|
Conference Proceedings 2000
Findings On Reproductive Health Of Refugees
And Displaced Populations
Washington DC | December 5-6, 2000
Expanding Our Base - New Audiences, New Services, New Channels
| Moderator: Mary Kay Larson, Centers for Disease Control and
Prevention |
Presentations:
Nadia Ali El
Toum |
A qualitative assessment of reproductive health among the displaced
communities of Khartoum, Sudan |
| Fariyal Fikree |
Enhancing the use of emergency contraception: A baseline survey
in Kakuma refugee camp, Kenya |
| Suzanne Fustukian |
Spreading the word: Health on air in the Somali-speaking Horn
of Africa |
|
| A qualitative assessment of reproductive health among the displaced
communities of Khartoum, Sudan
Abstract revision date: December 5-6, 2000
|
| Authors |
Laurel K. Fain, Nadia Ali El Toum, International Rescue Committee,
Khartoum, Sudan
|
| Presenter |
Nadia Ali El Toum
|
| Background |
An estimated 2.2 million displaced people reside in camps, squatter
and settlement areas around Khartoum, Sudan. Little attention has been
given to reproductive health issues, despite an apparent need for services.
Maternal mortality for the entire country is estimated to be 365/100,000
live births, but for displaced populations is 865/100,000 live births;
infant mortality is 78/1,000; and the fertility rate is 5.4 children per
woman. 82% of women in Sudan are estimated to have undergone female genital
cutting.
|
Purpose of study
or program |
The purpose of this qualitative study conducted in El Salam displaced
camp was to gain information about the reproductive health status of the
Khartoum displaced population in order to design reproductive health outreach
programs applicable to the needs of these communities.
|
Data collection
methods |
This assessment included a series of focus groups with men and women
living in El Salam displaced camp to assess their knowledge, attitudes
and practices about reproductive health issues. Nineteen focus groups were
designed to allow for representation from all areas and tribes within El
Salam camp. Participants were selected randomly, and men and women were
assigned to separate groups of six to ten people each.
|
Study or
program findings |
Focus group participants expressed knowledge of certain health issues,
reflecting successes of current health education projects in the camp.
Financial and transportation issues were identified as barriers to accessing
quality care.
Most women in the camp give birth at home,
with or without the help of traditional birth attendants. Little knowledge
or use of modern contraceptive methods was indicated. Participants demonstrated
some knowledge of HIV and AIDS, and reported that people in El Salam camp
are afraid of getting AIDS. Little awareness of modes of transmission and
treatment for sexually transmitted diseases was expressed by focus group
participants. High-risk sex activities were described as common in El Salam
camp. The majority of participants had never heard of condoms.
Domestic violence is reported to be the norm
among families in El Salam camp. According to focus group participants,
the suna form of circumcision, or removal of the clitoris, is the form
of circumcision most commonly practiced by camp residents.
|
Conclusions
and program
implications |
These findings provide an example of the health situation that can
develop when issues of reproductive health are not immediately addressed
within an emergency situation. The authors hope this information will be
useful to the design and implementation of reproductive health services
programs among displaced populations, for which a need is clearly present.
|
For further
information |
Nadia Ali El Toum, Health Education Coordinator, International Rescue
Committee Sudan,
PO Box 8269, Khartoum, Sudan
Email: Nadiaali60@hotmail.com |
|
| : |
| Enhancing the use of emergency contraception: A baseline survey
in Kakuma refugee camp, Kenya
Abstract revision date: December 5-6, 2000
|
| Authors |
Esther Muia, Reproductive Health Program Associate, Population Council,
Nairobi, Kenya
Fariyal F. Fikree, Program Associate, Population Council, New York
Joyce Olenja, Consultant, Population Council
|
| Presenter |
Fariyal Fikree
|
| Background |
Kakuma Refugee Camp, located in Turkana District of northern Kenya,
has a population of 79,316 refugees of whom 40% are women.
|
Purpose of
study or program |
To contribute to the improved quality of reproductive health services
for refugees through an operations research project regarding emergency
contraception in the context of expanding family planning access.
|
Data collection
methods |
A baseline survey applying qualitative and quantitative techniques
was conducted to assess knowledge, attitude and practice regarding emergency
contraception in late 1999. A total of 927 women of reproductive age residing
in the refugee camps and 16 health care providers were interviewed. This
was complemented by focus group discussions among opinion leaders, adolescents
(male and female) and representatives from the women's support groups.
|
Study or
program findings |
Sixteen health care providers, the majority of whom were Kenyans (56.3%)
or Sudanese (31.3%), were interviewed. Though 12 were female, only one
doctor, a Kenyan male with 10 years experience, serviced the refugee population.
Family planning services currently offered
included contraceptive pills and condoms. Information and/or supplies
were provided, on average, to 2 clients per month for emergency contraceptives
and only at the camp hospital. There was no consistency regarding the emergency
contraceptive regimen offered. Furthermore, there were no educational materials
on emergency contraceptives or standard service delivery guidelines available
in the camp hospital.
Most of the women respondents interviewed
were either refugees from Sudan (50.5%) or Somalia (32.0%). Nearly 56%
were unaware that anything could be done to prevent a potential pregnancy
following unprotected sex. The most frequently reported option (25.7%)
was to go to the hospital. Nearly 15% of women claimed to have ever heard
of emergency contraception, nearly half of whom had heard about emergency
contraceptives recently.
The majority of the focus group participants
had not heard about emergency contraceptives despite their availability
at the camp hospital. However, the community elders strongly advocated
dissemination of emergency contraceptives through their active participation
and support. The avenues for dissemination of information recommended included
health facilities, youth and women support groups, drama and puppetry sessions,
among others.
|
Conclusions
and program
implications |
Findings from this study reflect the lack of knowledge regarding emergency
contraception both among health care providers and the refugee population
and its restricted availability at the camp hospital. Our results therefore
suggest training regarding protocol regimens, counseling, provision of
IEC materials at health facilities and dissemination of information via
youth and women support groups be considered.
|
For further
information |
Dr Esther Muia, Reproductive Health Program Associate, Population Council,
Multichoice Towers, Upper Hill, PO Box 17643, Nairobi, Kenya
Email: emuia@popcouncil.or.ke
|
|
| Spreading the word: Health on air in the Somali-speaking Horn of
Africa
Abstract revision date: January 15, 2001
|
| Authors |
Suzanne Fustukian, Research Fellow, Health Policy Unit, Department
of Public Health and Policy, London School of Hygiene and Tropical Medicine
|
| Presenter |
Suzanne Fustukian
|
| Background |
Health Unlimited, a British-based non governmental organisation initiated
the 'Well Women Media Project' (WWMP) in the Somali-speaking Horn of Africa
in November 1997. The project represents an ambitious programme aimed at
increasing awareness, discussion and acceptance of safe and informed sexual
and reproductive health outcomes in a context of instability and poorly
developed regional infrastructure and communication systems.
Gender roles, as elsewhere, are highly differentiated
in Somali society. Following the conflict in the late 1980s and 1990s in
Somaliland, a change in gender roles has been noted, with women "increasingly
emerging as the major breadwinners and as heads of households."1
However, "traditionally the man has overall responsibility for the family
and its finances; it is the woman's job to look after the children and
the livestock and do the housework."2 It is in the context of
such gender relations, in which male family members remain dominant, that
the project context must be understood.
__________
1 Abdillahi, Mohamed Sheik. (1997). Somaliland NGOs:
challenges and opportunities. London, CIIR.
2 Evaluation fieldwork focus group discussion (1999)
|
Purpose of study
or program |
Radio is used as a means of communicating health information aimed
at promoting positive change in health and social behaviour.
|
Data collection
methods |
An evaluation was undertaken by the presenter. Qualitative research
methodology was used to gather information regarding the relevance and
cultural appropriateness of the radio programme to the audience and their
families. This included discussion with well-informed stakeholders, established
and informed audience groups, focus groups and natural groups in several
urban and rural sites.
|
Study or program
findings |
Two inter-related issues will be the focus of the presentation:
the socio-cultural issues raised by research on female genital
mutilation (FGM) in the context of Somaliland;
the significant contribution of radio in highly decentralised
'post'-conflict countries.
The project objectives targeted women's reproductive health, with a
particular focus on FGM. The strategy used, however, was to broadcast a
radio programme to a wide, undifferentiated radio audience. It is important,
therefore, to consider the gendered response to the issues raised in the
programme, for example, to what extent women and men had different responses
to the information. Although gender analysis was not directly attempted
by the evaluation team, some observations emerged from the discussions
with the stakeholders and discussion groups. These will be presented under
the following headings: marital relations, virginity and marriage, and
women's status.
|
|
|
For further
information |
Suzanne Fustukian, Research Fellow, Health Policy Unit, London School
of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
Telephone 00 44 020 7927 2275
Fax 00 44 020 7637 5391
Email suzanne.fustukian@lshtm.ac.uk
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