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Author: Kamala Baeni Jemima, Feminist, Activist & Public Health Professional

"I experienced eight years of amenorrhea, with no pain or bleeding, and only after these long years did my periods return. I started bleeding nonstop for two months, with the blood accompanied by clots," shares Furaha, a woman who inject drugs and mother of six children. After giving birth to her youngest child, Furaha began injecting drugs, trapped in a cycle of addiction. Like many women in similar situations, her journey illustrates the severe effects of injectable drugs on reproductive health. (Names have been changed to protect the privacy of those who shared their stories.)

Women who inject drugs in the Democratic Republic of Congo (DRC) face numerous health risks, including gynecological complications, obstetric risks, and an increased risk of contracting HIV. A combination of using contaminated syringes, exposure to sexual violence, and limited access to healthcare makes this population extremely vulnerable.

Injectable drugs disrupt the endocrine and reproductive systems of PWID, causing amenorrhea (absence of periods), irregular menstrual cycles, miscarriages, and high-risk pregnancies. The physiological stress caused by substance use, often coupled with poor nutrition, exacerbates hormonal imbalances, leading to a decline in overall reproductive health.

Yvette, a young woman who inject drugs from Goma, testifies:
"I had my first pregnancy at a young age, but my child passed away before reaching 1,000 days. Since then, I haven’t had a period in four years. I may look like a woman on the outside, but inside, there's nothing to distinguish me from a man."

The prolonged absence of menstruation is not only a physiological alteration—it also leads to psychological distress, reinforcing feelings of marginalization.

High-risk pregnancies are common among women who inject drugs, with outcomes often fatal due to inadequate care. Kavira, another woman who inject drugs, shared:
"I faced several miscarriage threats during my pregnancy, but without prenatal care or detox services, there was no way to protect myself or my baby."

The lack of appropriate healthcare services exposes these women to severe complications, such as postpartum hemorrhages, which are worsened by irregular drug use. As multiple women explain:
"We’ve seen friends lose their lives giving birth because they couldn’t access drugs after delivery. Without drugs, the bleeding becomes uncontrollable."

In the DRC, postpartum hemorrhages account for 38% of maternal deaths in North Kivu Province (North Kivu Ministry of Health, 2022). The absence of obstetric care and reliance on injectable substances exacerbates these deaths, creating an alarming situation for this population.

HIV poses one of the greatest threats to women who inject drugs. Sharing contaminated syringes and engaging in unprotected sex significantly increases their vulnerability to infection. According to UNAIDS, people who inject drugs are 35 times more likely to contract HIV than the general population.

Sexual violence further heightens  women's risk of HIV infection. A study revealed that women struggling with addiction are more frequently subjected to sexual violence, compounding their vulnerability to HIV (Global Fund, 2018). The lack of access to clean syringes and integrated healthcare services prevents effective care for this population.

The absence of preventive measures also exposes  women who inject drugs  to sexually transmitted infections (STIs). Despite these challenges, very few centers in the DRC provide harm reduction services, such as methadone treatment, syringe exchange programs, Prophylaxie Pré-Exposition (Prep) or antiretroviral (ARV) treatments.

Faced with this situation, Repro Justice Congo organizes educational discussions with young men and women who inject drugs to promote the use of self-locking and sterile syringes for preventing HIV transmission, raise awareness about condom use to prevent HIV and other sexually transmitted infections (STIs), combat sexual and gender-based violence (SGBV), and encourage access to Pre-Exposure Prophylaxis (PrEP), antiretroviral treatments, and reproductive health services.These initiatives aim to reduce the spread of HIV and improve access to harm reduction services. They also work to reduce stigma by involving women in awareness and psychosocial support programs.

The social exclusion and stigma faced by women who inject drugs  severely hinder their access to healthcare. However, the right to health is a fundamental right recognized by the constitution of DRC as well as  regional and international human rights instruments ratified by DRC.

The gynecological complications and HIV risks among PWID women in the DRC highlight the urgent need for an inclusive and adapted public health response. Their testimonies reveal a reality marked by inadequate care, stigma, and high mortality risks. However, with targeted community initiatives and increased political commitment, it is possible to break the cycle of exclusion and build a more inclusive society.