Page last updated at 09:30 GMT, Tuesday, 8 September 2009 10:30 UK

Giving birth in Congo's war zone

By Steve Bradshaw
Life on the Edge, BBC World News

Grace Kodindo in a camp for displaced people in north west Congo
Chadian obstetrician Grace Kodindo says reproductive health care in war zones must be seen as a frontline priority

Claudine Maombi has been living on two frontlines at once: She is a mother and she is from eastern Democratic Republic of Congo.

Being pregnant in some areas of sub-Saharan Africa can be as hazardous as being a civilian in a conflict zone.

There was shooting everywhere so we fled. As we ran my wife started having labour pains
Sebutanwa Maombi

But Claudine actually lives in one - she has been caught in a conflict that has cost more than five and a half million lives and lasted longer than World War II.

Claudine had to hide in some bushes to give birth.

"It was cold," she recalls stoically. She was escaping the fighting with her husband Sebutanwa.

"There was shooting everywhere so we fled," he remembers.

"As we ran my wife started having labour pains. All we had were the rubber glove and the razor blade. I cut the cord with the razor."

They were lucky to have anything. An aid agency had given them an emergency "clean delivery kit", knowing that by Western standards many deliveries in North Kivu become emergencies.

"We had no baby clothes, so I wrapped him in my scarf," Claudine says.

Iconic figure

Across sub-Saharan Africa, women have a one in 13 lifetime chance of dying in pregnancy and childbirth.

Grace Kodindo (left) and Yvonne Salama
I hid myself away because I didn't want anyone to know
Yvonne, rape victim

In DR Congo's North Kivu, where the basic kits and tools can be in egregiously short supply, the odds are often far worse.

Like Claudine, Esther Maombi (no relation) was on the point of delivering her baby as she fled the fighting.

But she was not so lucky.

"The clinic had given me an emergency birth kit, which I put in my bag. But we were robbed as we ran," she says.

Her baby died soon after birth.

The two women tell their experiences - all too commonplace in DR Congo - to Dr Grace Kodindo, an obstetrician and gynaecologist from Chad.

She became something of an iconic figure after appearing in a BBC Panorama documentary Dead Mums Don't Cry in 2005 about her struggle to stop mothers in her country dying.

It led to her being invited to address the UN and she was awarded for her work in championing the Millennium Development Goal of cutting maternal mortality - particularly in Africa.

Life and death

Dr Kodindo now works as an advocate for emergency reproductive care for the organisation Raise, at Columbia University in New York.

DR Congo soldiers on trial for rape
Recently a group of DR Congo soldiers received life sentences for rape

She has watched over many emergency deliveries, but for her, Claudine's story was a first - the first time in Africa that she has heard from a husband who has delivered his wife's child.

"There's only a plastic sheet, a razor, some string and soap, that's all," she says of the emergency clean delivery kit.

"But that can make the difference between life and death, because it helps prevent tetanus.

"Which is one of the most common causes of neo-natal or even maternal death."

Dr Kodindo says she has come to DR Congo "to see for myself the impact of the fighting on its main victims - the women and children".

The remote bush and emergencies wards of her native Chad were hard enough for women.

But her first trip to a warzone, even though much of the fighting has subsided, still shocks her.

Sign of hope

Twenty-year-old Yvonne tells Dr Kodindo how she was raped by soldiers from one of the warring militias as she made her way to her parents' field.

By far the biggest casualties of this conflict are civilians - not the fighters. Reproductive health care must be seen as a frontline priority
Grace Kodindo

"I hid myself away because I didn't want anyone to know," she says.

"Only when I found I was pregnant did my parents send me to the clinic."

Dr Kodindo knows it would not take much more to transform lives - for example making post-exposure prophylaxis (Pep) kits available, an emergency cocktail of drugs to protect rape victims from infections (including HIV) and unwanted pregnancy.

Even where there is good news, it can be misleading - the first clinic Dr Kodindo visits has very few cases of HIV, and no recorded maternal deaths.

It seems that while some medicines are available here, the ability to keep accurate records may be lacking.

But Dr Kodindo does come across one sign of hope, a story that has not been much reported in the West.

She sees an an army court marshal where soldiers found guilty of rape have their insignia ripped off their uniforms and are handed down life sentences of hard labour by be-gowned judges.

Together, justice and access to better medicine could help the plight of women caught on both front lines.

"By far the biggest casualties of this conflict are civilians - not the fighters. And the women and children suffer the most - their need is greatest," Dr Kodindo says.

"Reproductive health care must be seen as a frontline priority - not something to think about only after the fighting is over."

Grace Under Fire is broadcast on BBC World News on Tuesday 8 September, at 1930 GMT.

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