of women between the ages of 15 and 49 do not use a modern method of contraception
women a day are diagnosed with cervical cancer
abortions are performed every year within a very restrictive legal framework
Women’s health: humanitarian emergency in Côte d’Ivoire, one of the highest rates of maternal mortality in West Africa
Côte d’Ivoire records a maternal mortality rate of 614 deaths for 100,000 , of which 15% are due to complications following unsafe abortions. In other words, between one and two women die in childbirth in the country every day.
There are still many barriers to accessing good sexual and reproductive healthcare, in particular the absence of a legislative framework for SRH, the lack of funding for contraceptive products and disruptions to supplies.
Low levels of contraception and early pregnancies: the need for medical assistance in Côte d’Ivoire
Just under one in two young people (45%) don’t use contraception the first time they have sex. More generally, only 30% of young people (aged 10-24) use modern methods of contraception. Every year significant numbers of pregnancies are recorded in primary and secondary school pupils, leading to high levels of unsafe abortions (75%, according to a study carried out in schools in 2018).
The law remains very restrictive on abortion
Yet despite Côte d’Ivoire having signed and ratified the Maputo Protocol, the law remains very restrictive on abortion (since 2019, the Penal Code only permits it in cases of rape). Healthcare staff are not trained in the management of unwanted pregnancies which increases the likelihood of people seeking unsafe abortions.
Precancerous cervical lesions too often overlooked
“Around 1,000 new cases of cervical cancer are recorded every year in Côte d’Ivoire, with a mortality rate of 65% ” (Médecins du Monde exploratory mission, 2017). Médecins du Monde’s 2017 exploratory mission highlighted a number of inadequacies: lack of training for healthcare staff, inadequate and or inappropriate awareness-raising and poor access to screening and treatment.
HIV, hepatitis and tuberculosis: high prevalence of infectious diseases and medical assistance which should be based on awareness-raising and access to care
Médecins du Monde conducted a study in Abidjan in 2014 among 450 regular users of cocaine, heroin and crack cocaine. The study showed that people who use drugs are vulnerable and at risk of infectious disease due to their unsafe sexual behaviour, drug use and extremely precarious living conditions.
In 2014 the rate of HIV among drug users was estimated to be 9.8% in Abidjan. Today the figure is around 3.4% (study for the national AIDS programme conducted by CECAF in 2019). There is a particular problem with STIs among people who use drugs, especially syphilis which has a prevalence of 9.3%. Similarly, levels of tuberculosis in this group are higher than in the general population (according to the CECAF study, 2.9% contracted it in 2019). This often leads to cases of HIV/tuberculosis co-infection. In addition, 12.1% of people who use drugs are carriers of the hepatitis B virus.
Our humanitarian assistance in Ivory Coast
The study carried out by Médecins du Monde in 2016 on the sociocultural determinants of unwanted pregnancy revealed that the sexual and reproductive health services available for young people are not tailored to their needs. Data from a study conducted in April 2019 show that only 30% of girls (10-24 years) who are sexually active use a ‘modern’ method of contraception, of whom 81% were using male condoms. In addition, 10.3% of girls interviewed for another survey had been pregnant at least once and 36.4% of pregnancies were terminated through abortion (60% of these are unsafe abortions).
Médecins du Monde has supported the public healthcare system
Since 2017, Médecins du Monde has supported the public healthcare system through a project which uses a rights-based approach and aims to improve prevention and management of unwanted pregnancies among young people in the Nawa region (in the west of the country).
In an effort to find solutions to the issue of access to family planning services for women and girls, Médecins du Monde is supporting advocacy activities at the national level and is working with local and international actors to secure funding for and distribution of family planning supplies. As a pillar of our humanitarian work in Côte d’Ivoire, this advocacy work highlights the alarming health problems in the country.
Humanitarian mission in Côte d'Ivoire: key aspects of our health plan
Combining awareness-raising and access to care, our medical assistance in Côte d’Ivoire focuses on a number of health issues.
Covid-19: implementing effective measures
In response to the pandemic Médecins du Monde ran awareness-raising sessions on protective measures aimed at school pupils and households. The project stakeholders were provided with personal protective equipment and activities were carried out, while respecting protective measures and in accordance with WHO recommendations and Ivorian government guidelines.
As part of this, Médecins du Monde supported the national pandemic response through specific interventions targeted at people who use drugs in Abidjan. We delivered educational and prevention activities, distributed protective equipment at 58 consumption sites, provided food support to 6,220 people who use drugs and supported 22 healthcare facilities with Covid prevention supplies and equipment.
Treatment of precancerous cervical lesions: a humanitarian emergency in Côte d’Ivoire
Since 2020, Médecins du Monde has been working on a new project which aims to prevent, screen and treat precancerous cervical lesions in Abidjan. The Covid-19 epidemic delayed the start of the project which was eventually initiated at the end of the year and delivery will continue in 2021. Four innovative approaches will be trialled: implementing an organised screening strategy, self-testing as an alternative to testing by healthcare staff, PCR testing for HPV instead of VIA testing, and treating lesions by thermocoagulation as an alternative to cryotherapy.
Supporting people who use drugs: Médecins du Monde’s commitment at the heart of our humanitarian mission in Ivory Coast
Since January 2015, Médecins du Monde and its local humanitarian organisation partners have been running prevention and harm reduction activities for people who use drugs in Abidjan, with the aim of improving the way they are treated by the healthcare system.
Care and access to care is thus an issue that lies at the heart of our humanitarian mission in Côte d’Ivoire.
Médecins du Monde is working to build these individuals’ capacity to act in order to develop appropriate responses and combat the stigmatisation, exclusion and criminalisation which represent barriers to accessing care.
The second phase of this project, launched in 2018, led to the opening in August 2019 of an Addiction Treatment and Counselling Centre (CASA) which provides holistic treatment and support for people who use drugs. The CASA currently offers a package of different services, including facilities for washing and laundry, places to rest, information and awareness-raising, distribution of harm reduction tools, screening and testing, medical consultations, welfare support, psychological treatment and community activities, alongside outreach work (HIV testing, primary healthcare and referrals).
Phase 3, which will be launched in 2021, aims to consolidate existing provision and replicate specially tailored integrated care services accessible for vulnerable people who use drugs in Grand Abidjan, Yamoussoukro, Bouaké and San-Pédro.
In figures: our humanitarian mission in Côte d’Ivoire in 2020
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