Factors affecting women's health in the democratic republic of congo

FACTORS AFFECTING WOMEN'S HEALTH IN DEMOCRATIC REPUBLIC OF CONGO

CASE STUDY: BUTEMBO, LUBERO DISTRICT

A dissertation submitted to

The Institute of Ethics and Development Studies

In partial fulfillment of the requirements for the award of degree of Bachelor of Arts

(Ethics and Development Studies)

Uganda Martyrs University

MEDHO KALUMBO SYLVAIN

[2005-03-ETH-038]

April 2009

DEDICATION

This research work is dedicated to my beloved family members, Papa Eric Mongo, Mum Yvonne Ontoma, Mum Beatrice Medho, my late Sister Denise Moke and my father Lou Michels, who had great love and interest in my education and has unselfishly, laid the ground for me to reach the top. Mr. Theo Groot, who was my first teacher and has, until now, guided me along my path of studies at Uganda Martyrs University.

May the Almighty God bless them abundantly

ACKNOWLEDGEMENT

I wish to acknowledge the efforts of various individuals, who contributed in one way or the other towards the study, 'Factors Affecting Women's Health in Democratic Republic of Congo: Butembo, Lubero District, North-Kivu Province'.

I appreciate and acknowledge the support of Sr. CECILIA MARY DRARU of the Department of Ethics and Development Studies, Madam OKULLO NELLIE of the Department of Education as well as of my supervisor, VIVIENNE LAING, for their timely guidance, wisdom and invaluable comments at each stage of the study.

I acknowledge the valuable information rendered to me by the various people and NGOs: FEPSI & CFII, families, fellow students without which this study would not have been a success.

I would like to recognize and thank my family for the financial and moral support accorded to me.

ABSTRACT

This study was to find out factors affecting women's health in the Democratic Republic of Congo (DRC). The objective of the research included: to identify the major health problems of Women in post-conflict Butembo; to identify the coping mechanisms used to combat health problems associated with violence and the major causes preventing use of health care services. The study was descriptive and mainly qualitative methods in design were used to carry out and obtain information from the field. These included the use of interviews and focus group discussions.

The findings show that women suffer from the common ailments found in DRC; that they get very little information concerning their health and have little extra resources to obtain preventative measures for example ITN. The expected result of the study was that people would experience the effects of war, but such effects were not mentioned. Nevertheless, data from a local NGO - FEPSI - show that women suffer some forms of post traumatic shock syndrome, but in a silent way. This has to do with lack of awareness but also with traditional cultural norms. The latter means that «what happens within the home should be kept into the home». General experience however has shown that such behavior makes the situation only worse. It was therefore recommended as a way forward that the Ministry of health should focus more on health promotion and education in order to sensitize the communities on these various issues.

It was also recommended that the health promoters, NGOs and community development officers should discuss issues of domestic violence and post traumatic stress symptoms with the people of Butembo district.

In conclusion, the district health department should liaise with other sectors like education, agriculture and water supply services to streamline health issues concerning Women.

LIST OF ACRONYMS

ARV: Anti Retro Viral

CFII: Centre de Formation et Information de l'Ituri

DRC: Democratic Republic of the Congo

FEPSI: Femme Engagées pour la Promotion de la Santé Intégrale

EWPSI: Engaged Women for Integral Health Promotion

GPSALW: Gender Perspectives on Small Arms and Light Weapons

HAC: Human Artificial Chromosome

HIV/AIDS: Human Immune Virus / Acquired Immune Deficiency Syndrome

NHIDMP: National Health Infrastructure Development and Maintenance Plan

NGO: Non Governmental Organization

SGBV: Sexual and Gender Based Violence

ST: Sexually Transmitted

STD: Sexual Transmitted Diseases

UHB: Uganda Health Bulletin

UMU: Uganda Martyrs University

UN: United Nations

UNDP: United Nations Development Program

UNFPA: United Nations Programme for Population Fund

WHO: World Health Organization

CHAPTER ONE

GENERAL INTRODUCTION

INTRODUCTION

The researcher based his research on factors affecting women's health in Democratic Republic of Congo. It is organised chronologically in five chapters all of which were crucial in the success of this study.

According to the Constitution of the World Health Organization 1948, health is defined as `a state of complete physical, mental, emotional, intellectual, environmental, spiritual health, and social well-being and not merely the absence of disease or infirmity' (WHO, 2004).

In order to justify health it is important not to ignore the fact that health is fundamental to an individual's well being in many ways and it is therefore independently valid. The Joint Initiative on the Fight against Sexual Violence towards Women and Children of the United Nations documented 41,225 cases in the provinces of Kivu, Maniema and Kalemi in DRC since 1998 (WHO and HAC, 2005).

Services that address women's needs, especially when they are subject to sexual violence, will reduce the impact of trauma, rates of undesired pregnancy, and the incidence of sexually transmitted diseases (STDs) and HIV infection. The specific purpose of such programmes is to establish the best practices for health services that operate in conflict period so that they promote women's health (with particular attention to the needs of women exposed to acts of violence); to improving sexual and reproductive health, reducing risks of HIV infection, and providing effective health care to those who have acquired HIV and (seeking, where feasible, access to ARV-based AIDS care). Through Women studies, the inequality between men and women in health status and decision making has become clearer. The studies indicate that in most cases women are at a disadvantage (Gender and Health Promotion, 2007) and therefore their health special attention needs to be paid to the issues surrounding in conflict and post conflict.

Women's health and HIV/Aids

Women are affected by diseases such as Malaria, sexually transmitted diseases, high-pitched respiratory infections, flu and diarrhoea (Gender and Development, 2005). On the other hand, women's reproductive health activities focus primarily on contraception safety and efficacy, fertility, infertility, and HIV/AIDS and other sexually transmitted diseases. (STDs) http://www.cdc.gov/reproductivehealth/WomensRH/index.htm

Women from socially and economically backward groups have lower odds, both of having awareness of AIDS and knowledge of ways to avoid getting the disease (Women's Health in Today's Developing World, 2005). The spread of the epidemic to rural areas presents a need to actively disseminate AIDS related knowledge for health protection. Approaches to health promotion that do not consider differing contextual factors are unlikely to succeed. Therefore, an innovative strategy to disseminate knowledge among disadvantaged population groups is needed. (Reproductive Health, 2005)

Factors affecting women's health

War

War is one of the factors that have affected Women's health in Butembo from 1998 to 2003. Due to insecurity, people were forced to leave their homes in the town and go to the villages for refuge and safety, escaping the hostilities in Butembo. The women were exposed to sexual violence, rape and other gender based violence by armed groups and also civilians (FEPSI-NGO, 2007). Sexual and gender based violence (SGBV) remains one of the greatest threats to Women's Health.

Moreover, in the villages there were no health facilities of any kind, no food, and no shelter.

After the war they returned home unfortunately few health care units available services were offered so women and their dependants could not access adequate healthcare, including safe contraceptive methods as a greater proportion of money was directed to the war.

Societal: culture and patriarchal society

People in Butembo are of the Nande ethnic group. Like most rural people throughout the DRC they speak one language, they have the same tradition, culture, customs, which are derived from one ancestral line.

Among the Nande, Women have less rights in the family meaning that men are privileged because of cultural beliefs. In every situation women have to seek permission from their husbands except when it concerns health issue whereby women are allowed to seek treatment according to their will.

BACKGROUND TO THE STUDY

Butembo

Butembo, the second town of the province after Goma is situated in Lubero district, North Kivu province in the Eastern part of Democratic Republic of the Congo. The citizens living in the town majority is of Nande by tribe. Since independence 1960, the population has lived in poor health conditions.

The inhabitants here suffer from various types of diseases such as Malaria, TB, and HIV/AIDS but also reproductive health and non-communicable diseases, such as those linked to Tobacco smoking.

Like most rural people through the country, the population of Butembo depicts a low to average standard of living. As judged by the current definition of poverty, which is the situation where one lacks most of the basic necessities and assets for life or even any means of acquiring them.

Government health facilities

As mentioned before, most of the Government health facilities countrywide have not been maintained or rehabilitated during and after war, and many health centers and communities lack appropriate medical equipment and staff (FEPSI-NGO, 2007). The Ministry of Health has recognized the importance of maintenance and is in the process of developing a National Health Infrastructure Development and Maintenance Plan (NHIDMP) as the priority for health.

Study context

The study context is characterized by ongoing conflicts where community systems including health systems are weakened, and easily overwhelmed. Societal cohesion and the rule of law are undermined. Proposed responses need to take into account the extreme challenges to their successful study, development and implementation.

PROBLEM STATEMENT

War and society related to women's health

During the war in Butembo health facilities were destroyed and rundown resulting into a deterioration of women's health. Even after the war there are still factors affecting women's health. Among these include: Policy reasons such as poor collaboration between health workers and the local council; poor planning, and lack of material.

Goal

The overall goal of this study is to offer suggestions that will help improve the impact of health services on the health of women in post-conflict settings. As said before, services that better address women's needs, especially when they are subject to violence, will reduce the impact of trauma, rates of undesired pregnancy, and the incidence of sexually transmitted diseases and also by ascertaining the effects of the war on women's health and studying how women's health is after the cessation of war.

RESEARCH OBJECTIVES

Main objective

To establish the factors relating to women's health in the post-conflict situation that promotes women's health with particular attention to the needs of women exposed to violent acts, improving sexual and reproductive health, reducing risks of STD infections. While identifying Different types of health care to those who have acquired, for example HIV/AIDS and victims of different types of violence or rape.

Specific purpose

1. To identify the major health problems for women in post-conflict Butembo

2. To identify the coping mechanisms used to combat health problems associated with violence

3. To identify the major causes preventing use of health care services.

RESEARCH QUESTION

What are the factors affecting women's health in Butembo District?

HYPOTHESES

It is supposed that improving quality of care must begin with the formation of human resources for health; a formation which should include value, care process of men and women. However, what might be important is to provide opportunities to female health workers to come together as women and as professionals to provide care to the community.

Women's health may thus be improved in the way that women engage themselves in public health services, which can play a big role in improving quality of care.

Scope of the study

The scope of this study focused on the factors affecting women's health, in Butembo, Lubero District as the case study. Data was obtained from the NGO-FEPSI headquarter 63 Martyrs Road, Butembo town.

JUSTIFICATION

Diseases have had profound social and health consequences on women in Butembo. Sometimes they remain mute and suffer silently from the diseases and trauma. The outcome of this study will identify how healthcare delivery can support women after identifying the factors which affect women and their health. It will also identify healthcare gaps in service delivery, which once identified can aid health planners and policy makers in provision of services.

CONCLUSION

The chapter focused on the researcher's area of study, the introduction, and the objectives that helped the researcher carry out his study including the Significance and hypothesis of the study.

CHAPTER TWO

LITERATURE REVIEW

INTRODUCTION

Women's health is among the most important problems that developing countries face. The magnitude of the women's health problem is so important that it has affected their development.

The current concept of women's health should be expanded to embrace the full spectrum of health experienced by women, and preventive and remedial approaches to the major conditions that afflict women. Allocation of health service resources should be aligned with the epidemiological realities of these threats to women's health, (Women's Health in Today's Developing World, 2005).

What are the causes preventing use of health care?

Income and loss of employment leads to poverty that can become rampant and widespread in such a way that one cannot easily sustain him/herself and provide the basic needs like food, shelter and maintenance of a good quality of health, especially in post-conflict communities. The challenge is to define the essential elements of women's reproductive health services, upgrade the services as appropriate and reduce women's risks of disease and suffering, (WHO, 2004).

What are the factors affecting women's health?

WAR-effects on women's health

War is one of the major factors that affect Women's health. Discrimination and gender difference are the most brutal consequences of war on women's health. In war areas women are the most affected, especially those wars in which the world's media take only token interest. For example, the incidence of rape in Darfur, DRC, Northern Uganda and Sierra Leone may never be known, let alone carry any hope of accountability. ( http://uk.oneworld.net/guides/uganda/development)

According to UHB (2000) the overall goal of organizations in war, such as local and international NGO's is to improve the impact of health services on the health of women caught up in violent conflict, or post-conflict settings. Services that better address women's needs especially when they are subject to situations like sexual violence will reduce the impact of trauma, rates of undesired pregnancy, and the incidence of sexually transmitted disease and HIV infection, (Uganda Health Bulletin, 2000).

SOCIETAL: CULTURE, PATRIACHIAL SOCIETY AND HEALTH

In the majority of poor countries only a small proportion of women will be engaged in paid employment which itself is likely to be of low quality, (Senators and Representative, 2006).

According to the Global Policy (2006) in Asia a relative important proportion of women are able to find employment. This is quite different from Congo and for instance few women in Butembo think of having work. Otherwise, they are mostly focused on agricultural work and business, while Asian Women focus more on the business model of global corporations, which typically engages them at the bottom of the production chain, for example in factories.

HIV/AIDS

According to the Executive director of UNFPA - [Ms.Thoraya Obaid], (2007) - HIV/AIDS constitute another big area of health factors affecting Women. Part of it is that developing countries are facing critical shortfalls of contraceptives and condoms. The solution to the HIV problem is the combination of sex education, abstinence, couples remaining faithful to their partners and greater use of condoms.

Gender Inequalities

According to UNFPA (2005) gender inequalities need to be addressed including violence, limited access to education and violation of human rights. When women are educated, healthy and employed, and able to make decisions about childbearing and reproductive life, everyone benefits.

What are the major health problems for women?

According to WHO (2005; 2007) being poor or being a woman was often a reason for being discriminated. Worldwide, millions of women are unable to protect themselves from HIV infection due to lack of prevention methods that can be controlled by women, causing unnecessary suffering and death. One of the most urgent actions is to increase funding for vaccine development, proper nutrition and invest in education that will ensure they are accepted within communities.

The Convention on Elimination of all forms of Discrimination Against Women [adopted and opened for signature, ratification and accession by General Assembly resolution 34/180 of 18 December 1979 entry into force 3 September 1981, in accordance with articles 27(1)] stipulates that «the discrimination against women violates the principles of equality of rights and respect for human dignity, is an obstacle to the participation of women, on equal terms with men, in the political, social, economic field and in the family and makes more difficult to realise the full development of the potentialities of women in the service of their countries and of humanity», (The conventions on the elimination of all forms of discrimination against women, 1981).

http://www.mafhoum.com/press/51s4.htm,October 2007

According to Farr, (2002) health is not a gender issue, but a poverty issue. It effects men as well as women and depends on the area they live. For this to be seen as a woman issue is typical of real discrimination.

Women are the bearers of new life. In order to protect future lives we must protect women. Promoting women's health physically and mentally should be a top priority internationally. A progressive society can be measured by the way that its women are treated. If women are healthy then their children and families will have a greater chance of also being healthy and productive, (Gender Perspectives on Small Arms and Light Weapons, 2002).

http://www.iansa.org/women, (September 2007)

There is no excuse for this grave human inequality. Women should no longer be valued as second class citizens. If all the money that has been poured into aid for third-world countries was used for a common benefit, there would be no hunger and health problem in the world today.

http://disarmament.un.org/gender.htm (September 2007)

Gender and health promotion

According to Östlin et al, (2007) women and men are different as regards their biology, the roles and responsibilities that society assigns to them and their position in the family and community. These factors have a great influence on causes, consequences and management of diseases and ill-health and on the efficacy of health promotion policies and programmes.

What mechanism can be taken to combat health problems?

Health promoting interventions aimed at ensuring safe and supportive environments, healthy living conditions and lifestyles, community involvement and participation, access to essential facilities and to social and health services need to address these differences between women and men, boys and girls in an equitable manner in order to be effective, (Gender and Health Promotion, 2007).

The different health measures showed considerable variation in strengths of association with health related factors, most noticeably so with gender and socio-economic status. The choice of health measures in population studies should comply with the intention to analyze its associations with any of those related factors, or, in reverse, with the wish to prevent their confounding properties, (Health Measures, 2007).

Extending the definition of women's health to include a concern for chronic diseases is critical if the needs of women in less developed nations are to be met. In less developed countries, chronic diseases are the most important cause of female death even during childbearing years and for women with young families. Development agencies and private philanthropy must begin to fund the studies that will further refine our understanding of the role of chronic diseases in women's health in the developing world, (Women's health in today's developing world, 2005).

CHAPTER THREE

RESEARCH METHODOLOGY