The Ebola outbreak in eastern Congo is the fastest-spreading on record, and it is hitting women with a particular cruelty: nearly every pregnancy touched by the virus ends in the death of the fetus. The tools to prevent those pregnancies exist and are cheap. A small portion of them are already bought and paid for, sitting in a warehouse in Belgium. The United States is spending close to a billion dollars fighting the outbreak. It is not shipping the contraceptives.
That is the complaint in a letter two US senators sent to Secretary of State Marco Rubio this week. Jeanne Shaheen, the ranking Democrat on the Senate Foreign Relations Committee, and Lisa Murkowski, a Republican from Alaska, are asking the State Department to do three things: release the $608 million Congress appropriated for international family planning in the current budget year, distribute $1.7 million worth of family planning supplies already purchased and stored in Geel, Belgium, which will otherwise be destroyed, and grant a humanitarian exemption so the UN Population Fund can run its reproductive health programs in the affected areas.
The numbers in the letter are stark. Ebola during pregnancy carries a nearly 100 percent fetal loss rate and a catastrophic risk of maternal death from hemorrhaging. In the affected region, an estimated 642,000 women are of reproductive age, and about 37,820 are pregnant. During the 2014-2016 West Africa Ebola outbreak, maternal mortality rose by roughly 75 percent, partly because pregnant women stayed away from clinics for fear of catching the virus there. That pattern is repeating, and the conflict in Ituri and North Kivu is making it worse: displacement, gender-based violence and survival sex are spreading the virus through a population already on the move.
The outbreak is outgrowing every precedent. Caused by the Bundibugyo strain of the Ebola virus, it has infected more than 3,300 people and killed more than 1,400 in the DRC, according to the US Centers for Disease Control and Prevention. It passed 1,000 confirmed cases within 40 days of the response being activated; the 2018 outbreak in North Kivu took about 235 days to reach that mark. It is now the third-largest Ebola outbreak ever recorded. Uganda, which absorbed cases from Congo, declared itself free of the disease on July 28. The DRC is far from done.
The senators’ argument is that family planning is not a side issue to the Ebola response; it is the response, for the women in the affected areas. Condoms block transmission. Contraceptives prevent the pregnancies that end in stillbirth or maternal death. Post-rape care addresses the sexual violence that is one of the outbreak’s engines. Anti-hemorrhage medicines treat the bleeding that kills mothers. The UNFPA is already working in 29 health zones in the DRC and in Uganda, so the money could move immediately, with no time spent building new systems.
The White House has not responded publicly to the letter. The request sits inside a familiar pattern: money appropriated by Congress, a response already costing close to $1 billion, and a gap where the administration’s policy meets the needs of the outbreak. The senators wrote that investment in voluntary family planning is fiscally rational in addition to being morally urgent.
The outbreak will end eventually. The question is how many of the 37,820 pregnant women are still standing when it does. The supplies are in Belgium. The money is in the budget. What is missing is the order to move them.