Reclaiming Women’s Reproductive Health After Conflict

As a 14 year old girl, Esther Abeja was abducted by the Lord’s Resistance Army. While in captivity, she was forced to kill her baby girl and was raped unconscious by countless rebels. “After that, some of the women put something in my birth canal to pull out the semen,” she explains.  At 47 years old, Esther’s life in her hometown Lira, is still disrupted by the resulting uterine prolapse, as her uterus protrudes through the vagina. She is unable to farm for a living, still faces social stigma and deals with unaddressed psychological trauma.

“I never went through a rehabilitation centre or hospital. I come to this health centre many times but we have no HIV drugs”, explains Helen Ayo, another woman whose mental, sexual and reproductive health was affected by the conflict in Northern Uganda. Helen, an abductee who was later internally displaced, got infected with HIV after several rapes during the conflict. As an IDP, she did not receive medical following the rape and still has challenges accessing anti-retroviral drugs.

Alarmingly, women like Esther and Helen form a significant portion of women in post-conflict Northern Uganda whose mental and reproductive health needs remained unaddressed. While the government of Uganda and development partners designed and implemented a Peace, Recovery and Development Plan (PRDP) for Northern Uganda, women’s health needs during times of relative peace remain a non-priority. As opposed to considering the reproductive and mental health of women war survivors, the PRDP heavily focused on infrastructure and other hardware issues.

To evaluate the status of women’s health in these post-conflict settings, Isis-WICCE with the support of SIDA and HIVOS, conducted a medical assessmentin Lira district in 2011. This was followed by an intervention to respond to some of the identified reproductive health needs of conflict-affected women tagged Raising Hope, Reclaiming Lives in Northern Uganda. The study revealed that 83% of the respondent women (mostly former abductees or IDPs) had chronic pelvic pain, a symptom of pelvic inflammatory disease resulting from sexual violence or other infections which often becomes chronic due to lack of medical care. 65% of the women had previously been abducted, sexually abused and suffered from lower abdominal pain for several years.

The medical team also discovered that women needed surgery for critical conditions like genital prolapse, uterine fibroid, ovarian mass and hernia. They also identified cases of stool and urine incontinence, endometrial cancer, perineal tears among other complications. As a result, these women war survivors are unable to engage in agricultural activities to earn a living (88% were peasant farmers). They reported great challenges in their sex lives including painful sexual intercourse leading to domestic trouble and in some cases domestic violence.

While these and many other women have spent several years out of captivity or internal displacement, they do not define their lives as peaceful. For women like Esther and Helen Ayo, more action needs to be taken to ensure survivors of sexual violence in conflict access reproductive health treatment, ARVs, psychosocial support and consistent medical care.

 “Women cannot claim to have peace if their reproductive health is still an issue they are struggling with on a daily basis” Isis-WICCE’s Helen Kezie-Nwoha explains. She clarifies that women’s health in post-conflict situations is a prerequisite for recovery and sustainable development, considering women as active, productive, participating members of society.

Helen expounds, “at Isis-WICCE, we believe that post conflict reconstruction cannot be complete without addressing the needs of women and attending to their reproductive health complications. We have to bring these services to the people and we are saying to the government that this is what it means when you talk of post-conflict reconstruction for women.”