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Conference Proceedings 2000
Findings On Reproductive Health Of Refugees
And Displaced Populations
Washington DC | December 5-6, 2000
Reproductive Health for Refugees - Multi-Site Perspectives
| Moderator: Margaret Pollack, Bureau of Population,
Refugees and Migration, US Department of State |
Presentations:
| Carolyn Mansfield |
The complex impact of conflict on women's health |
| Daniel Pierotti |
The RH-Kit: A useful tool to implement reproductive
health services during an emergency |
| Michelle Hynes |
Reproductive health indicators of displaced persons
in post-emergency phase camps of humanitarian emergencies |
|
| The complex impact of conflict on women's health |
| Authors |
Manuel Carballo, International Centre for Migration
and Health (ICMH)
Carolyn Mansfield, International Centre for Migration
and Health (ICMH) |
| Presenter |
Carolyn Makinson |
| Background |
This presentation draws on 3 separate studies conducted
by ICMH that assessed a) the impact of siege on the health
of pregnant women in Sarajevo, b) the health and social
status of displaced people in Bosnia and c) sexual violence
in refugee camps. |
Purpose of study
or program |
The purpose of the 3 studies was to describe ways in
which conflict and displacement impacts on reproductive
health. |
Data collection
methods |
The 3 studies utilized varied methodologies. The survey
of pregnancy outcomes involved detailed analysis of health
records of women attending the Kosovo Clinic and Maternity
Hospital in Sarajevo from 1992-1995. The survey of the
health of displaced people in Bosnia involved a population-based,
nationally representative sample of over 5000 family units
in Bosnia-Herzegovina. The survey on sexual violence involved
extensive literature review, field interviews with NGO
staff in Tanzania, Cambodia and Bosnia, and focus group
discussions with refugee women in Cambodia and Tanzania. |
Study or
program findings |
Pregnancy Outcomes Among Displaced and Non-Displaced
Women in Bosnia and Herzegovina
- Available ob/gyn hospital beds reduced from pre-war
450 to 50; available operating rooms from 4 to 1;
estimated 60 senior staff members lost.
- Immediate reduction in the number of live births
from pre-war average of 10,000 per year to 2,000 per
year during the war.
- Abortion requests rose, averaging more than 2 abortions
for each pregnancy taken to term.
- Perinatal mortality rate rose from 15.3 per 1000
live births before the war to 38.6 after the war.
- Low birthweight (<2500 g) rate rose from 5.3
to 12.8.
- Frequency of congenital abnormalities involving
anacephalus or hydrocephalus rose from 0.37% to 3.0%
(until Feb. 1994)
Health & Social Status of Displaced People in Bosnia-Herzegovina
(Sarajevo, Tuzla, Zenica, Mostar)
- Only 17% of displaced women sought or were able
to access gynaecological care.
- Among displaced women, 11% aged 16 to 49 said that
they personally knew of a woman who had been sexually
tortured/abused/raped during the war; they reported
that 34% of the victims became pregnant as a result.
Of the women who were reported to be pregnant, 31%
were known to have interrupted their pregnancies and
9% were known to have taken them to term. 92% of the
sexual violence survivors were reported to have serious
psychological impairment.
- 3% of non-displaced women knew of someone who had
been sexually tortured/abused/raped.
Sexual Violence in Refugee Settings
- A longstanding historical "tradition" of rape during
conflict has been neglected and the concept of safe
havens has been exaggerated.
- Women face sexual violence during flight/transit
and in refugee camp settings. Women may be at
increased risk of politically motivated sexual violence
during the acute phase of conflicts, but face sexual
exploitation for goods or services once they reach
refugee camps.
- Variations in national legislation and local attitudes
towards rape and its sequelae are a problem. These
influence post-rape access to services and care in
refugee settings.
- While many aid agencies provide staff with reproductive
health training, there is limited training on sexual
violence prevention and treatment. Coordinated efforts
are also still weak.
- In Cambodia and Tanzania, interviewees indicated
a reluctance to report rape due to concerns about
confidentiality and a lack of confidence in the legal
system. Resorting to traditional mechanisms of dispute
resolution offered few solutions to women.
- Interviewees indicated that the most frequent perpetrators
of rape were likely to be people in positions of authority
in the camps, followed by other refugees, friends,
family and local people.
|
Conclusions
and program
implications |
These surveys indicate that the reproductive health
of women in conflict situations has been neglected. A
large proportion of humanitarian relief agencies still
do not have the necessary technical guidelines available
to field workers to maximize interventions in this domain,
making it a priority area. Comprehensive reproductive
health strategies are required that involve prevention,
protection and timely action to promote women's safety
and health. |
For further
information |
Dr. Manuel Carballo, Coordinator, International Centre
for Migration and Health, 11 Route du Nant D'Avril, Geneva,
Switzerland, CH 1214
Email: icmh@iom.int |
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| : |
The RH-Kit: A useful tool to implement reproductive health
services during an emergency
Abstract revision date: December 5-6, 2000 |
| Authors |
D. Pierotti, C. Saunders, T. Myint, T. Delvaux, W.
Doedens; UNFPA |
| Presenter |
Daniel Pierotti |
| Background |
In June 1995, the first symposium on "Reproductive
health in refugee situations" was organized jointly
by UNFPA and UNHCR and attended by more than 20 UN agencies
and NGOs. An output of the symposium was the creation
of an InterAgency Working Group (IAWG) as well as a
"Minimum Initial Service Package" (MISP), a new concept
which incorporates RH activities required during an
emergency.
UNFPA hired 2 consultants (a
midwife and a gynecologist, former Médecins Sans
Frontières staff members) to design the RH-Kit;
decisions were approved by the IAWG. The result was
a RH-Kit composed of 13 sub-kits that would allow for
the delivery of comprehensive RH services in an emergency.
In May 1998, UNFPA assembled the RH-Kit and made it
available to UN and NGO partners. |
Purpose of
study or program |
The RH-Kit would play an important role in facilitating
the work of an RH coordinator and the implementation
of the MISP in emergency situations. |
Data collection
methods |
Statistics on RH-Kit orders were compiled from requisitions
made between May 1998 and October 2000 (29 months). |
Study or
program findings |
During this period, RH-Kits were ordered on 73 occasions
for use in a total of 34 countries. Multiple requests
came from Afghanistan (6 occasions); East and West Timor
(6); Angola, Eritrea, Kosovo and Uganda (4 each); Congo/Brazzaville,
Nicaragua, Rwanda and Sierra Leone (3 each); and twice
from 7 additional countries. 74% of the orders come
from UNFPA country offices, 26% from other UN agencies
(UNHCR and Unicef) and from international NGOs (e.g.,
ARC, IRC, RI).
Kits ordered by UNFPA are distributed
to implementing partners. The sub-kits most frequently
requested are the 2 designed for assisting with deliveries:
midwife sub-kit N? 6 (856 times) and clean delivery
sub-kit N? 2 (874 times). The STD sub-kit N? 5 has also
been in high demand (820 times). Other popular sub-kits
include the oral and injectable contraception sub-kit
N? 4, the condom sub-kit N? 1 and sub-kit N? 8 for management
of the complications of abortion. The cost of a complete
RH-Kit (excluding transport) has decreased from US $10,870
in June 1998 to US$9,940 in October 2000.
In 5 projects, training related
to the use of the sub-kits was organized for doctors,
nurses, community health workers or traditional birth
attendants. Training included safe delivery, STD care,
condom use, post-rape management, contraceptive use
and management of complications of abortion.
At the end of the first year
of use, questionnaires were sent to 18 users to review
the kit and how it was being utilized. The results and
recommendations were presented in February 2000 to the
5th IAWG meeting, which suggested the formation of a
sub-working group to revise the kit. The sub-working
group met in Geneva in July 2000. As a result, a second
edition of the RH-Kit is due to be finalized prior to
the end of 2000 and this will contain, among other improvements,
additional promotion and training documents, both in
hard copy and as a CD-ROM. |
Conclusions
and program
implications |
The RH-Kit is an excellent example of a successful
and innovative initiative, completed only through the
collective effort of numerous motivated UN and NGO partners. |
For further
information |
Dr Daniel Pierotti, UNFPA Geneva Principal Officer,
Crisis Relief, GEC Building, 9 Chemin des Anemones,
1219 Geneva, Switzerland
Telephone: 41-22 917 8314
Fax: 41-22 917 8049
Email: unfpaero@undp.org |
|
Reproductive health indicators of displaced persons in
post-emergency phase camps of humanitarian emergencies
Abstract revision date: December 5-6, 2000 |
| Authors |
Michelle Hynes, Division of Reproductive Health, Centers
for Disease Control and Prevention, Atlanta, GA.
Mani Sheik, Center for Refugee and Disaster Studies,
Johns Hopkins School of Public Health, Baltimore, MD.
Hoyt Wilson, Division of Reproductive Health, Centers
for Disease Control and Prevention, Atlanta, GA.
Paul Spiegel, International Emergency and Refugee Health
Branch, Centers for Disease Control, Atlanta, GA. |
| Presenter |
Michelle Hynes |
| Background |
Although the international community has recently
emphasized reproductive health (RH) services for displaced
populations, there is a paucity of epidemiological data
on RH outcomes among these populations during the post-emergency
phase of humanitarian emergencies. |
Purpose of study
or program |
To determine the most important factors which affect
RH outcomes of displaced populations in 52 post-emergency
camps in seven countries; to compare RH outcomes of
displaced populations in camps to outcomes of their
host country and country of origin. |
Data collection
methods |
A retrospective survey covering a 3-month period in
each camp was conducted from November 1998 through March
2000 among displaced populations in 52 post-emergency
phase camps in Azerbaijan, Ethiopia, Myanmar, Nepal,
Tanzania, Thailand, and Uganda. For rate comparison,
camp data was aggregated into 11 displaced population
groups according to country of origin. Main outcome
measures were crude birth rate (CBR), neonatal mortality
rate (NNMR), maternal mortality ratio (MMR), incidence
of complications of unsafe and spontaneous abortion
(ICUSA), and percentage of low birth weight babies (LBW).
Rates and ratios were compared to host country and country
of origin rates. |
Study or program
findings |
RH outcome measures among displaced groups living
in camps were better than those found in host countries
and countries of origin. Nine of the 11 displaced groups
(82%) had significantly lower NNMRs; 6 of 8 groups (75%)
had significantly lower MMRs; and 7 of 9 groups (56%)
had significantly lower LBW percentages than both host
countries and countries of origin. In addition, 8 of
11 groups (73%) had significantly lower CBRs than those
of the host country and country of origin. Multivariate
analysis showed that NNMR was positively associated
with a per capita increase in the number of traditional
birth attendants (p<0.01), and percentage of LBWs
was positively associated with a per capita increase
in the number of local health staff (p=0.04). No significant
associations were found for MMR and ICUSA. CBRs were
negatively associated with longer established camps
(p=0.02) |
Conclusions and
program implications |
Displaced populations in post-emergency phase camps
may have better RH outcomes than populations in their
respective host countries and countries of origin. Higher
per capita health care staffing was associated with
poorer outcomes in some of the RH measures, most likely
due to more complete and accurate surveillance. CBRs
decreased with the length of existence of the camps. |
For further
information |
Paul Spiegel MD, MPH, Centers for Disease Control
and Prevention, International Emergency and Refugee
Health Branch, Mailstop F-48, 4770 Buford Highway NE,
Atlanta, GA 30341 USA
Telephone: 770-488-3136
Fax: 770-488-7829
E-mail: pos4@cdc.gov |
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