Scars of conflict: ‘We should not forget Africa’s women’


Women often feel forgotten in post-conflict settings, their needs neglected. For them, even seemingly simple ways to prevent HIV transmission present real challenges. Take Cameroon for example, where the average HIV prevalence is 4.3%, according to Cameroon’s Demographic and Health Survey of 2011. In the southwest region, that rate rises to 5.7% but in the post-conflict areas of this region, it could be as high as 20%.  

Reach Out Cameroon, a nongovernmental organisation, started a community programme to prevent mother-to-child transmission in the Bakassi area, where decades of conflict between Nigeria and Cameroon over possession of the peninsula only ended in 2008. It has also been doing free voluntary counselling and testing. These tests revealed that while more than 17% of women were HIV positive, the infection rate among men was only 4%. 

We know that interventions to prevent mother-to-child transmission of HIV can reduce the risk of infection to less than 5%, according to the World Health Organisation. Normally, the first step would be to get pregnant mothers into healthcare centres to be tested and treated appropriately ahead of the birth, as well as through the process of breastfeeding, if they are HIV positive.  But it is not enough to tell women that they must go to a clinic. 

Read our story on how programmes on prevention of mother-to-child transmission of HIV impacted on Cotlands baby hospice in Johannesburg.

Limited resources
The high infection rate in Bakassi reflects the real challenges faced by women there: insecurity, no communications network and limited transport.  For many women in maritime areas, their only means of transport is by boat – an option that is too expensive to warrant them visiting a clinic. Access is therefore almost impossible and many women end up giving birth to HIV-positive children. This is compounded by the strong influence of culture and religion – many people believe in prayer as an alternative to healthcare. 

Culturally, women are reluctant to give birth at an institution if there is a male doctor or nurse present. As a result, many choose to have their babies at home or at a church, using a traditional birth attendant who is unable to provide the necessary support to prevent HIV being transmitted to the newborns. Women’s health choices are further determined by a lack of finances. 

Reach Out Cameroon’s programme with the African Women’s Development Fund has found that husbands, who are usually the breadwinners, are more likely to make health decisions about matters such as starting antenatal visits. While the recommended time is 12 weeks into a pregnancy, most women only start having check-ups after 30 weeks – often because of the cost of transport.  

Interventions, such as antiretrovirals, to prevent mother-to-child transmission of HIV can reduce the risk of infection to less than 5%. (Reuters)

Read our story on prevention of mother-to-child programmes in the rural Western Cape in South Africa. 

Community health workers
We should not let these women feel forgotten. One solution explored by Reach Out Cameroon is the use of community health workers, as most government health workers don’t operate in these post-conflict areas. The organisation has trained almost 100 community health workers – more than half of whom are women. They, in turn, have reached more than a thousand pregnant women. These workers go from home to home to sensitise residents on the importance of accessing healthcare. They also search for “lost” or lapsed HIV-positive mother-baby pairs to bring them back for care and treatment at the nearest health facility. 

Early indications are that about 80% of women reached through this system, and who participated in antenatal care, gave birth to HIV-negative children. This shows a significant reduction of the health burden in a region struggling to contain HIV infections.  The results are very promising, but much more can be done. This figure will be even higher if we encourage women to give birth in a medical facility. We have to ensure they have the resources to go to clinics. We also need to find ways for community health workers to go out to assist women who do not want to come to health centres. This might be as simple as doing home-based antenatal consultations where pregnant women get tested and HIV-positive women are treated, followed by regular outreach visits to HIV-positive mother-baby pairs.  

Empowering women
Even when women do give birth at home, we need to connect with them to ensure they receive the proper medication. We need an ambulance boat to transport women to the nearest clinic. Women have to be empowered economically so that they can take their own health decisions. We should not let women in this post-conflict area feel forgotten. It is in everyone’s interest that we move this community away from HIV. People move from region to region and having one area with such a high prevalence of HIV puts everyone at risk of infection. If we can make progress in such difficult conditions, we can take lessons learnt to the cities, where such progress can be scaled up quickly and cheaply. 

We know that economically empowered women are more likely to take vital health decisions early. We also know that an economically empowered health system is more likely to create an environment conducive to women making these informed decisions. Investing in rural health is critical. The government alone cannot do it – it needs partners in the private sector as well as funders to recognise the economic value of healthcare. If we tackle this now — together— we will make long-term gains.

Ngo Bibaa Lundi Anne is health programme manager at Reach Out Cameroon and an African Women’s Development Fund fellow. Follow her on Twitter @LundiAnne1

Subscribe to the M&G

These are unprecedented times, and the role of media to tell and record the story of South Africa as it develops is more important than ever.

The Mail & Guardian is a proud news publisher with roots stretching back 35 years, and we’ve survived right from day one thanks to the support of readers who value fiercely independent journalism that is beholden to no-one. To help us continue for another 35 future years with the same proud values, please consider taking out a subscription.

Related stories

Stop the ‘war on drugs’, it doesn’t work

Punitive measures simply drive drug use underground. A more effective way is to adopt harm reduction interventions

Six injections a year could stop new HIV infections

New research from seven countries in Africa signals the future of HIV prevention — but what can it learn from its past?

The Trump era is over. But the fight for democracy is just getting started

A respected and robust United States — with all of our flaws, mistakes and missteps — can be good for the defence of democracy, not least in Africa

Q&A Sessions: Meet Thembisile Xulu, a doctor, hip-hop fan and mother

Dr Thembisile Xulu, the newly appointed chief executive of the Sanac Trust, tells Nicolene de Wee about a new plan to fight HIV, TB and STIs — and her hip-hop dance moves

Ethiopia is about to cross the point of no return

As the conflict between the national government and Tigray escalates, the window for intervention is closing fast

Conflict in Cameroon: The schools caught in crossfire

A slew of recent attacks in the country means sending your child to school can be a life or death decision

Subscribers only

Covid-19 surges in the Eastern Cape

With people queuing for services, no water, lax enforcement of mask rules and plenty of partying, the virus is flourishing once again, and a quarter of the growth is in the Eastern Cape

Ace prepares ANC branches for battle

ANC secretary general Ace Magashule is ignoring party policy on corruption-charged officials and taking his battle to branch level, where his ‘slate capture’ strategy is expected to leave Ramaphosa on the ropes

More top stories

See people as individual humans, not as a race

We need to ingrain values of equality in education, businesses, society broadly and religious groups to see people

JJ Rawlings left an indelible mark on Ghana’s history

The air force pilot and former president used extreme measures, including a coup, enforced ‘discipline’ through executions, ‘disappearances’ and floggings, but reintroduced democracy

Sudan’s government gambles over fuel-subsidy cuts — and people pay...

Economists question the manner in which the transitional government partially cut fuel subsidies

Traditional healers need new spaces

Proper facilities supported by well-researched cultural principles will go a long way to improving the image and perception of the practice of traditional medicine

press releases

Loading latest Press Releases…