Monday, July 29, 2019 | News

When ‘women don’t really have a say over their bodies’

Ipas Democratic Republic of the Congo (DRC) Country Representative Patrick Djemo on making progress for women and girls

As the Country Representative for Ipas Democratic Republic of the Congo (DRC), Patrick Djemo is a strong advocate for women’s and girls’ sexual and reproductive health and rights. But he wasn’t always that way. A doctor by training, Djemo says he didn’t put much emphasis on abortion in his clinic practice, “until I came across some situations that really made me think twice about my approach.”

Ipas DRC Country Representative Patrick Djemo

Djemo studied medicine at the DRC’s University of Lubumbashi, then moved to Zambia, where he worked as a doctor for eight years before joining Ipas Zambia in 2011. He held several positions—health systems advisor, senior health systems advisor, program manager and interim country director—before becoming program manager for the Ipas Francophone office. In
2018, he became the country representative for the newly established Ipas DRC program.

Below, Djemo shares why he supports sexual and reproductive health and rights (SRHR), how the colonial-era penal code continues to punish people who have or provide abortions, and the strategy behind a major policy victory.

‘This is the solution I’ve been looking for’

Djemo was working at a hospital in Lusaka, Zambia, when a feverish woman arrived. “When we asked about her sickness, she talked about a lot of things—but we never thought [they were] complications of abortion.”

She received treatment but didn’t improve. The next day, she shared that she was separated with her husband and became pregnant with someone else. She had tried to end the pregnancy by inserting leaves and roots into her vagina—a common practice in the area. While Djemo was preparing to give her postabortion care, she died.

“That’s a case that has always been on my mind,” he said. “She had three kids. I started thinking about it—what could have been done to prevent her death from happening?”

Though Zambian law permits abortion for social and economic reasons, abortion-related maternal mortality and stigma remained high. To combat this, the Minister of Health invited Ipas Africa Alliance to conduct a strategic assessment on abortion and contraception, followed by operations research on introducing medical abortion to the public health sector. That research was eventually scaled up, and the Ipas Zambia program was launched in 2011.

A few months after the patient came to Djemo’s clinic, staff from the Ipas Zambia office visited the facility. Djemo participated in a values clarification and attitude transformation (VCAT) training, and “it really worked for me. Every single day at the hospital, I saw four or five young girls with complications of abortions. I had started asking myself questions and collecting data. Everything built up into Ipas coming, and that was the day I said, ‘This is the solution I’ve been looking for.’” And that’s how Djemo became a staunch advocate for women’s sexual and reproductive health and rights.

A policy win: We had to ‘make things move for women’

Djemo helped secure a policy victory before the Ipas DRC office even opened. The Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa—an international treaty also known as the Maputo Protocol—requires signatory states to protect women’s reproductive rights by authorizing legal access to abortion. In the DRC, international treaties ratified by the government supersede national laws—but only once treaties are published in the nation’s legal gazette. The DRC’s penal code criminalizes abortion and contraception, so implementing the Maputo Protocol—which had already been ratified, in 2008—was critical to advancing women’s and girls’ rights.

Ipas and partners worked with several ministries—including health and gender—plus the national police force, judges, civil society organizations and professional associations, to show the problems caused by legal restrictions on abortion and contraception. “We presented the information in such a way that people realized the solution was the Maputo Protocol,” Djemo said. “We had to think about the situation and make things move for women.”

The Maputo Protocol was published in March 2018. Women can now legally access abortion in cases of sexual assault, rape or incest, and when a continued pregnancy would endanger the mental and physical health of the woman or the life of the woman or the fetus.

SRHR in the DRC: ‘You still find people who are in prison for abortion’

While contraception is available, often in areas supported by non-governmental organizations, supplies are frequently out of stock and information is scarce. And there are many “cultural, religious and traditional issues around contraception. DRC’s society is highly conservative, and women don’t really have a say over their bodies. They are told that they don’t own their bodies—that their bodies are owned by men. That’s a very big challenge: trying to reverse those cultural and religious beliefs around the role and position of a woman or girl.”

Abortion is stigmatized in the DRC, and though the criminal code is not often enforced, “you still find people who are in prison for abortion,” Djemo said. “We may not find a decision from the court that sentences someone on the basis of the law, but arrests are being made. People are being kept in custody, awaiting judgement—and they may be there for years before a judgment is passed or before they are acquitted or sentenced.” After last year’s publication of the Maputo Protocol, Ipas and other organizations in the DRC are interested in whether the criminal justice chain—from arrest to prosecution to court decisions—has started to consider the protocol in decisions around possible abortion-related arrests.

Looking ahead

“The DRC can almost feel like a continent,” Djemo said. “It’s a big country with a lot of challenges, and women and girls are disproportionately affected by everything which is going on.” Djemo described how he gets “emotional at the state in which most health facilities are found. There’s an advanced level of dilapidation; it’s really, really dilapidated, the health-care system.”

To achieve progress, “there’s a lot that needs to be done: community engagement, working on police harassment of providers, lowering costs, increasing access to information.” But Djemo feels hopeful; noting that it’s becoming more accepted for women to stand up and say, “‘I’m going to the clinic to get an abortion. I’m going to get contraceptive pills.’”

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