Global instability and the refugee crisis have combined to undermine the security of women’s sexual health and reproductive rights, according to the vice-president of the NGO Gynocology Without Borders (GSF).
Doctor Richard Beddock is the Vice-President of the NGO Gynaecology Without Borders, which has defended women’s health in developing countries since 1995.
Improving maternal and reproductive health was one of the Millennium Development Goals that expired in 2015. Do you think enough progress has been made on this issue?
The Millennium Development Goals (MDGs) allowed us to speed up progress on maternal and reproductive health issues, which had never happened before.
We have to remember the advances that were made possible by this framework: reducing maternal mortality by half and cutting infant mortality. But the objective of reducing maternal mortality by three quarters was not achieved, and the assessment of the MDGs revealed that the situation is still very worrying.
Improvements to maternal health have achieved more slowly than some of the other development goals. How can the speed of progress be increased?
There are lots of areas that require our action, none more so than the position of women in the world. For example, access to school education, healthcare and information on sexual and reproductive health needs to be improved.
For this to happen, girls need to stay in school until a certain age, so early and forced marriages need to be banned. Societal and political systems need to be improved, but this is outside the realm of medicine.
Secondly, we need to build a system that allows women to choose when they become pregnant and that gives them access to a certain level of healthcare during pregnancy and the option of a professional, medical abortion.
Finally, women should be accompanied by a qualified person during childbirth. One in four women today gives birth without the assistance of a midwife.
Most developing countries are a long way off having this kind of supportive political and medical framework. How do you intervene in these instances?
We visit health facilities in developing countries, mainly in Africa and Asia, but also in Europe, and help improve them.
We do not try to replace the system, but to train the local medical personnel to provide adequate care and pass on their training.
In Burundi, we carried out a mission for several years in Rema hospital. [60% of births in Burundi are not attended by qualified personnel and the maternal mortality rate is 800 deaths per 100,000 births. In France the rate is 8 per 100,000].
We provided training in emergency obstetric and neonatal care for surgical staff and for nurses. But the support we bring can only exist if the local demand is there, and we have no control over this.
We have also trained medical personnel to repair fistulas, a trauma often linked to childbirth in developing countries. This opening between the bladder and the vagina is typically a sign of a difficult birth. It often leads to the death of the child and if untreated, can leave women with permanent bladder weakness.
Thanks to a good, trusting relationship, we were able to do a really good job in this hospital. But the current political chaos in Burundi put an end to our mission. [Burundi’s President Pierre Nkurunziza decided to run for an unconstitutional third mandate, plunging the country into instability].
Have you been forced to suspend GSF missions in many countries?
We are only a small NGO, so we don’t go to areas where our staff might be put in danger. There are many countries where we have run missions in the past, like Haiti, but where we have been forced to call off our action due to the security situation. We were also present in the Za’atari refugee camp in Jordan, but there too, the deteriorating situation has meant we had to put an end to our mission.
Work on maternal and reproductive health is often held back by certain countries’ opposition to abortion. How do you manage to raise funds without government support?
Our guiding principle is not to impose our own principles. Not to present ourselves as an NGO that promotes abortion, but as an NGO that helps women through childbirth.
At our level, finding financing for missions can be difficult. We receive a lot of our finances from institutions and donors. When we ask for institutional support, it goes without saying that that institution should support our aims.
In Jordan, when we cared for the Syrians at Al Zaatari, we had funding from the French foreign affairs budget, so there were no constraints on who we could treat.
You mentioned your action at the Za’atari camp. How do you look after women’s maternal health along the migration route to Europe, which increasing numbers of women are taking?
In a crisis situation, the worst-affected victims are always the weakest: the women and children. Female migrants find themselves in an impossibly vulnerable situation.
We are unable to help women with childbirth along the migration route. The situation is just too precarious. And we also have to deal with the language barrier. So we have concentrated our action in Calais and other villages in the North of France.
Since last November, we have been providing women in Calais with gynaecological and obstetric care, providing relief for the northern French hospitals, which are completely overwhelmed.
The situation in Calais is very difficult, because we have been reduced to caring for women right down in the mud. They are mostly young women that take to the migrant route. But they are no better off in Calais than they were in Jordan.
We are very troubled by the absence of public funding. The politicians ignore the situation on the ground. When we arrive at the camps with our staff and our equipment, it is very clear that there is a dire need for greater care.
We have no institutional funding for Calais, we rely on the French National College of Gynaecologists and Obstetricians and on private finances to support our work.