|
Conference Proceedings 2000
Findings On Reproductive Health Of Refugees
And Displaced Populations
Washington DC | December 5-6, 2000
Family Planning - An Ongoing Challenge
| Moderator: Steve Hawkins, USAID |
Presentations:
Rosemary
Barber-Madden |
Demographic profile and the reproductive health
of internally displaced persons in Angola |
| Se Youry |
Research on reproductive health: Lessons learned
in Khao Phlu refugee camp, Thailand |
| Poonam Mazhar |
A family planning continuation study among Afghan
refugees in Pakistan |
|
| Demographic profile and the reproductive health of internally
displaced persons in Angola Abstract revision date: December
5-6, 2000
|
| Authors |
Rosemary Barber-Madden, UNFPA, Angola
Jose TL Ribeiro, UNFPA, Angola
Ana Leitão, UNFPA, Angola
João Bosco Feres, UNFPA, Angola
|
| Presenter |
Rosemary Barber-Madden
|
| Background |
In 2000, the Angolan government registered a total of
4 million IDPs (or 1/3 of the estimated national population)
from the war. In 1999, the provincial governments of Huila
and Benguela requested technical assistance from UNFPA
to explore the needs of the growing number of IDPs in
camps and peri-urban areas surrounding local cities.
|
Purpose of study
or program |
This study examined the conditions of family life and
of reproductive health among persons living in IDP camps
and in peri-urban areas of major cities in Huila and Benguela
Provinces. The study was undertaken in conjunction with
the health, education, social communications and planning
sectors in order to develop a program of intervention
at the community/camp level.
|
Data collection
methods |
The study was conducted in 2 phases: a survey in the
early phase and focus groups and in-depth interviews in
the second. The survey questionnaire consisted of
70 questions regarding: homeland of origin, fertility,
assistance to pregnant women, knowledge of family planning,
infant and child mortality, knowledge of STDs, use of
male and female condoms, unwanted pregnancy and abortion,
sexual and physical violence, prostitution. The focus
groups and in-depth interviews pursued these same issues.
This paper presents a summary of the survey data.
For the survey, a sample of 710 women, men and youth was
drawn using stratification by geographic zones in IDP
camps and peri-urban areas where IDPs were re-integrated
into the communities of the 2 provinces.
|
Study or
program findings |
The majority of IDPs in the survey were from rural areas
of the same province, many having been displaced more
than once. The average number of children per woman was
8.6, with 3.8 children having died. 15.4% of the women
were pregnant at the time, with 2/3 reporting having received
some prenatal care. The infant mortality rate was 236
per 1000 live births, with an under-5 mortality rate of
395 per 1000 live births. The fertility and mortality
rates are significantly higher than the national average.
60.7% of men and 38.7% of women had heard about
STDs, with 80.3% of men and 60% of women having heard
of AIDS. Condom use was limited, with 8.7% of men and
3.6% of women reporting having used a condom during the
last sexual contact. However, it must be noted that condom
availability (male and female) is very limited in the
provinces.
|
Conclusions
and program
implications |
Together with the provincial authorities, UNFPA unfpa
proposed an emergency reproductive health package. With
funds from the Dutch government and OCHA, these services
were introduced in IDP camps and peri-urban areas of Huila,
Bengueeulla, Malange and Huambo provinces in 2000:
- upgrading maternity services by providing
equipment (including RH rh kits/MISPmisp), materials,
contraceptives, medications and training for integrated
RH rh care, essential obstetrical care, STD std diagnosis
and treatment
- providing female- and male-directed RH rh
education by health promoters supervised by provincial
mobile RH rh teams in 9 camps
- special radio programmes broadcastedbroadcast
in national languages and Pportuguese at listening
posts in selected camps and peri-urban areas
- okulyelisa (intimate hygiene kit) at health
services points and in IDP idp camps (containing material
for menstruation, soap, male and female condoms)
|
For further
information |
Rosemary Barber-Madden, UNFPA Representative/ Angola,
Mailing address: 137 West Central Park North, Apt 7E,
New York, NY 10026 USA
Telephone: 212- 531-4985;
Email: rbarber_madden@hotmail.com
Dra. Ana Leitão, National Project Advisor and
Dr. João Bosco Feres, Chief Technical Advisor,
UNFPA, Rua Major Kanhangulo, 197, CP 910 Luanda, Angola
Telephone: 244-2-393531; Email raul.feio@netangola.com,
joaobos@hotmail.com
|
|
| : |
| Research on reproductive health: Lessons learned in Khao
Phlu refugee camp, Thailand Abstract revision date: January
15, 2001
|
| Authors |
Virginia Morrison, Lowell Community Health Center,
Lowell, MA,
Se Youry, Clinical Coordinator, American Refugee Committee,
Sangklaburi, Thailand |
| Presenter |
Se Youry |
| Background |
Research done in 1998 attempted to document the need
for and barriers to contraceptive services in Khao Phlu.
This camp existed from 1997-1999, housing approximately
12,000 people. Reproductive health services were provided
by the American Refugee Committee under the auspices
of the United Nations High Commission for Refugees.
Populations in Khao Phlu came from border areas of Cambodia
and had little access to government health services
for 25 years.
|
Purpose of
study or program |
This was one of the first efforts to document the
implementation of the Reproductive Health Response in Conflict Consortium recommendations. This presentation will cover
methodological and practical findings learned during
research and data collection.
|
Data collection
methods |
Quantitative data included serial interviews with
women living in the camp as well as midwives working
at the maternal child health center. Qualitative data
were collected through three focus groups with Khmer
men and two focus groups with traditional birth attendants.
Records from the log books at the maternal child health
center provided demographic data and number of women
obtaining contraception through ARC services.
|
Study or
program findings |
- Findings indicated a greater need and demand
for contraception since arriving at the camp among
all participants. Barriers to contraception included
fear of side effects, being labeled as promiscuous,
embarrassment and difficulty traveling to the health
center.
- Interviews and focus groups gave extensive information
on contraceptive services. As a possible result,
more women came for contraceptives during and after
data collection, a trend not observed in a nearby
camp.
- The maternal child health center changed its
family planning schedule from twice a week to everyday
services to meet this need. Additional rape crisis
protocol was put in place as a result of women who
mentioned they had been victims of rape.
|
Conclusions
and program
implications |
- Identify areas of local concern by assessing
the population before formulating research questions.
- Security is difficult to guarantee and may present
limitations on access to the camp. Collaboration
with camp and expatriate staff is essential.
This can avoid delays in permission from the host
authority to access the camp and builds on an established
relationship with camp residents.
- Camps are highly mobile, making it difficult
to enumerate populations or guarantee random sampling.
This can be ameliorated with division of the camp
into different sections or obtaining information
on native country origins of participants.
- More research is needed in the beginning of refugee
crises when women are at highest risk for rape and
unwanted pregnancy. The research protocol
should assure services for women at highest risk,
sensitize staff to concerns of SGBV and train staff
in detection, counseling and treatment of those
affected.
|
For further
information |
Dr. Se Youry, American Refugee Committee, P.O. Box
6 Sangklaburi, Kanchanaburi 71240, Thailand
Telephone and Fax: 6634 595-177
Email: arcsang@loxinfo.co.th
|
|
| A family planning continuation study among Afghan refugees
in Pakistan Abstract revision date: December 5-6, 2000
|
| Authors |
This work is a joint effort of staff of Frontier Primary
Health Care; Heilbrunn Center for Population and Family
Health, Columbia University; International Rescue Committee,
Hangu; JSI Research & Training Institute; Kuwait
Joint Refugee Committee; Project Directorate Health;
Save the Children/US, Haripur; UNHCR/UNFPA Reproductive
Health Unit, Peshawar; Union Aid for Afghan Refugees
|
| Presenter |
Poonam Mazhar, UNHCR/UNFPA, Pakistan
|
| Background |
UNHCR and its partners provide health services to
1.2 million Afghan refugees residing in 170 officially
recognized refugee villages in the North West Frontier
Province (NWFP), Balochistan and Punjab provinces of
Pakistan. Some 78% of the current refugee population
reside in the NWFP.
One aspect of UNHCR's Reproductive
Health Project, initiated in January 1999, was to improve
its own and its partners' capacity to collect, analyze
and use program data to improve services. Collaborative
workshops among 7 local agencies and 2 US-based RHR
Consortium member agencies led to a decision to carry
out a joint study to improve family planning continuation.
|
Purpose of study
or program |
The intent of the joint study was to learn the 3-,
6- and 12-month family planning continuation rates;
to gain an understanding of the program and community
factors affecting continuation and discontinuation;
to apply that awareness to programs to better serve
couples; and, in the process, for staff of the 9 agencies
involved to improve their data collection and management
skills.
|
Data collection
methods |
The study has 4 components.
BHU record review: Data on age, parity, method,
and duration of use, where possible, were compiled on
all 1,550 women accepting a family planning method from
January to June 1999 at the 46 project BHUs offering
family planning services.
Review of agencies' policies and management systems:
Self-administered open- and closed-ended questionnaires
were completed by each of the 7 local participating
agencies, covering agency-level information on
policies and management systems relevant to the organizations'
family planning services.
BHU survey: Self-administered open- and closed-ended
questionnaires were completed by all 54 BHUs managed
by the partners, covering information on policies and
management systems relevant to their family planning
services.
Follow-up survey of acceptors: A simple random
sample of 716 women drawn from the 1,550 who accepted
a family planning method at one of 46 project BHUs from
January to June 1999 were visited and interviewed in
October-November 2000.
|
Study or program
findings |
Preliminary analysis of the BHU record review, which
appears to be confirmed by the follow-up survey, suggests
that continuation is considerably higher for injectables
than for pills, the 2 most common methods, and higher
among younger women than older. Program and community
factors associated with continuation and discontinuation
are currently being analyzed.
Agency and BHU policies and
management systems are adapting to family planning,
a relatively new service, as they are to other reproductive
health services, also recently introduced. Continued
support from UNHCR is important to maintain momentum.. |
Conclusions and
program implications |
Improved counseling to users of all methods, particularly
the pill, appears needed. Additional program shifts
and community awareness-raising will be called for to
respond to additional study findings. |
For further
information |
Dr. Poonam Mazhar, UNHCR/UNFPA, I Gulmohr Lane, Peshawar,
Pakistan
Telephone 92 91-842375/ 76; 842998 Fax 92 91-842101
Email pakpe@unhcr.ch
Dr. Emel Khan, Frontier Primary Health Care, PO Box
52, GPO, Mardan, Pakistan
Telephone 92 931-63837 Fax 92 931-61403
Email fphc@brain.net.pk
|
|
Back to
Contents
|
