Conflict-zone contraception for the Boko Haram homeless
MAIDUGURI, Nigeria – Sixteen-year-old Aisha slips into the white family planning tent at the Bakassi camp for displaced people in Maiduguri, northeast Nigeria, and whispers in case she is overheard.
The teenager, among the hundreds of thousands of Nigerians who have sought sanctuary from Boko Haram Islamists in the region's biggest city, began taking a contraceptive pill 3 months ago.
Despite her tender years, she has seen death and cruelty up close, fleeing into exile through the hostile, arid bush.
But in the Bakassi camp, which is home to more than 21,000 people like her, she has to fight another type of attack.
"I have never been with a man before," she told Agence France-Presse, lowering her eyes. "But in the camp there are so many rapes, it happens all the time.
"One of my friends is pregnant because she was raped and I'm afraid it's going to happen to me."
Another woman tells how she heard a neighbor's cries ring out across the camp one night in June.
"Young boys came to her tent but nobody would come out to help her," she said. "People are scared, they think it's Boko Haram.
"There is too much trauma after what we've been through."
For the Hausa and Kanuri, the two main ethnic groups in the region, rape is taboo, said Alice Janvrin of the International Rescue Committee (IRC), which runs the family planning clinic.
She said that very few women admit it has happened for fear of being rejected, but added: "Women and girls tell us that sexual violence is pervasive... in and out of camps."
Many of those who turn up on their own at Bakassi have been separated from their families during attacks. The situation is hardly any better for those who arrive with their husbands.
The Boko Haram insurgency, which has killed at least 20,000 since 2009, has left more than 2.6 million people homeless and triggered a humanitarian crisis in Nigeria's northeast.
More than 5 million people are starving as the fighting has devastated farmland, leaving farmers unable to sow or cultivate crops for several years.
Janvrin, the IRC's reproductive health manager, said internally displaced people (IDPs) were also "extremely vulnerable to sexual abuse".
"Many of them exchange sexual services against food and there are much more STI (sexually transmitted infections), abortions or unwanted pregnancies," she added.
The IRC women's center in Bakassi was opened in September 2016 and includes a maternity unit and an obstetrics service, which is always packed.
Dozens of women with swollen bellies wait patiently on benches to be seen in the crushing heat of the midday sun.
According to the IRC, more than 1,000 women have adopted some form of contraception since January.
Similar operations have been set up elsewhere in Borno State, where there are also sizable numbers of displaced people.
Options include oral contraception, an implant under the skin or a hormone injection which lasts up to 3 months.
Fanne, a 20-year-old, said she had never heard of contraception before she arrived in Bakassi.
She already has two children and talks of "the stress of having children on and on" in an impoverished region which had poor access to health and education even before the insurgency.
"In the villages, some women give birth every year," Fanne said. "In the current situation, if I have more children, what will I give them to eat?"
Talatu, who is in her 30s and has had 5 pregnancies, said her husband had prohibited her from going to the clinic.
But she said she now felt relieved to be taking the pill. "Now I have time for myself. I needed to rest," she said.
Control over health
Rachel Sunday Okoye, a midwife, says many women come to the centre in secret, given the strong resistance to contraception among men.
"They feel like we don't want their women to reproduce. We try to make them understand that it's not the case. It's about planning for the next pregnancy," she said.
On Tuesday, July 11, international experts, policy makers and donors meet at a family planning conference in London to increase efforts for women to have access to contraception – and more control of their own future and health.
Conflict zones are seen as a priority.
In Bakassi, Aisha has just one thing on her mind: how to get back to studies the conflict forced her to abandon, so she can train to become a doctor.
"I have nothing to do here," she said. "Every day I come to sit at the clinic and watch the doctors. I'm trying to learn." – Rappler.com