|
Conference Proceedings 2000
Findings On Reproductive Health Of Refugees
And Displaced Populations
Washington DC | December 5-6, 2000
Adolescents - Who Are They and How Do We Serve Them?
| Moderator: Pamela Delargy, UNFPA |
Presentations:
Allison A.
Pillsbury |
Addressing war-affected adolescents' reproductive health needs |
Margaret
Mukabana |
Reproductive health KAP survey of refugee adolescents in the Kigoma
region of Tanzania |
Matthew
Tiedemann |
The "Health of adolescent refugees project" (HARP): A peer education
project in Egypt, Uganda and Zambia |
|
| Addressing war-affected adolescents'
reproductive health needs
Abstract revision date: December 5-6,
2000
|
| Authors |
Jane D. Lowicki, Allison Anderson
Pillsbury, Women's Commission for Refugee Women and Children
|
| Presenter |
Allison Anderson Pillsbury
|
| Background |
Adolescents have distinct experiences
in armed conflict, distinct needs and distinct capacities for recovering.
However, information about war-affected adolescents' needs and programming
to meet those needs, including in the realm of reproductive health, has
been insufficient.
|
Purpose of study
or program |
To raise awareness among decision-makers
and practitioners about the reproductive health rights and needs of war-affected
adolescents; spur and strengthen further action-oriented research and field
programming; and generate funding to create new programs for adolescents.
|
Data collection
methods |
The Women's Commission conducted an
adolescent-specific policy and program review across five sectors: health
and reproductive health, education, livelihood, pyschosocial and protection.
Staff interviewed and collected documentation from dozens of representatives
from donor governments, intergovernmental organizations, nongovernmental
organizations and academic institutions about their past, current and future
work with adolescents affected by armed conflict. In doing so, the Women's
Commission identified gaps and barriers to meeting the needs of war-affected
adolescents, along with achievements.
|
Study or
program findings |
As they enter their reproductive years,
adolescents affected by armed conflict are generally not targeted in the
provision of reproductive health information and services despite facing
many distinct risks. Adolescent girls are primary targets for sexual violence
perpetrated as a weapon of war, including rape, sexual assault and sexual
slavery. Some of the health consequences of sexual violence and exploitation
are STDs, including HIV/AIDS; unwanted pregnancy, often leading to potentially
dangerous childbirth or unsafe abortion; and physical and mental trauma,
leading to excess morbidity and mortality. Adolescents, particularly girls,
are also less likely to have access to formal school settings, where reproductive
health information may be available and where their health condition may
be more easily monitored. Often with few alternatives, girls are particularly
at risk of sexual exploitation and prostitution. Furthermore, boys and
men are rarely targeted in efforts to promote and ensure the prevention
of sexual violence and exploitation, or in efforts to promote their reproductive
health and that of women and girls.
|
Conclusions
and program
implications |
While the specific reproductive health
needs of adolescents are gaining increased attention, on the whole few
reproductive health programs are designed to meet the needs of adolescents,
and more are urgently needed.
Adolescent programming must be approached
holistically, including cross-sectorally. Better age- and gender-specific
data collection is needed to help programmers better identify and address
adolescent reproductive health care needs. Furthermore, involving adolescents
themselves in identifying their needs and participating in creating solutions
to their problems greatly contributes to appropriate programming on their
behalf. Finally, programming must be culturally appropriate and should
ensure the training and sensitization of those working with adolescents.
|
For further
information |
Allison Anderson Pillsbury, Project
Manager, Children and Adolescents Project, Women's Commission for Refugee
Women and Children, 122 East 42nd Street, 12th floor, New York, NY 10168-1289,
USA
Telephone 212-551-3107
Fax 212-551-3180
Email allison@theIRC.org
|
|
| : |
| Reproductive health KAP survey
of refugee adolescents in the Kigoma region of Tanzania
Abstract revision date: December 5-6,
2000
|
| Authors |
Margaret T. Mukabana, Consultant,
International Federation of Red Cross and Red Crescent Societies
Michelle M. Thompson, Consultant, Women's
Commission for Refugee Women and Children
|
| Presenter |
Margaret T. Mukabana
|
| Background |
For the past 30 years, Tanzania has
hosted refugees escaping ethnic and political violence from throughout
the Great Lakes Region. UNHCR reported that at the end of 1999 there were
approximately 410,000 refugees in 11 Tanzanian refugee camps, including
an estimated 290,000 from Burundi and 100,000 from Congo-Kinshasa.
|
Purpose of
study or program |
The objectives of the KAP survey were
to assess the level of knowledge and attitudes of refugee adolescents about
sexual and reproductive health (SRH) issues and the magnitude of SRH problems,
in order to help design appropriate adolescent-specific interventions.
|
Data collection
methods |
During February and March 2000, a
cross-sectional KAP survey was conducted amongst 1,572 adolescents, aged
10 to 19 years, from 3 selected refugee camps (Lugufu, Mtendeli and Karago)
in the Kigoma region of Western Tanzania. 100 interviewers were recruited
from the cadre of community health workers and health information team
members. In each camp, 25% of the villages were randomly selected, 7% of
the households were chosen, then one boy and one girl were interviewed
per household. The questionnaire had been translated into Kiswahili and
Kirundi, and interviews were conducted in these languages.
|
Study or
program findings |
The mean age of survey respondents
was 15.6 years and 58.9% were male. 43.4% of the adolescents were Congolese
and lived in Lugufu camp; refugees from Burundi lived in Mtendeli (33.3%)
and Karago (23.3%). For all ages, more boys than girls currently attend
school. 18.1% of the females said they are married versus none of the males.
16.7% of the adolescents reported that they are sexually active; amongst
non-married adolescents, more males (18.5%) than females (13.8%) are sexually
active.
12% of adolescents said they have heard
of family planning (FP) - females were more aware (17.4%) than males (8.1%),
and a greater proportion of sexually active respondents have heard of FP
(35.0%) than those not sexually active (5.9%). Of the 41 adolescents who
were pregnant at the time of the interview, 21.9% said they wanted to get
pregnant, 36.6% would have preferred to get pregnant later and 41.5% did
not want to get pregnant at all. 76.7% of the survey respondents have heard
of AIDS (males 72.2%, females 83.2%) and 21.5% have known someone who has
died from the disease. Amongst those who were aware of AIDS, only 26.3%
had discussed the disease with anyone. 66.7% of males believed that condoms
can prevent AIDS versus 71.8% of females. 57.3% of sexually active adolescents
said they could get a condom if they needed one as compared to 29.8% of
those not sexually active.
|
Conclusions
and program
implications |
Knowledge about family planning was
quite low. Education efforts should be targeted equally to male and female
adolescents, and to both sexually active and non sexually-active adolescents.
Awareness of AIDS was fairly high, yet there is a need to discuss the disease
openly in order to dispel myths and to provide counseling for adolescents
who have lost family members or friends. Additionally, it is important
that the adolescents know where they can access condoms and other contraceptives.
The development and implementation of adolescent reproductive health programs
in the refugee camps of Tanzania will be a challenge. However the process
will be greatly enhanced if a multi-sectoral approach is utilized, including
the direct participation of the adolescents themselves.
|
For further
information |
Michelle M. Thompson, WCRWC Consultant,
Department of Epidemiology, University of Washington, School of Public
Health and Community Medicine, Box 357236, Seattle, WA 98195 USA
Fax 206-543-8525
Email mmt@u.washington.edu
|
|
| The "Health of adolescent refugees
project" (HARP): A peer education project in Egypt, Uganda and Zambia
Abstract revision date: December 5-6,
2000
|
| Authors |
Cynthia Waszak, Matthew Tiedemann,
Family Health International
|
| Presenter |
Matthew Tiedemann
|
| Background |
Family Health International (FHI)
collaborated with the World Association of Girl Guides and Girl Scouts
(WAGGS) to conduct the Health of Adolescent Refugees Project (HARP), a
UNFPA-supported reproductive health education and clinical services project
for adolescent girls living as refugees in Egypt, Uganda and Zambia. HARP
was implemented through the Girl Guide Associations in the 3 countries,
with the collaboration of local partners, including UNHCR, the Ministries
of Health and other NGOs from 1997 to 2000.
Up to 300 refugee girl guides in each
country completed a curriculum developed by FHI and WAGGS to earn a reproductive
health merit badge and certificates for peer education activities. The
curriculum covered physical and psychological well-being and emphasized
utilization of clinical services to protect one's health.
FHI trained clinical service providers
in the refugee communities to provide adolescent-sensitive information
to the participating guide units. HARP activities facilitated linkages
between the girl guides and local health clinics.
|
Purpose of study
or program |
HARP was a pilot project designed
to improve the health of female adolescent refugees through peer education
emphasizing reproductive health, and through linking the adolescents to
local health providers.
|
Data collection
methods |
Process data were collected throughout
the project. FHI conducted a baseline qualitative assessment prior to the
intervention and an end-of-project assessment. Interviews were conducted
with leaders and Girl Guides from most project Guide units.
|
Study or program
findings |
-
Increased comprehension and awareness
of health issues among the adolescents, though the level of knowledge varied
among groups and across topics.
-
While the concept of self-esteem was difficult
to convey, many participants were proud of their new knowledge and were
eager to convey it to their peers.
-
Involving community leaders and parents
is critical; the project generated demand for including additional girls
and programming for boys.
-
There was evidence of increased utilization
of health services by adolescents in the target communities.
Additional outcomes not directly related
to the original objectives include:
-
HARP created a safe space and provided
productive activities for refugee adolescents.
-
HARP increased guide leaders' RH knowledge
and community status.
-
The project raised community awareness
of RH topics and services.
|
Conclusions and
program implications |
HARP demonstrated that the model was
feasible and sustainable, as the 3 national Girl Guide Associations have
continued the project beyond the pilot phase. The project has been adapted
for non-refugee boys and girls in India. Further adaptations for other
countries are under consideration.
|
For further
information |
Matthew Tiedemann, Senior Program
Officer, Field Operations, Family Health International, PO Box 13950, Research
Triangle Park, NC 27709 USA
Telephone 919-544-7040 x 210
Fax 919-544-7261
Email Mtiedemann@fhi.org
|
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Next: Using
Data to Improve Reproductive Health Programs
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