Indigenous women in the Republic of Congo, better known as pygmies - a minority group threatened with extinction - are virtually excluded from reproductive health services. They mostly give birth at home and are exposed to related health risks, according to a 2012 study conducted by the Ministry of Health with support from the UN Population Fund (UNFPA).
The study, Determinants of the Use of Reproductive Health Services by Indigenous Peoples, was conducted in four regions of Congo - Likouala, Sangha, Plateaux and Lekoumou - where most of the 43,500 indigenous people live.
In terms of reproductive health, "the numbers are not encouraging" for indigenous women, UNFPA representative David Lawson told IRIN.
"While 94 percent of the general population gets antenatal care, only 37 percent of pregnant aboriginal women receive such services; and while 93 percent of Congolese women usually give birth in a health centre, only 4 percent of indigenous women do so,'' said Lawson, citing the study.
"The risks are enormous for indigenous women because they do not receive emergency care at birth," he added.
According to the same study, at least 45 percent of Congolese women use contraceptive methods, while only 25 percent of indigenous people do so, "because of a lack of access to family planning".
Also, 50 percent of indigenous people said they were not getting any information on HIV/AIDS (the country has an HIV prevalence rate of 3.2 percent), while studies show that 99 percent of Congolese are getting information on the epidemic and prevention methods.
Why the gap?
There are several reasons for this gap.
"Pygmy women, like men, move around and often live in the bush far from health centres, in the provinces,” said the country’s director-general of health, Alexis Elira Dokekias.
"In order not to disrupt their way of life, we send health services to these populations. In Lekoumou, where their concentration is very high, we decided that health care is free," he said.
The indigenous people’s customs, extreme poverty, low education levels and traditional beliefs help explain why they are on the fringes of the health system.
"Generally, indigenous women give birth in the forest without the assistance of a midwife. They consider their traditional medicine there to be the best in the world," ethnologist Sorel Eta told IRIN.
"Their medicine has no adverse consequences, contrary to what one might think. You must accept the pygmies as they are and respect their expertise," said Eta.
"Instead, there should be a comprehensive approach that allows indigenous peoples to preserve traditional medicine in reproductive health, but also to enjoy the benefits of modern medicine," David Lawson advised.
Aboriginal people make up 2 percent of the population, as opposed to 10 percent a few years ago. In 2011 the country enacted a law on the “promotion and protection of their rights”. But NGOs are demanding better implementation of the law to counter - however slightly - the discrimination they face.