The Second Congo War in the Democratic Republic of Congo (DRC) officially ended in 2003. Yet even more women are dying from complications of pregnancy and childbirth now than they were then. New survey results reveal maternal mortality in the DRC was higher during 2007-2014 than it was during 2003-2007, despite the country enduring war from 1996-2003. Why is this happening, and what can it tell us about women’s health in areas of conflict?

The DRC has faced war and insurgency conflict since the 1990s. While the Second Congo War officially ended in 2003, ongoing insurgency violence from dozens of national and international rebel groups has continued through the present day. Traditionally, war can cause increased maternal (and non-maternal) mortality due to social and economic disturbances, including “disruption of health services, poor food security, deterioration of infrastructure and population displacement.” However, the DRC is still facing these issues in a time not formally characterized as one of war.

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This increase in maternal mortality rates is highlighted by new Demographic and Health Survey (DHS) results that were recently released for the DRC. The DHS findings show regressions in family planning and reproductive health, particularly in the area of maternal mortality. The 2014 report shows that maternal mortality increased to 846 deaths per 100,000 live births (compared to 549 deaths per 100,000 live births in the 2007 report), and that 35 percent of all female deaths in the DRC were attributed to maternal causes (up from 19 percent in the 2007 report). These developments stand in contrast to overall improvements in reproductive health in many other countries in sub-Saharan Africa, where regional maternal mortality has decreased by over 40 percent over a period of 20 years (from 1990-2010). While there are a variety of factors that contribute to rising maternal mortality, one of the most likely causes is the DRC’s ongoing conflict.

The 2007 maternal mortality numbers reflect the impact of war and slow post-conflict recovery, while the 2014 numbers reflect a continuation of violence outside of the realm of what is traditionally called a “war.” Traditional wars are those with clear starting and end points, and clear enemies that are recognized as combatants. However, despite a massive uptick in violence in the DRC in recent years, there has been no official declaration of war. The violence includes fighting among various armed militias and government troops that have caused 100,000 civilians in the Northern DRC to flee their homes in 2012, and 7,075 cases of sexual violence in the same year, much of which primarily targeted women and children and directly involved armed insurgents. These incidences, along with the DHS findings, demonstrate the striking impact of insurgency violence on a country not “technically” at war, and highlight the changing nature of conflict and its effects on all areas of civilian life.

Changing conflict styles are not only concerning from a state military and security perspective, but also warrant broader humanitarian and development considerations.  The rise in maternal mortality illustrates just one of the many ways that the Congolese are clearly feeling the impacts of this insurgency—in some ways even more strongly than during the First and Second Congo Wars. Furthermore, women and children are disproportionately negatively affected by conflict, especially insurgency. This disproportionate impact is highlighted by the DHS maternal mortality numbers, as well as the increasing, rampant sexual violence in the DRC.

Policymakers and aid organizations need to recognize the broad and long-term impacts that both traditional and non-traditional conflict have on the health and rights of women. Strong and peaceful post-conflict societies are only truly realized if women are guaranteed safety and security, access to reproductive healthcare, and protection of their rights.