Despite danger and upheaval, midwives help women deliver safely at Burundi’s Musenyi refugee camp

Burunga Province, BURUNDI - "When I found out I was pregnant, I was very afraid because I knew giving birth was going to be dangerous for me," said 36-year-old Maombi Kijijwa.

A year earlier, Ms. Kijijwa, her husband and their 13 children had fled their home in eastern Democratic Republic of the Congo, following a midnight raid by armed militia in which many of their family and friends were killed. After an exhausting three-day journey on foot, the family crossed into Burundi and were relocated to the Musenyi refugee site.

Doctors had warned the couple that another pregnancy carried serious risks: Years of closely-spaced pregnancies had taken a heavy toll on her health, leaving her at risk of potentially life-threatening complications.

"My body felt tired, and I knew that if I kept having children like this, I could die," Ms. Kijijwa told UNFPA, the United Nations Population Fund, which is the UN's sexual and reproductive health agency.

"I was praying for a solution for me not to have any more children."

"I knew giving birth was going to be dangerous for me" - Ms. Kijijwa

Midwives can provide almost all essential sexual and reproductive health services, yet there is a shortage of at least 1 million of them; over half the gap is in Africa, which has some of the world's highest maternal death rates. In Burundi, maternal death rates have dropped over the past 30 years and are low for the region, yet much more can be done to invest in midwifery training and spread the message of their importance.

It was only late in her pregnancy when Ms. Kijijwa sought urgent medical attention at a UNFPA-supported health clinic at the Musenyi refugee camp. Midwife Aline Niyonkuru explained, "Some women arrive already in labour and with complications, because they are not yet aware that they should come for regular prenatal check-ups. But with community outreach and awareness, we believe this will improve."

Continued critical care

Just weeks later, Ms. Kijijwa went into labour - and midwives trained in emergency obstetric and newborn care were ready to assist.

"Our midwives ensure that services are available 24 hours a day for the many pregnant women living at this site," said Ms. Niyonkuru. "We also educate mothers about family planning after delivery, because many women here have multiple pregnancies without proper spacing."

On average, the clinic receives at least 15 women each week for childbirth. Some arrive with serious complications such as haemorrhaging, requiring urgent medical care. With the right medicine, equipment and training provided by UNFPA, with financial support from the Government of the Democratic Republic of the Congo, midwives are able to manage these obstetric emergencies.

"It was a very difficult labour, and I kept praying for my life and that of my baby," said Ms. Kijijwa. "The midwife encouraged me to push gently, and finally my baby was born. I am just happy that we both survived."

Her newborn son became the 100th safe birth at the Musenyi clinic - a reflection of the vital frontline role midwives have in ensuring reproductive health services for displaced women living in fragile conditions.

The importance of contraceptive choice

With counselling from the clinic's midwives, Ms. Kijijwa chose to start using family planning, to protect her health and be able to continue caring for her children.

"Now I speak to other men and religious leaders so they understand the importance of protecting women's health" - Mr. Salongo

Her husband, Mapenzi Salongo, explained that cultural and religious beliefs had stopped him from realizing the importance of spacing births - a misconception that has cost many women their lives.

"In the past, we did not believe in family planning," said Mr. Salongo. "I even lost my sister to excessive bleeding during childbirth. The doctor had told her that another pregnancy would not be safe, but we chose to ignore the advice."

But after witnessing the danger his wife was in and the care she received, he has changed his mind. "Now I speak to other men and religious leaders so they understand the importance of protecting women's health."

Essential frontline health workers

The ongoing conflict in the Democratic Republic of the Congo has displaced tens of thousands of people into neighbouring Burundi, which is already struggling with climate crises, food insecurity and influxes of refugees from other countries as well as returnees.

"If these health workers had not been here, I might have lost my wife" - Mr. Salongo.

UNFPA and partners are responding to the urgent needs of over 100,000 refugees living within the host communities in the Musenyi and Busuma displacement sites. Health workers are assisting safe births and providing consultations, obstetric ultrasounds and other essential reproductive health services for women and girls.

Midwives not only ensure safe pregnancies and save lives, they can also help to reduce unintended pregnancies, mother-to-child transmission of HIV, and unnecessary Caesarean sections, leading to healthier societies and communities.

"If these health workers had not been here, I might have lost my wife," said Mr. Salongo. "Today we are together and raising our children, and for that, we are deeply grateful."