When 16-year-old Esther* arrived at Panzi hospital in Bukavu, in the Democratic Republic of the Congo, doctors confirmed her worst fear: she was pregnant. Esther had been raped seven months earlier. Ostracized by her friends and family, she felt betrayed and alone. She said her pregnancy made her "feel dirty."
Around the world, unintended pregnancies - especially those resulting from rape or coercion - are often met with stigma and judgment, despite how common it is for women's reproductive choices to be denied. Almost half of all pregnancies globally are unintended, and research indicates rape-related pregnancies are just as common, if not more so, than those resulting from consensual sex.
Cases of rape-related pregnancies must be handled with particular care. Sexual violence is a human rights violation, and resultant pregnancies often exacerbate harm. Survivors need specialist support to avoid retraumatization.
Most existing health services are not designed or equipped to manage the devasting physical and psychological harm and economic fallout from sexual violence. Too often, health providers do not have access to the knowledge, training and resources necessary to support their patients' mental and physical wellbeing.
But at Panzi hospital, midwives are using a groundbreaking new birthing model to provide survivors the holistic support they need throughout pregnancy, childbirth and the postpartum period. The model, developed in 2020, matches midwives with women and girls to ensure continuity of care, encourage one-to-one connections, and empower survivors to be more in charge of their labour and delivery experiences.
Backed by multidisciplinary teams including psychologists and social workers, the model aims to foster positive birth experiences, boost women's self-confidence, promote attachments between mothers and babies, and aid transitions into motherhood.
"Before, it was very difficult. I did not know how to handle the situation [with a girl who has experienced sexual violence] going into labour and not wanting to give birth," said Odette Malebameka, a midwife at the Panzi hospital.
"Now, when a pregnant girl arrives, I know I can support her, and [I know] how to listen to her."
Supporting survivors
Gynaecological surgeon Dr. Denis Mukwege, who grew up in Bukavu, founded Panzi hospital in 1999. Over the past two decades, the hospital has gained global renown as a refuge for survivors of conflict-related gynaecological trauma and sexual violence. Dr. Mukwege won the Nobel Peace Prize in 2018.
The Democratic Republic of the Congo is afflicted by high levels of poverty, as nearly two thirds of its population lived on less than $2.15 a day in 2021. More than 100 armed groups compete for power and resources across the country, putting women and girls like Esther at risk. The UN reported that nearly one thousand cases of conflict-related sexual violence were committed in the country in 2021.
More than 430 women and babies have been served under the Panzi hospital's holistic birth model of care, and hospital officials hope that with further investment, the project can be scaled beyond the country's borders. UNFPA has been a supporter since November 2022.
Grace and reconciliation
On a humid night in May 2021, Esther went into labour. Over the two months since her first visit to Panzi hospital, she had become curious and excited about her baby. At eight months, she attended a birth preparation class with four other girls - new mothers like Esther can serve as mentors in these classes.
Additionally, she worked with a midwife to establish a specialized birth plan, which included her request that no male doctors or staff be nearby during the birth.
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When Esther went into labour, her midwife led her to a birthing room. As Esther had expressed concerns over vaginal examinations, the midwife put Esther in charge of guiding her hand during the procedure. Following six hours of labour - during which Esther's midwife stayed close, gave massages and encouraged Esther to try different labouring positions - Esther gave birth to a baby girl at 4 p.m. She named her daughter "Grace".
Even after Esther and Grace left Panzi Hospital, its impact on their story lives on. During Esther's pregnancy, staff from the hospital visited her family and began a reconciliation process with the aim of enabling Esther to return home. She has since done so - and an outreach team including the midwife from the hospital visited to provide mother and baby support.
*Names have been changed to protect identities.
