One in seven women in South Sudan will die during pregnancy or childbirth, making the world’s newest country – and one of the poorest - the most dangerous place in the world to give birth. A 15 year old girl has a better chance of dying in childbirth than of finishing school. It is likely that statistics on maternal mortality in South Sudan don’t reflect the scope of the problem: a 2012 report by the Small Arms Survey, “Women’s Security in South Sudan: Threats in the Home” found that a national survey undertaken in 2006 may have underestimated the scope of maternal mortality in South Sudan, as many deaths may go unreported in a context where 90% of women give birth away from medical facilities and without the help of professionally trained assistants.
Since South Sudan’s independence a little over a year ago on 9 July 2011, South Sudan has remained high on the international community’s radar and continues to receive high levels of developmental aid. Discussions on security issues within South Sudan tend to dwell on militias and bombings by Sudan along the disputed border; paradoxically, women’s lives are threatened more by the risks posed by pregnancy and childbirth. These “risks” – the sorts of complications that may be rooted in malnutrition, conflict, sexual violence, inequalities in the household, and lack of access to medical services – are anything but natural and are the products of complex overlapping factors which determine which women live and die. Maternal mortality is a neglected tragedy, largely because those who suffer from it are neglected people with little power and influence over how national resources are allocated.
In the South Sudanese context, the state has functioned autonomously since only 2005 – and as an independent state for little over a year – and remains extremely reliant on donor money and oil. One of the issues is lack of access to medical services. The health sector in South Sudan was devastated by the end of the civil war, so lack of government capacity may be understandable to a certain extent.
According to UNFPA, South Sudan has just eight registered midwives and 150 community midwives. A UNFPA South Sudan report published in May established that midwives can prevent up to 90% of maternal deaths. However, for women that experience complications and are lucky enough to make it to a hospital, there may not be adequate medication or even the correct ones. For women that hemorrhage and may need a life-saving blood transfusion, there is only a small fridge in the corner of Juba Teaching Hospital. Speaking about maternal mortality, Chuol Kuma stated in a January 2012 interview with IRIN news that “the first cause of maternal mortality in our department is bleeding.” His colleague Wani Mena elaborated that for the hospital’s patients, “sometimes they bleed until they die and we cannot do anything about it.” South Sudan is reportedly in the process of building a bigger national blood bank.
Since 2005, an estimated $4 billion has been stolen through rampant corruption, leaving little money for social services. It doesn’t help matters that South Sudan’s oil pipelines (oil comprises 98% of South Sudan’s national budget) have been turned off since January 2012 following disputes with Sudan over transit fees, though a deal was brokered just days ago. Without making sweeping generalisations, research conducted in other contexts with quota systems for women in government has shown that female officials may be more likely to spend government money on social services. Despite South Sudan having a quota system for women in government, women are often sidelined from decision-making processes at a national level.
Of course all of these issues are compounded by poor health and inequalities at the community and household levels, as well as social factors that may encourage marriage at young ages in which the body may not be fully developed for childbirth, particularly for women who already may suffer from malnutrition. Food insecurity was compounded by a recent Sudanese blockade that has dramatically increased food prices. Sexual violence experienced in the South during the 22 year civil war may also be a significant factor in maternal mortality, particularly for women who may have fell pregnant and sought unsafe abortions. This is not withstanding many women being compelled to have large families during the civil war; the late Dr. John Garang urged the women of South Sudan to produce as many children as possible. Women themselves also may desire large families, particularly in the aftermath of displacement that may have dislocated families and where many lack immediate financial security. After all, the main asset of the poor is their bodies.
This is not to serve as an indictment of South Sudan’s government; it is likely that the most immediate levels of threat are rooted in household inequalities. It is more to conjecture that national processes and very real security threats are intimately intertwined with human security, and that for some – like South Sudan’s women – that may be a matter of life and death.
South Sudan, Women's Rights, Sexual Violence