The Reproductive Health Crisis in the Southern Kordofan Region of Sudan

In 2011, South Sudan, led by the Sudan People’s Liberation Movement (“SPLM”), voted to break from Sudan.[1] The vote for independence came after many years of civil war between the northern and southern regions of Sudan, driven by religious and ethnic divisions.[2] The northern regions of Sudan were predominantly Arab Muslim, whereas the southern regions of Sudan were predominantly black Christian.[3] The Sudanese government was controlled by the north and civil war broke out originally in 1983 in response to the government’s attempt to institute Islamic law over the south.[4] In January 2005, the leader of the southern Sudanese regions signed a peace agreement with the Sudanese president, which ended the more than 20 years of ethnic and religious conflict.[5] The vote for independence in 2011 was the result of the 6-years peace process that followed the peace agreement of 2005.

Following the vote for independence in 2011, war broke out again between the Sudanese government and the now-independent South Sudan. South Sudan is ruled by the armed wing of the Sudan People’s Liberation Movement-North rebel forces, a spin-off group of the original SPLM.[6] War has raged between Sudan and SPLM-North rebel forces for the past six years, predominantly in the Southern Kordofan region of Sudan, which is held by the SPLM-North rebels.[7]

[8]

The women and girls living in Southern Kordofan, and other rebel-held regions of Sudan, have endured the most devastating consequences of living in a war-torn country and are facing a humanitarian crisis because they have little to no access to reproductive healthcare. In 2011, the Sudanese government instituted a ban on international aid into the country, including United Nations agencies and other international non-government organizations.[9] With the ban on international aid in place, a UN-coordinated humanitarian response has not been undertaken and the few humanitarian aid workers in the regions have minimal resources at their disposal to effectuate any meaningful relief.[10] Beginning in mid-2014, the Sudanese government led a series of targeted bombings of hospitals and other facilities used for humanitarian services.[11] These targeted bombings shut down two major facilities that provided emergency obstetrics care and contraception.[12] Now, there remain only five doctors for as many as 900,000 people and two functioning hospitals.[13] For most people in the rebel-held regions, these hospitals can take up to a two-day journey to reach.[14] There are no ambulances and few civilian cars.

As a result of the actions by the Sudanese government and the SPLM-North rebel forces, women have little to no access to prenatal care[15], contraceptives, emergency obstetrics care, and family planning and education services. During pregnancy, women have no access to necessary prenatal vitamins to ensure proper development of their unborn child.[16] To give birth, most women have to rely on either local birth attendants with little to no training or on trained midwives with no proper equipment.[17] When women experience complications during labor, they have no access to local emergency obstetrics care and their only option is to travel many hours by motorcycle, being held by two men.[18] Consequently, the maternal mortality rate in Southern Kordofan has grown alarmingly. Whereas in the rest of Sudan, maternal mortality rates have dropped considerably from 744 per 10,000 live births in 1990 to 311 per 10,000 live births in 2015, in Southern Kordofan and other rebel-held regions, maternal mortality rates have jumped to 503 per 10,000 live births.[19]

Women in Southern Kordofan expressed a desire to space out the number and timing of their children out of deep concerns about food shortages and health risks For the women in these regions, there is no option for them to space out the number and timing of their children, despite many of their expressed concerns about food shortages and health risks, because they have no access to family planning education and services.[20] However, access to family planning education and contraception in Southern Kordofan is largely unavailable.[21] While a few facilities provide a three-month oral contraceptive, heavy restrictions are in place that require women to seek their husband’s permission.[22] No facilities distribute condoms. In fact, most of the 90 women interviewed in Southern Kordofan by the Human Rights Watch researchers had no knowledge of condoms.[23] As such, women have no protection against sexually transmitted diseases or unwanted pregnancies. Cases of gonorrhea and syphilis have risen considerably, with one facility reporting that cases of gonorrhea had increased from 39 in 2013 to 896 in 2016.[24]

The crisis in Southern Kordofan is a humanitarian crisis and the human rights of these women are being violated every day that they lack adequate access to reproductive health care. While Sudan is not a state party to the Convention on the Elimination of All Forms of Discrimination Against Women (“CEDAW”), the convention still provides a robust body of law that illustrates certain recognized rights guaranteed to women. With respect to reproductive rights, CEDAW requires that women have access to health care services, including those related to family planning, adequate nutrition, and prenatal care.[25] Moreover, a woman must have the right to freely decide the number and spacing of her children.[26] CEDAW devotes considerable attention to protecting reproductive rights of women because reproduction constitutes an intimate and unique aspect of the female identity. But above all, reproductive rights are inextricably intertwined with a woman’s right to life, which is a fundamental, non-derogable human right.[27]

Even though Sudan is not a state party to CEDAW, the convention is still persuasive authority as to the rights that Sudan should to be providing for the women in its country. As an internationally accepted treaty with over 165 state parties, the rights protected in CEDAW represent rights overwhelmingly recognized worldwide as deserving protection. Without access to reproductive health care, the lives of the women in Southern Kordofan are threatened by the lack of protection against sexually transmitted diseases and emergency obstetrics care for complicated and dangerous pregnancies. The rise in maternal mortality rates and cases of STDs alone illustrates how catastrophic this reproductive health crisis has become.

In January 2017, President Obama issued an executive order temporarily lifting the economic sanctions on Sudan, citing its cooperation in counter-terrorism and its reduced fighting in conflict zones.[28] In October 2017, the U.S. State Department permanently end sanctions beginning October 12^th. Many human rights groups view this decision as premature, and rightly so. The reproductive health crisis in Southern Kordofan is not the first of its kind, nor, unfortunately, will it be the last. But it is a devastating reminder of how easily wartime governments can denigrate the rights of their most vulnerable populations with often little to no reprisal from the international community.

[1] South Sudan Profile – Overview, BBC, (April 27, 2016), http://www.bbc.com/news/world-africa-14019208.

[2] South Sudan Referendum: 99% Vote for Independence, BBC News, (Jan. 30, 2011) http://www.bbc.com/news/world-africa-12317927.

[3] Id.

[4] Historic Sudan Peace Accord Signed, CNN, (Jan. 9, 2005) http://www.cnn.com/2005/WORLD/africa/01/09/sudan.signing/.

[5] South Sudan Referendum, supra note 2.

[6] South Sudan Profile – Overview, supra note 1.

[7] Id.

[8]Africa Confidential, https://www.africa-confidential.com/browse-by-country/id/46/Sudan.

[9] Sara Pantuliano, Sudan’s Unfinished Business: Fighting in Southern Kordofan, The Guardian (August 25, 2011), https://www.theguardian.com/global-development/poverty-matters/2011/aug/25/sudan-unfinished-business-southern-kordofan.

[10] Human Rights Watch, supra note 4, at 2.

[11] Id.

[12] Id.

[13] Id.

[14] Id.

[15] Prenatal care is a type of preventative healthcare for women during pregnancy. Prenatal care is designed to decrease the risks during pregnancy to increase the chances of a safe and health delivery. Regular visits to the doctor to check the health of the mother and baby, ultrasounds to view the fetus, blood tests to check for anemia and glucose levels of the mother, and to check the weight and development of the fetus. Additionally, prenatal care includes taking folic acid and other supplemental vitamins designed to aid in the healthy development of the fetus.

[16] Id.

[17] Id.

[18] Id.

[19] Id.

[20] Id. at 4.

[21] Id.

[22] Id.

[23] Id.

[24] Id. at 55. Information received by the Human Rights Watch researchers via an email from the hospital director at Mother of Mercy Hospital.

[25] Convention on the Elimination of All Forms of Discrimination Against Women art. 12, opened for signature Dec. 18, 1979, http://www.ohchr.org/Documents/ProfessionalInterest/cedaw.pdf.

[26] Id. at art. 16.

[27] Universal Declaration of Human Rights art. 3, adopted Dec. 10, 1948, http://www.un.org/en/universal-declaration-human-rights/. A non-derogable right is a right that cannot be suspended by a state in any circumstance, even in a state of emergency. The Universal Declaration of Human Rights has listed the right to life as a non-derogable human right.

[28] Carol Morello, U.S. Lifts Sanctions on Sudan, Ending Two Decades of Embargo, The Washington Post (Oct. 6, 2017), https://www.washingtonpost.com/world/national-security/us-lifts-sanctions-on-sudan-ending-two-decades-of-embargo/2017/10/06/aac1bd22-86d5-434e-9a21-1e0d57a72cb0_story.html?utm_term=.114f405d79ff.