Marguerite Kassa feared she would find herself alone in the small crowd of a dozen other pregnant women at the integrated health centre in Mossendjo, in the southwestern Republic of Congo.
"I am six months pregnant already, but I hesitated to come here before now, because there is so much contempt for us," the thirty-year-old indigenous woman tells IPS. "Yet I was warmly welcomed."
While around 80 percent of Congolese women give birth in health facilities, fewer than one in four indigenous women give birth at health centres.
In 2007, indigenous people in Congo numbered 43,500, just under two percent of the country's population of 3.7 million. To promote and protect their rights, a law was adopted in February 2011 which "forbids", in its first article, the usage of the appellation "pygmy". Article 22 of this law guarantees "access without discrimination" to health services for these populations.
According to the United Nations Population Fund (UNFPA), less than 20 percent of indigenous women in Congo visit a clinic even once during their pregnancy.
"They don't go because of discrimination. The staff treat them like objects," says Jean Nganga, president of the Association for Defence and Promotion of Indigenous Peoples, based in the Congolese capital, Brazzaville.
"The midwives leave us waiting, they laugh at us even before we reach the integrated health centre (CSI). This discourages us," explains Kassa.
In a survey conducted in April and May 2011, the Congolese Association for Health in Cuvette-Ouest, a non-governmental organisation based at Mbomo, in the north of the country, found that of 520 women of child-bearing age, only eight had given birth at a health centre.
"They tell us they don't have money to pay the consultation fee or for baby clothes," says Thomas Okoko, the head of the NGO.
"We see them pregnant, but we don't know where they give birth, because they don't turn up in our maternity wards," confirms Léonard Itoba, a doctor at the hospital in the northern town of Ouesso.
"I don't think that a lack of baby clothes is the real reason," says David Lawson, the UNFPA's representative in Congo. "These are snapshots of the demeaning stigmatisation which pushes them away from health facilities."
"Hostility towards indigenous women in the CSIs is what pushes them to give birth in the forest," agrees Roger Bouka Owoko, executive director of the Congolese Observatory for Human Rights, an NGO based in Brazzaville.
Community cares for its own
In Paris, a village some 60 kilometres from Ouesso, a traditional birth attendant says that on average she helps five or six indigenous women give birth each month.
"I am sometimes forced to use a razor blade to ease the birth of the child, because of the lack of antenatal care, these women have very small/constricted uteruses," she says.
"We still have confidence in our traditions," explains a sexagenarian woman in the village of Ngouha II, in the south of the country. "For example, when a woman is approaching full term, she no longer walks alone in the forest. And once the birth pains start, she knows what needs to be done: she has to sit down at the base of a tree."
Gyldas Ngoma-Mifoundou, a sociologist at the Université de Brazzaville tells IPS: "It's a question of culture, and there are many herbs which help indigenous women to give birth more easily."
Change beginning to be felt
To encourage more pygmy women to labour and give birth in the presence of a skilled attendant, the CSIs in two of the country's twelve administrative departments, Lékoumou in the south and Sangha in the north, have waived consultation fees for pre and post-natal checkups. "We have directed that not a single franc should be asked from a pregnant indigenous woman," Dr Marcel Elion, director for health for Sangha, tells IPS.
Supporting this initiative by the departmental directors, the UNFPA is supplying birth kits to indigenous women. "The bag has got baby clothes, medicine, gloves and syringes," says Philomène Ipande, an indigenous woman.
Angélique Bounda, 24, is a young indigenous woman who gave birth at the Dolisie Maternity Unit in the southwest of Congo-Brazzaville at the end of July. "I came in to be weighed [prenatal checks] here and I followed the advice of the midwife right until the delivery," she tells IPS with a smile.