|
Conference Proceedings 2000
Findings On Reproductive Health Of Refugees
And Displaced Populations
Washington DC | December 5-6, 2000
Using Participatory Data Collection Methods to Plan Reproductive
Health Programs
| Moderator: Beverly Tucker, Family Health International |
Presentations:
| Zeinab Abdi Ahmed |
SGBV as viewed by refugees in Kenya: Learning about
sensitive RH issues and developing responses using participatory
assessment techniques |
| Tracey Lee |
NORPLANT® for Karen refugees on the Thai-Burmese
border |
Aftab Tariq
Ihsan |
Participatory rapid appraisal (PRA) of the reproductive
health needs of Afghan refugees in Pakistan |
|
| SGBV as viewed by refugees in Kenya: Learning about sensitive
RH issues and developing responses using participatory assessment
techniques Abstract revision date: December 5-6, 2000
|
| Authors |
Susan M. Igras, CARE-USA Health Unit
Zeinab Abdi Ahmed, CARE-Kenya Refugee Assistance Program
|
| Presenter |
Zeinab Abdi Ahmed
|
| Background |
Sexual and gender-based violence (SGBV) in the Dadaab
refugee camps in northern Kenya has been an issue since
refugees began arriving from Somalia. In response, an
inter-agency SGBV program has existed in Dadaab since
the early 1990s. A 1999 survey indicated that 28% of women
in the camps had been sexually aggressed since becoming
refugees. The program was viewed as needing to respond
better.
|
Purpose of study
or program |
CARE's RH for Refugees Initiative staff facilitated
a multi-agency assessment of SGBV in late 1998 that focused
on substantive discussions with refugee groups, using
participatory exercises to focus discussions.
|
Data collection
methods |
The 1995 UNHCR publication, Sexual Violence Against
Refugees: Guidelines on Prevention and Response, guided
the development of question guides for use at the community
level to explore the problem and its causes, and to solicit
solutions to reduce violence. Concurrently, a systems
analysis of the actual SGBV reporting, treatment and support
systems was conducted.
|
Study or
program findings |
Refugees provided their definitions of violence and
its consequences. They identified areas where they felt
vulnerable to assault within the camps. They spoke of
individual and community coping mechanisms to prevent
violence and support survivors of violence. When asked
about solutions, ideas emerged: forming vigilance groups
to patrol the camps at night, cleaning up bushes inside
camps that could hide perpetrators, asking UNHCR and the
police to establish 'safe corridors' for firewood collection,
and expanding economic opportunities for women so they
would not need to collect firewood or enter into coercive
sexual relationships. The systems review indicated that
greater sensitivity was needed for rape survivors as they
maneuvered numerous and at times uncoordinated services.
|
Conclusions
and program
implications |
Suggestions from the assessment resulted in improvements
in the SGBV program, including better inter-agency coordination
of reporting, treatment and support services, and refugee
outreach activities to recognize trauma, support survivors
of violence, and prevent violence from occurring in the
first place. CARE, Médecins sans Frontières/Belgium
and the National Council of Churches of Kenya plan to
expand the program further to address new forms of violence
(intimate partner violence and coercion) and to experiment
with women's drop-in centers to bring services closer
to the refugee communities and expand RH and social services
to women in the camps.
The use of participatory assessment
techniques provides an appropriate way to get input on
sensitive issues and plays a critical role in identifying
issues and better supporting survivors and communities
faced with violence. Concurrent systems analysis can validate
these issues and help define what solutions are feasible
given available resources.
|
For further
information |
Zeinab Abdi Ahmed, Vulnerable Women & Children's
Supervisor, Refugee Assistance Project, Dadaab, CARE Kenya,
PO Box 43864, Nairobi, Kenya.
Telephone : 254-131-2060
Fax: 254-131-3242
Email: zeddie@ddb.care.or.ke |
|
| : |
NORPLANT for Karen refugees on the Thai-Burmese border
Abstract revision date: December 5-6, 2000 |
| Authors |
T. Lee, N. Lay Hter, D. D. Cho, Eh Paw, R. McGready,
F. Nosten; Shoklo Malaria Research Unit
|
| Presenter |
Tracey Lee
|
| Background |
The use of long-term, reversible contraceptives is
infrequently reported in displaced populations. In 1996,
Norplant , a sub-dermal implant with contraceptive duration
of five years, was offered free of charge within a family
planning program. The program served a stable
population of 30,000 Karen displaced persons in Maela
camp on the western border of Thailand. Norplant has
been used in Thailand since 1987 but is unavailable
in Burma. The proportion of women who chose the method
was 6%.
|
Purpose of
study or program |
To describe use of Norplant , a long-term contraceptive,
by a refugee population.
|
Data collection
methods |
Between January 1997 and March 1999, 105 consenting
Norplant users were followed every three months
in order to establish rates of continuation and side
effects. At least six months after insertion, women
were questioned regarding reasons for choosing the method
and plans for removal in the event of returning to Burma.
A further 33 known Norplant users who did not
participate in the routine follow-up and who consented
to interview were included for comparison.
|
Study or
program findings |
70% (n = 74) of women were able to be followed. The
remainder either went to work, moved or were lost to
follow-up (n = 31). One third (n = 24) of women requested
to have the implants removed. The most commonly cited
reasons for requesting removal were pain or infection
at the insertion site or desire for pregnancy. 17% (4/24)
of removal requests were attributed to bleeding irregularities.
Headache and dizziness were the most frequently reported
side effects. The median (range) number of weeks before
removal was 35 (1-135).
|
Conclusions
and program
implications |
The study reports Norplant usage by refugees
in stable circumstances, a novel report. While requiring
extensive training for providers and client counseling,
it expanded contraceptive choice for this displaced
population.
|
For further
information |
Tracey Lee, Shoklo Malaria Research Unit, PO Box 46,
Mae Sot, Thailand 63110
Email: shoklo@cscoms.com |
|
Participatory rapid appraisal (PRA) of the reproductive
health needs of Afghan refugees in Pakistan
Abstract revision date: December 5-6, 2000 |
| Authors |
Ariel Ahart, Save the Children Consultant
|
| Presenter |
Aftab Tariq Ihsan, Save the Children Federation, Pakistan
|
| Background |
Save the Children/United States (SC/US) provides assistance
to 105,000 Afghan refugees in the Haripur District of
Pakistan through meeting basic health needs: child health
care, tuberculosis and malaria control programs, basic
curative services and reproductive health programs including
Maternal and Newborn Care and family planning.
|
Purpose of study
or program |
In April 1997, SC/US initiated a study on the RH needs
of Afghan refugees. The main purposes of the study were
to: 1) field test the RHR Consortium's needs assessment
guide and 2) ascertain the community's knowledge, beliefs
and practices related to critical RH areas.
|
Data collection
methods |
SC/US used the Participatory Rapid Appraisal (PRA)
technique to gather information through a multidisciplinary
team. A total of 1,370 Afghan Refugees participated
(920 women, 450 men). PRA tools included: direct observation,
secondary sources, pair-wise ranking, causal flow, lifeline
analysis and livelihood analysis diagrams. The team
secured community support before embarking on the survey
and cross-checked results with refugees before writing
the final report.
|
Study or program
findings |
- Married Afghan women typically reported 8 to
11 pregnancies over the course of their reproductive
lives.
- Refugees expressed the desire to space their
children in order to protect the mother's health
and/or because they could not afford additional
children.
- Knowledge about STDs and HIV/AIDS was extremely
poor. Men who had sex with multiple partners and/or
traveled outside the camp were at greatest risk
of contracting and transmitting STDs and HIV.
- A number of health problems identified amongst
women pointed to a high incidence of RTIs and genital
prolapse.
- The incidence of domestic violence appears to
be high. Husbands were identified as the primary
perpetrators. However, the role of other family
members deserves further attention.
- Early marriage is common and increases the risk
of domestic violence.
- Major weaknesses were identified in the referral
system.
- Girls and boys had limited knowledge about puberty,
their bodies, and reproductive health.
|
Conclusions and
program implications |
Through PRA, it is possible to openly discuss RH topics
within a conservative Islamic community. A number of
program implications were identified: the need to make
contraceptives more readily available; greater education
on critical areas of RH as well as RTIs, STDs and HIV/AIDS;
increased access to emergency obstetric services; education
and outreach to primary RH decision makers; and additional
training of staff. The issue of domestic violence emerged
as one of the most sensitive and most difficult topics
to address, one which must acknowledge the cycle of
violence and the role of different family members.
|
For further
information |
Dr. Aftab Tariq Ihsan, Regional Health Director, Save
the Children Federation,
P.O . Box 1952, Islamabad, Pakistan
Telephone: 92-51-227-9211
Email: tihsan@savechildren.org.pk |
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