit, leaving her alone to face a pregnancy she did not feel ready for. When Moïse was born, her boyfriend finally decided to come back to her and assume his responsibility as the baby’s father. But Irène had been deeply marked by a pregnancy that she did not want. She now insists that her boyfriend uses a condom: the next time she is pregnant it will be because she has freely decided to have a baby.
Orphaned at a young age, Nadège was brought up by her aunt who did not have the means to pay for her schooling. After an adolescence marked by poverty, she was just 20 when she found she was pregnant with her first child. For Nadège, the pregnancy was like “the end of the world”. She wasn’t expecting it and did not want the baby. She sought an abortion at all costs and, for a fee, a nurse agreed to help her. But on the day of the operation, the nurse told her he had had a nightmare the previous night in which he had seen Nadège die. He refused to carry out the procedure and gave her back her money. Since then, Nadège has gone on to have two other children, the latest just a year old. That means two further unwanted pregnancies. She has of course heard about methods of contraception, particularly the implants that last 5 years and cost around 20 dollars. Nadège hopes one day to be able to save up such a sum. In the meantime, she uses condoms.
In North Kivu and Kinshasa, on the strength of its expertise in sexual and reproductive health for young people, Doctors of the World works with local, civil and institutional partners to strengthen the quality of prevention, screening and treatment services, and care for people living with HIV.
The project targets young people and teenagers (aged from 10 to 24), regardless of their status, origin or sexual practices. In addition, the project is part of the DRC national HIV/AIDS strategy, which it supports through knowledge generation about the epidemic and the promotion of an environment conducive to the fighting the disease.
Our programme is structured around 4 major themes:
- Improving knowledge about the epidemic
- Capacity building for professionals and screening
- The creation of links between health facilities and young people
- Advocacy to create a social and legal framework for the fight against HIV/AIDS
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