Skip to main content

    Reproductive healthcare  

    Doctors Without Borders/Médecins Sans Frontières (MSF) is often associated with medical responses to conflict settings, epidemics and disasters, but the work in the field involves much more. In locations around the world, we work on neglected diseases, malnutrition, healthcare exclusion, and a variety of health issues in the field. Among these health issues is reproductive health. 

    Reproductive health programs are an integral part of the medical care field workers provide to all kinds of people, whatever the context, in many of countries where we work around the world. Reproductive health services are critical in locations where our field workers are responding to emergencies, epidemics, conflict settings, and disasters.  

    In every region and mission where we work, the mission to support reproductive health includes but is not limited to maternal health, HIV/AIDS, cervical cancer, adolescent health, and more.  

    A nurse in northern Colombia talks with a group of Venezuelan women gathered for sexual and reproductive health services.  © MSF

    A nurse in northern Colombia talks with a group of Venezuelan women gathered for sexual and reproductive health services. © MSF

    Maternal Health

    An estimated 99% of mothers who die in childbirth or from pregnancy-related complications live in developing countries. Many of these countries are embroiled in conflict, or frequently hit by disaster or epidemics. Some places have high incidence of malnutrition, while in other places pregnant mothers suffer from healthcare exclusion. There are many factors that threaten the survival of pregnant mothers, and their needs cannot be ignored. 

    Based on our assessment, the five main causes of maternal death are haemorrhage, sepsis, unsafe abortion, complications linked to high blood pressure, and obstructed labour. This is why ensuring the survival of mothers is a big part of our work in the field.  

    Most maternal deaths occur just before, during or just after delivery. Timely access to qualified staff in the field can be a question of survival for mothers experiencing complications during childbirth. Our programs work to remedy the delays mothers face in receiving care during childbirth. Apart from emergency obstetric and newborn care, our work in the field also includes assessment of needs and providing pre- and postnatal care and contraceptive services, all of which contribute to the survival of mothers. 

    In 2019, field workers provided assistance for 329,900 births, including caesarean sections.  

    MSF’s Khost maternity hospital was delivering an average of 2,000 babies per month before the COVID-19 pandemic spread to Afghanistan. In late June 2020, the project had to limit care to women who need lifesaving emergency services due to staffing shortages. © Andrea Bruce/Noor Images

    MSF’s Khost maternity hospital was delivering an average of 2,000 babies per month before the COVID-19 pandemic spread to Afghanistan. In late June 2020, the project had to limit care to women who need lifesaving emergency services due to staffing shortages. © Andrea Bruce/Noor Images

    Sualeha Mohamed Ayubiu, with her 10-day-old son, at the hospital in Cox’s Bazar, Bangladesh. She used to live in Myanmar. She now lives in a camp for Rohingya refugees in Bangladesh. © Hasnat Sohan/MSF

    Sualeha Mohamed Ayubiu, with her 10-day-old son, at the hospital in Cox’s Bazar, Bangladesh. She used to live in Myanmar. She now lives in a camp for Rohingya refugees in Bangladesh. © Hasnat Sohan/MSF

    Childbirth Complications

    Even with sufficient healthcare, even if there are no disasters, even outside conflict settings, even without malnutrition or exclusion from healthcare, there are many complications that mothers can experience during pregnancy and childbirth, and we work to prevent or treat these complications.  

    Obstructed and prolonged labour can result in a fistula: a hole between the vagina and bladder, the vagina and rectum, or both. The result is urinary and/or faecal incontinence. Mothers with fistulas experience shame and are often rejected by their families and communities. These women need an operation to close a fistula, and this requires specialised surgical skills. Based on assessment of needs, field workers have programs called 'fistula camps' to provide surgery. Fistula can be easily prevented with access to skilled birth attendance and adequate management of obstructed labour, namely caesarean section. 

    Romy was the first baby born in the MSF inflatable hospital in Tacloban, the epicenter of Typhoon Haiyan. © Yann Libessart

    Romy was the first baby born in the MSF inflatable hospital in Tacloban, the epicenter of Typhoon Haiyan. © Yann Libessart

    Stories from the field: Protecting maternal health after disasters 

    In 2013, one of the strongest typhoons ever recorded, Typhoon Haiyan, hit the Philippines. Amidst the various healthcare needs during disasters, no matter the assessment, it is part of our mission to ensure there is assistance for maternal health in the field.  

    In her work on Haiyan response in the Philippines, emergency coordinator Caroline Seguin made sure pregnant mothers did not suffer exclusion from healthcare services. She said, "In most locations in the country where we are working, the health services have been severely disrupted. We’re focusing on restoring quality primary healthcare and hospital services. At the moment, those with complicated deliveries have nowhere to deliver safely or undergo a caesarean section, so our field workers will urgently set up maternity, obstetrics and gynaecology units." 

    Outbreak Response  

    Around the world, in any region, pregnancy can have severe impact on women’s health. Diseases can make matters even more complicated, particularly in later stages of pregnancy. Pregnant mothers are more susceptible to the effects of malaria infection, which can lead to maternal death, miscarriage or stillbirth. In some projects, up to 50% of those in antenatal care may test positive for malaria.  

    Hepatitis E has a significantly higher death rate amongst pregnant mothers, reaching 25% for those who are pregnant and in the third trimester. In some cases, cholera can lead to premature labour or obstetric complications. From conflict to disaster settings, crises and other field settings, we work to vaccinate against and treat these diseases.  

    Even if pregnant women are able to protect from the disease itself, the shutdown of health programs and fear of infection can negatively affect pregnancy, as demonstrated by the West Africa Ebola outbreak. Even if they need assessment, tests or consultations, pregnant mothers fear going to health facilities where they could get infected. Thousands more lives are lost when safe delivery, neonatal, and family planning services become inaccessible due to outbreaks and epidemics. This is why maternal and reproductive health needs are always part of the mission. 

    Sexual Violence

    In 2019, the organisation treated over 28,800 victims of sexual violence. Most patients were women and girls, but there is increasing awareness of men and boys who experience sexual violence, in and out of conflict situations.  

    Rape and other forms of sexual violence are often widespread in conflict settings, where they can be used to humiliate, punish, control, injure, inflict fear, and destroy communities in the field, especially when there are changes in political contexts. They may also be used to reward combatants and troops in the field. Sexual violence can also occur in the aftermath of disasters, with displaced people crowding into refugee camps and evacuation centres, seeking work or seeking assistance for food, water and other essentials. But millions of people living in stable contexts, with neither conflict nor disaster, can also experience sexual violence. In these cases, the perpetrators are often acquaintances or family members of the victims. 

    Sexual violence affects millions of people, brutally shattering the lives of women, men and children. It is a medical emergency, but there is often a dire lack of health services for victims. In our projects around the world, survivors are given antibiotics to prevent sexually transmitted infections such as syphilis and gonorrhoea, and vaccinations for tetanus and hepatitis B. Survivors need timely medical aid, as HIV prevention has to begin within 72 hours of the assault. The assessment and management of physical injuries, and psychological support are also part of the package of care in the field. 

    Sexual violence against men and boys includes rape, sexual torture and sexual slavery. Men and boys are even less likely to report sexual violence than women for fear of stigmatisation. As a result, experiences of sexual violence among men remain particularly invisible and under-reported, and how to adequately provide assistance to male victims poses a particular challenge. 

    An MSF social worker talks with survivor Rosina Seela Moole at the Boitekong Kgomotso Care Centre (BKCC) MSF clinic in Rustenburg, South Africa. © Melanie Wenger

    An MSF social worker talks with survivor Rosina Seela Moole at the Boitekong Kgomotso Care Centre (BKCC) MSF clinic in Rustenburg, South Africa. © Melanie Wenger

    HIV/AIDS

    Since the discovery of this autoimmune disease, Doctors Without Borders/Médecins Sans Frontières (MSF) has witnessed the toll that the human immunodeficiency virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) epidemic takes on the vulnerable. In 1995 field workers began a project caring for people living with HIV in Surin, Thailand. Research work conducted in countries like Thailand has played a historical role in demonstrating the feasibility and effectiveness of HIV treatment in resource-limited settings. 

    While we have many HIV projects and activities in Africa, there are HIV projects in Asia and the Pacific as well. In 1994, Doctors Without Borders/Médecins Sans Frontières began providing assistance for people living with HIV/AIDS, and health information in Yangon, Myanmar, as well as the screening and management of sexually transmitted infections. In 2002, we became the first provider of antiretroviral treatment (ARV) in the country and at some point ran Myanmar’s largest HIV treatment programme.  

    Together, the Insein and Thaketa clinics treated over 17,000 patients, many of whom travelled from elsewhere in the country to access care. In Dawei, Tanintharyi region, we also worked to provide assistance for HIV-positive adolescents. After 26 years, the project was handed over to the National AIDS Programme (NAP). 

    In 2019, there were over 70,000 people living with HIV receiving treatment under our direct supervision in Myanmar; a further 74,000 people were receiving treatment in programmes supported by the organisation.

    Stories from the field: Patient-centred care in Myanmar 

    “Before MSF arrived and began offering treatment for HIV-positive patients, life was hard,” says Zarni Aung, who worked as a peer group officer at the Thaketa clinic. “In Myanmar, people living with HIV were not treated as members of society. Families rejected them. At the clinics, with the field workers, we didn’t only receive medicine, but dignity as human beings.”  

    For Dr. Soe Yadanar, a clinic manager who has worked with our HIV projects for 20 years, MSF’s person-centred approach was what made the clinics so special. “Patients who were too sick to collect their medication were included through the home-based model and would receive their medication and other support items, such as hygiene articles and food supplies, at home,” she says. 

    While the clinics in Myanmar have now closed, the peer groups have been so successful that patients have started independent groups themselves. “Their experiences of psychosocial activities and sessions have helped many patients regain mental strength and to believe in themselves, to support each other and become active and proud members of their respective communities,” says Zarni Aung. 

    Cervical Cancer

    Data show that cervical cancer rates have been rising worldwide, particularly in the developing world. In 2018 alone, over 310,000 women died of cervical cancer. Assessment shows that more than 85% of those are in low- and middle-income countries. In the same year, 570,000 new cases were diagnosed.  

    In 42 countries, it kills more women than any other cancer. As of 2018, mortality was highest in Malawi, where we have our most comprehensive programme. 

    education sessions on cervical cancer in a Tondo's barangays (neighbourhood). © Hannah Reyes Morales

    Young girls from low income families in Tondo, Manila, are seen in a Likhaan clinic before their free HPV vaccinations. © Hannah Reyes Morales

    Screening remains key to cervical cancer prevention despite the effectiveness of human papillomavirus (HPV) vaccination. Many women today grew up before the introduction of the vaccine, and many young girls still don’t receive it. In low-resource settings, "screen and treat" has been designed to achieve as much as possible for the patient in a single visit in their local clinic. 

    In several countries, Doctors Without Borders/Médecins Sans Frontières (MSF) works to conduct cervical cancer screening sessions and treats patients with early-stage disease. This is especially critical in high HIV prevalence contexts. In such contexts, we provide vaccinations against HPV.  

    Reproductive Health and COVID-19 

    Data show the COVID-19 pandemic is proving to be one of the biggest disasters threatening the health of women and girls around the world. Women are being further cut off from sexual and reproductive health services, threatening sharp rises in maternal and neonatal mortality. Women and girls are often denied services they urgently need, or face dangerous delays getting the services they need. The impacts are especially severe in places with weak or overburdened health systems—including many of the places where Doctors Without Borders/Médecins Sans Frontières (MSF) staff work. 

    COVID-19 poses additional challenges. Although access to safe delivery care has long been acknowledged as an essential health service, the pandemic means many pregnant women now have fewer options for health services. Some sexual and reproductive health services, such as contraception and safe abortion care, are often seen as non-essential, and therefore are not considered a priority during emergencies.  

    Christine Akoth is a Kenyan midwife. She led maternity services in MSF primary health centres in Jamtoli and Hakimpara, Cox’s Bazar, Bangladesh. © Anthony Kwan/MSF

    Christine Akoth is a Kenyan midwife. She led maternity services in MSF primary health centres in Jamtoli and Hakimpara, Cox’s Bazar, Bangladesh. © Anthony Kwan/MSF

    MSF health workers speak with a group of sex workers in Nsanje, Malawi, during a ‘one-stop’ outreach clinic in 2019. These clinics take place in different parts of the community on different days and provide a comprehensive package of sexual and reproductive health services and referrals. © Isabel Corthier/MSF

    MSF health workers speak with a group of sex workers in Nsanje, Malawi, during a ‘one-stop’ outreach clinic in 2019. These clinics take place in different parts of the community on different days and provide a comprehensive package of sexual and reproductive health services and referrals. © Isabel Corthier/MSF

    Travel bans and movement restrictions have impacted all aspects of sexual and reproductive healthcare. Women in places that have been hit by disaster or conflict often face difficulties getting transportation. Many are likely delivering at home with traditional birth attendants who have had no formal training, in an environment that may not be safe. Many maternal and neonatal deaths around the world will likely never be counted, precisely because women never made it to a health facility.  

    Supply chain breaks affect much more than PPE. Many countries face shortages of critical products. Costs increase due to scarcity and rising shipping charges, making sexual and reproductive healthcare products and services even harder to access for poor women and mothers, which could result in more maternal deaths in the field. 

    Stories from the field: Protecting reproductive health in a pandemic 

    At the start of the pandemic, Doctors Without Borders/Médecins Sans Frontières (MSF) doctor Andrew Dimitri flew to southeast Asia. “We had to determine how field workers could protect both the people we provide care for, and our staff.” 

    People living in places like the Tondo slums in Manila are at particular risk. “There’s high population density and poor conditions, with little clean water or toilets,” says Dr. Dimitri. Malnutrition can be a problem too. “A lot of the things we take for granted in terms of hygiene are just not possible. And there’s very little opportunity for social distancing: sometimes a whole family lives in a single small room.” 

    Through information sessions, Dr. Dimitri helped to train staff in how to screen and diagnose people thought to have COVID-19, safely transfer those found positive to local health authorities, and protect themselves with personal protective equipment and hygiene procedures.

    Reproductive health in Southeast Asia and the Pacific 

    In countries like Thailand, Malaysia, the Philippines, Indonesia, Bangladesh, Hong Kong, Myanmar and many others, providing reproductive healthcare and services can be critical and life-saving work, not only for mothers, but also for children and adolescents.   

    Screening for cervical cancer in the Philippines 

    Cancers are epidemics in their own category. Data showed that 12 women were dying of cervical cancer every day in the Philippines. In 2015, the Department of Health stepped up its efforts to combat cervical cancer, giving priority to patients in the country’s poorest regions. Though health policy integrated the HPV vaccination into the national programme, older women were still at risk, as the vaccine did not exist when they were teenagers and they are far more likely to contract the disease. 

    22-year-old Rosalita, who has two children, receives family planning advice with an MSF health information officer in the Tondo neighbourhood of Manila, Philippines. © Melanie Wenger

    22-year-old Rosalita, who has two children, receives family planning advice with an MSF health information officer in the Tondo neighbourhood of Manila, Philippines. © Melanie Wenger

    An assessment by Doctors Without Borders/Médecins Sans Frontières (MSF) confirmed the need for sexual and reproductive health services in Tondo, one of the most densely populated and impoverished locations in Manila, capital of the Philippines.  

    From 2016 to 2020, Doctors Without Borders/Médecins Sans Frontières (MSF) had a partnership with local non-government organisation Likhaan, to support a clinic providing screening for cervical cancer and cryotherapy alongside other sexual and reproductive health services. MSF field workers worked with Likhaan to provide information on cervical cancer, and gave consultations and free treatment. Routine screening takes only three minutes. Patients with precancerous cells were immediately treated with cryotherapy. Those suspected of being at a more advanced stage of the disease are referred to hospital for diagnosis. The field workers provided information and assistance to every patient at every stage of the process. 

    Since 2016, workers at the clinic screened more than 9,300 women, including 6,400 who were being screened for the first time. The first round of vaccinations was launched in February 2017. Over 25,000 young girls aged 9 to 13 received the vaccine.

    Patient stories: Saving girls from cancer 

    “We see them on TV, those who die young because of a cancer in the uterus,” Mary Jane explains, her daughters and her niece beside her. Together with 325,000 other people, she lives among the slums of Tondo, Manila.  

    Vaccination offers many advantages. By giving girls between the ages of 9 and 13 a one-off set of two jabs, the odds of them contracting cervical cancer will be vastly reduced.  

    Mary Jane sent her daughter to be vaccinated. Her niece went, too. Since they have information about the deadly disease, the immunisation should be less daunting the second time around.  

    Providing reproductive health services for refugees and irregular migrants in Malaysia

    In Malaysia, Doctors Without Borders/Médecins Sans Frontières (MSF) started its project in 2016, with mobile clinics in partnership with a local organization. Towards the end of 2018, field workers opened an outpatient clinic in Butterworth, Penang.

    In 2020, Doctors Without Borders/Médecins Sans Frontières (MSF) field workers saw that there was an urgent need for antenatal and postnatal care for women refugees and irregular migrants in Penang, Malaysia. While the outpatient refugee clinic sees around 40 to 50 patients each day, since September there has been a rise in antenatal consultations.  

    We work with the regional ministry of health in Penang, Malaysia, to provide undisrupted antenatal and postnatal care for women refugees and irregular migrants. A midwife comes in once a week to provide antenatal classes for pregnant women and mothers, and field workers provide counselling and family planning assistance. Our clinic in Penang, Malaysia, has integrated sexual and gender-based violence (SGVB) care as well as mental health counselling services, coordinating with the ministry of health for referrals. Each SGVB case has a designated MSF case worker who will support them and provide assistance during appointments.  

    In September 2020 alone, health workers at the clinic in Malaysia saw around 200 to 250 women for antenatal and postnatal care. 

    Supporting adolescent and maternal health in Indonesia  

    In Indonesia, Doctors Without Borders/Médecins Sans Frontières (MSF) is known as Dokter Lintas Batas.  

    Since February 2018, field workers have been in Pandeglang District for an Adolescent Health Project, and we work in collaboration with the Indonesia Ministry of Health. The adolescent health programmes in Jakarta province and Pandeglang district, Banten province, Indonesia, focus on activities that continuously improve the quality and availability of health services for adolescents, helping them understand the changes in their bodies, thoughts and feelings. Field workers also work to provide ante- and postnatal information and care for pregnant girls and young mothers, by building connections between local communities, schools and health service providers.  

    Doctors Without Borders/Médecins Sans Frontières (MSF) activities in Indonesia include supporting local health centre workers to run interventions for adolescent health and strengthens capacity through mentorship and training sessions. Field workers are also deployed to run health information activities and education sessions for teens and parents in their villages or in the education centre called Saung Rhino Youth Corner in Banten, Indonesia. 

    When multiple disasters struck Indonesia in 2018, including the Sunda Strait tsunami, maternal health consultations and services were among those we work to provide in the field, to the people who fled their homes or were trapped in far-flung villages.  

    In 2019, MSF provided 75 information and counselling sessions, 5,161 patient consultations in adolescent healthcare services, and ante- and postnatal consultations with 297 pregnant adolescents.  

    Elis was seven months pregnant when the Sunda Strait tsunami hit Indonesia.  MSF staff at the Labuan health centre provided medical care for her and her baby. © Cici Riesmasari/MSF

    Elis was seven months pregnant when the Sunda Strait tsunami hit Indonesia.  MSF staff at the Labuan health centre provided medical care for her and her baby. © Cici Riesmasari/MSF

    This MSF midwife is dressing the wounds of a 2018 tsunami survivor in the shelter. © Cici Riesmasari/MSF

    This MSF midwife is dressing the wounds of a 2018 tsunami survivor in the shelter. © Cici Riesmasari/MSF

    Patient stories: Protecting the pregnant  

    “I was taking a bath when the tsunami hit,” said Elis, talking about the day the tsunami hit the coast of Sunda Strait in December 2018. She was seven months pregnant. 

    When the first wave hit, Elis’ husband, Purwanto cried out: “Tsunami! Tsunami!” He shouted a warning to Elis and rushed to their daughter and his in-laws, who were next door. 

    “When my husband shouted, I put on my clothes as fast as I could. When he was going back inside the house to help me, the second and bigger wave hit our house,” she explained. “I tried hard to protect my pregnant belly. I could not see my daughter. I could not see my mom and dad. What I heard was my husband’s voice calling me.”  

    Elis and Purwanto walked two kilometers to the health centre in Labuan. Along the way, they met a man on a motorbike who offered them a ride to the centre. There, they saw a lot of people who were injured like them and awaiting treatment. 

    The MSF field workers that attended Elis ensured her medical care. “I met Ibu Dina, the MSF midwife, and Doctor Santi at the Labuan Health Center on Sunday,” Elis remembered. “They checked my condition and that of the baby. I had bruises with some swelling almost all over my body. But thanks to God, my baby is okay,” she said with a smile.