Doctors Without Borders/Médecins Sans Frontières (MSF) delivers emergency care in more than 60 countries around the world. While we are not specifically a women's healthcare organization, most of our patients are women and children, and many of our waiting rooms and wards are full of pregnant women, women who are injured or ill, and women seeking care for their children.

Our staff sees mothers walk great distances in dangerous circumstances to make sure their children get vaccinations and treatment, and risk everything, including rejection by their husbands, to prevent transmitting HIV to their unborn babies.

These are remarkably strong women and they are anything but victims. Yet in spite of the huge burdens they shoulder, they rarely possess the power to decide when they themselves can get lifesaving care.

Dispatches, Spring 2019 : Women's Health in Crisis Zones

The Spring 2019 issue of Dispatches, the MSF Canada magazine, is focused on the topic of Women's Health.

While MSF is not just a women's health organization, we are a humanitarian one, and we seek to alleviate the suffering of people made vulnerable by conflict, disaster, disease and neglect. In many of the places where we work, those with the greatest needs are women and their children, who make up the majority of our patients and face disproportionate levels of risk in times of crisis.

As MSF Canada Executive Director Joe Belliveau writes in his introductory message to this issue of Dispatches, MSF's job is "to deliver essential care wherever it is most urgently needed around the world. Impartiality is one of our core values, which means we treat anyone who needs our help most — regardless of age, religion, ethnicity, gender or any other marker of identity. But in humanitarian crises, it is often women who bear the brunt of the suffering. In such situations, a women-centred medical response is not a violation of our principles; it is the essence of impartiality." 

Or, as his colleague Meinie Nicolai, former president of MSF Belgium, writes in her own essay in the magazine, "put simply, women have distinct health risks that men do not have, and these risks must be attended to."

"As an organization," she continues, "we look forward to the day when women the world over have access to the kind of medical care many of us in the developed world take for granted; to a future where no girl or woman has to die because she could not reach a hospital in time; and to the day when any of us can be confident of entering a remote rural hospital without seeing the body, shrouded on the floor, of a woman lost in childbirth."

International Women's Day 2019: Unsafe abortions are a forgotten emergency

March 8 is International Women's Day. Doctors Without Borders/Médecins Sans Frontières (MSF) delivers urgently needed humanitarian medical care to people around the world who have been made vulnerable by crisis, conflict, persecution or neglect. While we provide assistance to anyone in need, in most places we work the majority of our patients are women and their children, who often bear the brunt of suffering when humanitarian emergencies occur.

One of the most significant health risks faced by women in places with limited access to medical services is maternal mortality — pregnant women who die before or during childbirth as a result of complications.

The world has made significant progress on addressing four of the five main causes of maternal mortality: post-partum hemorrhage, sepsis, complications from delivery and hypertensive disorder. But unsafe abortion — the only almost completely preventable cause — has been largely forgotten.

More than 22,000 women die from unsafe abortions every year

Unsafe abortion still accounts for at least one in 12 maternal deaths globally. And, compared to reductions in all the other direct causes of maternal deaths since 1990 — severe bleeding, severe infection, blood pressure disorders and obstructed labour —there has been little improvement in the negative impact of unsafe abortion.

Unsafe abortion is a procedure for terminating an unwanted pregnancy either by persons lacking the necessary skills or in an environment lacking minimal medical standards or both, as defined by the World Health Organization. Abortion, whether safe or unsafe, is a common event worldwide: approximately one in four pregnancies ended in an induced abortion during the period between 2010 and 2014.

About 45 per cent of abortions globally are deemed unsafe, and more than 22,000 women and girls die each year after undertaking an unsafe abortion, says the Guttmacher Institute’s comprehensive report published in 2018.

When a woman or girl is determined to end her pregnancy she will do so, regardless of the safety and legality of the procedure. Where safe abortion care is not available, she will risk her life with an unsafe abortion, often because the prospect of continuing the pregnancy is unbearable.

About 97 per cent of unsafe abortions and related deaths occur in Africa, Latin America and southern and western Asia, all regions where Doctors Without Borders/Médecins Sans Frontières (MSF) offers medical assistance to people in need.

Meanwhile, the scale of post-abortion complications is enormous, with an estimated seven million women and girls admitted to hospital every year. Some will be permanently disabled, and some will never be able to carry a child again. Yet we will never know the full extent, because there are many women and girls who dare not, or cannot, access care.


'This devastating cost to the health and lives of women and girls is completely preventable': An MSF physician on the unacceptable risks of unsafe abortions

We need to do more for women dying from unsafe abortion. Dr. Claire Fotheringham, MSF's medical advisor for obstetrics and gynecology explains why this is an urgent humanitarian medical emergency:

"It was September 2011, and I was on my first assignment with MSF. Setting foot in the busy maternity hospital in West Africa, I was completely unprepared for what I found: women arriving on death’s door, with complications like heavy bleeding and septic shock. In the operating theatre, examining many of these women, I found trauma marks on the cervix, caused by objects such as sticks that had been inserted to terminate their pregnancies. Examples of unsafe abortion that had resulted in horrific injury."

"I realized the sheer desperation that must have driven these women to do this, and how limited their options must have been. They were willing to resort to any means to terminate their pregnancy, even while knowing the huge risk to their own life."

"Some of these women needed antibiotics or a tetanus injection for infection. Others required a blood transfusion for life-threatening bleeding, or major surgery to repair perforations to their bladder, bowel or abdomen, or to remove infected tissue caused by peritonitis or an abdominal abscess. Even if these initial complications could be rectified, I knew these women faced the danger of long-term impacts, including chronic pain, anaemia and infertility. Even if a woman simply didn’t want this one pregnancy, she may never be able to have children again."


International Women's Day 2018: Forcibly displaced

More women and girls than ever before are currently forcibly displaced — at last count an estimated 32 million worldwide. Some are still on the move.

Needing access to contraception, or a safe place to deliver their baby, support in the wake of sexual violence or to care for their own children, they are no different to any other woman or girl around the world.

But displaced, they have significantly greater health challenges, simply because they are women and girls.

In response, Doctors Without Borders/Médecins Sans Frontières (MSF) has scaled up its action to meet them on their way in places as diverse as Tanzania, Bangladesh and Greece—and many others.

Across the spectrum of their journeys, displaced women and girls urgently need care in five key areas: obstetric care, family planning, safe abortion care, sexual violence care and mental healthcare.

Only then can they have the chance to navigate their health as they search for safety — and reduce the ongoing risk of sickness, suffering and death.


Sexual violence in Haiti: A special MSF report

In Haiti, the number of young people, especially women and girls, who report experiencing sexual and gender-based violence (SGBV) is alarmingly high, especially in the densely populated capital Port-au-Prince.

Yet the issue is not widely discussed, and SGBV cases are likely underreported due to stigma and shame, as well as fear of reprisal from perpetrators or the community. At the same time, the services that are available for survivors, especially for minors (under the age of 18), are insufficient and inadequate.

In May 2015, Doctors Without Borders/Médecins Sans Frontières (MSF) opened the Pran Men’m clinic (Creole for "take my hand") in Port-au-Prince that specializes in providing medical and psychological care to survivors of SGBV. The vast majority of the more than 1,300 survivors of sexual violence who have been treated in the clinic are younger than 25 years, and more than half are minors. 

In July 2017, MSF released Against Their Will: Sexual and Gender-Based Violence Against Young People in Haiti, a report that sheds light on this difficult subject, details the impact of this violence, and calls for action on the provision of medical services for those affected.


Pregnant women in high risk during Hepatitis E outbreak in the Diffa region, Niger

In southeastern Niger, a hepatitis E outbreak has particularly affecting pregnant women. Of the 186 women admitted to the main maternal and pediatric health centre run by Doctors Without Borders/Médecins Sans Frontières (MSF) in the town of Diffa, Niger, 34 died of severe complications related to the disease. Of the 876 cases of hepatitis E reported on June 11, the majority are displaced people and refugees – an official number of 247,900 according to the authorities. As the disease spreads mainly through contaminated water, the current outbreak highlights poor water and sanitation conditions and the lack of adequate sanitation facilities as causes. These as consequences of the violence of the ongoing conflict between Boko Haram and the armies of the region.


International Women's Day 2017: 'No woman should die to give birth'

A special MSF digital publication celebrating the women of Afghanistan and highlighting the dangers they face in pregnancy and childbirth.

Afghanistan remains one of the most dangerous places in the world to give birth. Every year around 4,300 women will die due to a complication during pregnancy or childbirth. Childbirth without skilled attendance represents a major threat to the survival and wellbeing of Afghan women and their newborns.

For International Women's Day 2017, MSF has created a special online publication about the challenges facing women and young mothers in Afghanistan, looking at the hurdles many still face and the hope offered by emergency humanitarian medical care.

Other coverage of International Women's Day

'I wish she didn’t have to battle to survive': A Canadian MSF nurse on delivering care to refugee victims of sexual-based violence

Young woman lays on hospital bed

Courtney Bercan is a Canadian nurse who recently returned from working with MSF on-board the search-and-rescue vessel Dignity I in the Central Mediterranean. In an excerpt from a blog post she wrote last December,she describes meeting a young woman fleeing violence and poverty and the deep and lasting impact sexual and gender-based violence can have.

India: A new MSF project offers a ray of hope for victims of sexual and gender-based violence

A health worker speaks to a group of women

A new Doctors Without Borders/Médecins Sans Frontières (MSF) clinic in India gives refuge and care to victims of sexual and gender-based violence.Canadian project coordinator Marise Denault and her team have been networking and talking to the local community in order to increase awareness of the accessible, confidential and quality treatment that MSF provides.

There has been progress in the realm of women’s health. Between 1990 and 2010, there was a 45 per cent drop in maternal mortality worldwide, according to the World Health Organization. 

This is welcome news, to be sure. But in many countries where MSF works, a shocking number of women are still being lost. At present, 38 times as many women die in childbirth in Afghanistan as they do in the United Kingdom. Maternal mortality rates are 178 times higher in Central African Republic than in Japan, and 220 times higher in Chad than in Sweden.

At MSF medical projects around the world, we provide health services and emergency first aid, as we have always done. But we also build delivery rooms and spaces to treat survivors of sexual violence. Our female patients and their particular needs are not afterthoughts. They cannot be, because tomorrow needs them. 

As an organization, we look forward to the day when women the world over have access to the kind of medical care many of us in the developed world take for granted; to a future where no girl or woman has to die because she could not reach a hospital in time; and to the day when we can be confident of entering a remote rural hospital without seeing the body, shrouded on the floor, of a woman lost in childbirth.

'They want to go home with a healthy baby': A Canadian obstetrician helps MSF deliver maternal care in Pakistan

Canadian obstetrician Karthika Devarajan recently returned from helping MSF run a maternal health program at a remote hospital in northern Pakistan. She shared her experiences of providing care to women often forced to travel for hours to seek care for life-threatening birth complications. "As time went on, I started to trust that we had what we needed to do a good job. Most pregnant women are young and healthy. It was humbling to see that a basic OR and some essential drugs were all we really needed to save their lives. There were people we couldn’t save and situations that shocked me, but there were also so many things that went so much better than I could possibly have imagined. So many people who did so remarkably well despite all odds - and that put the final balance hugely into the positive. I cannot describe how powerful it was to know that each day really, truly meant something. I realized all over again what a gift my surgical training has been and I have a new appreciation for the immense freedom that has defined my own life."

Eyewitness: Hope and heartbreak at MSF's obstetrics hospital in Haiti

In the video above, Laura Puteris, a nurse from Toronto who worked at Doctors Without Borders/Médecins Sans Frontières (MSF)'s obstetrics hospital in Port-au-Prince, Haiti, describes the challenges of trying to save a pregnant mother and her unborn child following a tragic accident.


Sierra Leone: A Canadian nurse finds hope in a country with one of the worst maternal mortality rates in the world

Fifteen years after her last field posting with Doctors Without Borders/Médecins Sans Frontières (MSF), Canadian nurse Jane Little returned to the organization last February to work on a maternal and child health project in Sierra Leone. Below she recounts her experiences delivering healthcare in a post-Ebola context.


South Sudan: At Bentiu protection camp, women made more vulnerable by war 

Jaime Wah is a Canadian nurse who has worked overseas with MSF in conflict situations from Central African Republic to Democratic Republic of Congo, delivering medical care to people in need. She recently returned from South Sudan, where she worked at the MSF hospital in the United Nations' Protection of Civilians camp in Bentiu, which is home to more than 100,000 people who have been displaced by the country's violent and ongoing civil war. In the video above, she describes how armed fighters use sexual assault as a weapon, putting the health and lives of already vulnerable women already at even greater risk.

The Rose of Masisi: 'Maman Agathe' cares for women with high-risk pregnancies in Democratic Republic of Congo

Agathe Farini Sena, otherwise known as Maman Agathe, is a counsellor at the Village d’Accueil at the MSF-supported Masisi general hospital in North Kivu, Democratic Republic of Congo. Women with high-risk pregnancies stay at the facility as they wait to give birth; this way, when the time comes, they have access to high quality healthcare to ensure they give birth safely. Last year at the Masisi Hospital, the highly skilled MSF and Ministry of Health teams delivered more than 3000 babies, more than 900 of them to women staying at the Village d’Accueil.

A Canadian nurse on the challenges of treating sexual violence in conflict settings

Mariko Miller works with rape and sexual violence survivors in Vancouver. She recently returned from Bentiu, South Sudan, where she helped MSF deliver care to people displaced by conflict and violence — and saw first-hand the challenges of treating victims of sexual violence in a context where rape and assault are used as weapons of war.

Is Ebola a death sentence for pregnant women? Breaking new ground amid a health emergency

Meet Adama, a survivor who lost her child to Ebola but made her own unprecedented recovery at the height of the outbreak in West Africa. 

Return to Abuser: MSF report reveals cycle of abuse for survivors of family and sexual violence in Papua New Guinea

A new report from Doctors Without Borders/Médecins Sans Frontières (MSF) uncovers the gaps in services and systems trapping women and children in cycles of severe family and sexual violence in Papua New Guinea.

Return to Abuser details how a dire lack of protection mechanisms, a weak justice system and a culture of impunity endanger the health and lives of patients, even when they manage to reach medical care. The report includes comprehensive data from more than 3,000 survivors of family and sexual violence treated by MSF in 2014-15 in its two projects, one in rural Tari, in Hela Province, and the other in the capital city of Port Moresby. It reveals the repeated and often escalating violence that women and children endure in the places where they should be safest: in their homes and communities.

Stories from the MSF urgent obstetric hospital in Haiti

The MSF Centre de Référence en Urgence Obstétricales (CRUO), an emergency obstetric hospital in Port-au-Prince provides urgent care for pregnant women in Haiti facing dangerous or difficult complications during childbirth. The lack of available alternatives in the Haitian healthcare system means the hospital is overwhelmed with patients, and only those most at risk can be admitted.

Central African Republic: Amid ongoing conflict, treating victims of sexual violence

Médecins Sans Frontières/Doctors Without Borders (MSF) clinical psychologist Hélène Thomas recently helped open a medical and psychological support program for victims of sexual violence (VSV) at the general hospital in Bangui, the capital city of Central African Republic (CAR). She was in CAR between April and December 2014. Here she discusses some of the cases she saw during that time below.

Democratic Republic of Congo: Treating survivors of abduction, sexual slavery and torture

Women in some regions of Democratic Republic of Congo face ongoing threats of abduction and sexual violence. Some are assaulted several times a day, or are kept as sex slaves for months at a time. MSF is working to provide psychological and medical support to rape survivors. 

Thousands of people have fled their villages to escape the constant threat of abduction and violence. Seeking safety in numbers, most are staying with friends or relatives in small towns such as Nia Nia, whose population had at times almost doubled since the start of the year. People are arriving in Nia Nia with stories of the atrocities they have suffered or witnessed at the hands of various militia groups, including killings, torture and repeated rape. An MSF medical team has been working in the town since May 2014 to provide them with primary healthcare, emergency medical care and much-needed psychological support.