Sudan: Medair starts reproductive health-care programme in West Darfur

Ivor Morgan, Country director
Despite being conceived and born amongst conflict and suffering, increasing numbers of babies in West Darfur are entering the world in safe and hygienic conditions, thanks to a new reproductive health-care programme implemented by the Medair.

Until recently, giving birth in West Darfur generally meant an expectant mother crouching on the mud-floor of a straw hut, still wearing her long robes due to a lack of any other form of privacy. Trained medical care was unlikely to be available, and the lack of even basic supplies such as a clean blade to cut the umbilical cord would mean that tetanus and other infections were a real risk for the new-born child. The situation has been particularly difficult for women displaced by the current conflict but even in 2001, before the conflict started, reproductive health-care in West Darfur was extremely limited, with less than 30% of pregnant women receiving ante-natal care and less than 1% of women using contraception.

Fortunately, the situation has started to improve since Medair introduced a reproductive health-care component alongside its long-running Primary Health-care Support programme in West Darfur. Initially trialled in two camps for displaced people, core reproductive health-care services have now been introduced in all 20 of the clinics that Medair supports in the state, both in camps for the displaced and in conflict-affected villages.

At first, the programme focussed on providing additional training and support for existing village midwives, to enable them to carry out their work more effectively. "Forty-four such midwives have now been trained and equipped", explains Dr Sally Bell, Medair's Reproductive Health Coordinator, "but perhaps most importantly of all, they've been given a new sense of dignity and value."

These midwives are now able to provide ante-natal care for pregnant women, and to attend deliveries. Given the problems of finding hygienic conditions in which to deliver, especially in the crowded camps, Medair has opened 9 'Safe Delivery Areas.' These rooms, attached to existing clinics, provide a clean, private and well-equipped place in which to give birth. "For the first time, women in West Darfur have a real choice about where to give birth," says Dr Bell, "and the 'Safe Delivery Areas' have the added advantage that the clinic doctor or medical assistant is accessible, and so it is easier for midwives to make referrals, should any complications occur."

For those pregnant women who are unable to attend a clinic for delivery (for example, because they live too far away) Medair provides 'Safe Delivery Packs.' These packs contain: a plastic sheet to provide a clean space on which to deliver; a cloth to wrap the new-born baby in; a clean razor-blade with which to cut the umbilical cord; and a bar of soap, to enable general hygiene.

There has been a dramatic increase in the uptake of these services, since Medair started introducing the programme six months ago. The 'Safe Delivery Area' in Sisi Camp, home to around 10,000 displaced persons, started off seeing around 30 deliveries per month, but that number has since increased nearly fivefold, with 148 deliveries in the last month. A new 'Safe Delivery Area' in Umshalayah village started with 50 deliveries in its first month, and across Medair's project area, more than 6,000 'Safe Delivery Packs' have been given to expectant mothers since January this year.

A particularly traumatic aspect of the conflict in Darfur has been the high level of reported cases of rape and other incidences of sexual and gender-based violence. This is a sensitive and shameful topic for the traditional Muslim society of Darfur - and recently, staff from an international aid agency who reported on the subject were even arrested. However, should incidents of rape occur, Medair is now able to provide post-rape care and treatment in all its supported clinics, and it seems women are now bolder in coming forward to seek treatment.

Although the reported incidence of HIV/AIDS in Sudan is not as high as in other parts of Africa, it is important not to be complacent, given the devastating impact that the disease can have on communities. In order to raise awareness both of the risks of HIV/AIDS and of ways of reducing its transmission, Medair has provided HIV/AIDS education for all its national staff in West Darfur, and is progressively providing such training for clinic staff. Eventually, HIV/AIDS education will also be provided at community-level. Other Sexually-Transmitted Infections (STIs) are already a problem in West Darfur, and so Medair is providing STI treatment in all its supported clinics. An important element of such treatment is follow up of a person's partner(s) : "Medair has achieved 80% successful partner follow-up" comments Dr Bell, "which is a higher rate than you would expect to see in Britain !"

"It's amazing what's been achieved in such a short space of time", concludes Dr Bell. "Women have so often been neglected, so they really appreciate services and attention that are specifically for them. There's been a big increase in women attending ante-natal care, and in the communities in which we work, it's now common to see new-born babies wrapped in the bright cloths from the 'Safe Delivery Packs' Medair has given out."