|
Conference Proceedings 2000
Findings On Reproductive Health Of Refugees
And Displaced Populations
Washington DC | December 5-6, 2000
Using Data to Improve Reproductive Health Programs
| Moderator: Suzanne Fustukian, London School of
Hygiene and Tropical Medicine |
Presentations:
| Amarasiri de Silva |
Are IDPs at increased risk of reproductive
ill health? Measuring RH risk in a displaced setting using a reproductive
health risk index (RHRI) |
| Henia Dakkak |
Improving reproductive health services
among Roma women refugees in Macedonia through program monitoring |
| Beth Vann |
How-To Guide: Monitoring and evaluation
of sexual and gender-based violence programs |
|
| Are IDPs at increased risk of reproductive
ill health? Measuring RH risk in a displaced setting using a reproductive
health risk index (RHRI)
Abstract revision date: January 15,
2001
|
| Authors |
Amarasiri de Silva, Department of
Sociology, University of Peradeniya, Sri Lanka |
| Presenter |
Amarasiri de Silva |
| Background |
Data on reproductive health (RH) among
IDPs has been problematic particularly in the developing world. Implementers
of RH programmes in such situations face difficulties in identifying at-risk
persons and groups to whom to direct interventions. |
Purpose of study
or program |
This paper aims at developing a behavioural
Reproductive Health Risk Index (RHRI), which helps to identify women and
groups who are potentially at risk for RH problems, and to delineate factors
that influence reproductive ill health in community settings of the IDPs. |
Data collection
methods |
Data for the study were obtained from
a larger study of the RH situation among the IDPs in Sri Lanka. The data
were collected in 2 phases; first in a formative phase where variables
related to RH behaviours were identified using narratives, random walk
observations, case histories, listing, pile sorting and ranking. The data
were analysed to see patterns and relationships of variables. Later, a
survey instrument was developed on the basis of qualitative data for the
second phase of the research. The findings reported in this study are drawn
from the sample survey of 834 families in 6 districts of Sri Lanka where
the IDPs are located. |
Study or
program findings |
The survey identified 122 items in
4 behavioural domains that are important in order to measure the RH risk
in IDP populations of Sri Lanka. Reliability analysis of items in the four
domains indicated that each variable domain has an alpha of .82, .85, .69
and .73 respectively. The RHRI scale was used to create a categorical variable
comprising three levels of LOW RISK, AVERAGE RISK and HIGH RISK. The LOW
RISK group, which comprises the scale below one standard deviation (SD)
of the mean, is 35.1% of the sample. The AVERAGE RISK group, which comprises
+/- 1 SD of the mean is 30.7%, while the HIGH RISK group comprising those
who were above +1 SD of the mean is 23.3%.
In order to check the reliability of
the scale, some correlations were performed between RHRI scale and RHRI
outcomes. It shows that 66.2% of reported abortions and 83% of infant deaths
occurred in the High and Average Risk groups in the RHRI scale. When analyzed
against variables that have a potential impact on RH of the IDPs, it showed
that living-together arrangements (not legally married), poor SES, not
having formal education or fewer years of schooling, young age at marriage
(especially below 16 yrs), having an older husband (especially older by
5 years) and proposed/arranged marriages are some of the factors that have
increased the potential RH risk among IDP women in Sri Lanka.
|
Conclusions
and program
implications |
The RHRI scale can be used to identify
potential risk groups for RH in IDP settings. The scale has the potential
for developing a simple mechanism for rapid assessment of RH status of
women in IDP settings, which can help RH service programme organisation
and delivery of reproductive health services in a much more focused and
efficient manner. |
For further
information |
Amarasiri de Silva, Ph.D. Senior Lecturer,
Department of Sociology, University of Peradeniya, Sri Lanka
Telephone 94 8 218619/ 218620
Fax 94 8 232517
Email adesilva@slt.lk
|
|
| : |
| Improving reproductive health services
among Roma women refugees in Macedonia through program monitoring
Abstract revision date: December 5-6,
2000
|
| Authors |
Henia Dakkak, Visiting Scholar, Columbia
University, New York City
Nermine Zitkovic, Ahmed Dakkak, International
Medical Corps, Macedonia
|
| Presenter |
Henia Dakkak
|
| Background |
The influx of Roma refugees into Macedonia
coincided with movement of Kosovar refugees in 1999. At the end of NATO
operations, Albanian refugees returned to Kosovo, leaving a number of Roma
refugees in camps. Feeling threatened in Kosovo, more Roma refugees fled
into Macedonia. International Medical Corps (IMC) was a designated health
provider for refugees in Macedonia.
|
Purpose of
study or program |
Analysis of morbidity statistics in
camps showed an increase in gynecological diseases among Roma refugee women.
Health providers also documented an increase in referrals for hospital
deliveries. This indicated a need to integrate RH services into the PHC
delivery system in camps. Integration made it possible for health care
providers to better understand the refugee population and to collect data
necessary for a baseline survey while providing quality health care services.
|
Data collection
methods |
Initially, health providers in camps
spent a majority of their time developing relationships and gaining the
trust of female refugees. IMC developed a questionnaire designed to collect
detailed obstetric and gynecological histories. All female refugees were
encouraged to come for an exam and to complete the questionnaire as part
of their medical record. There was 100% compliance due to good relationships
developed between refugees and providers. Data collected included history
on: general health, obstetrics, gynecological problems, family planning
and breastfeeding.
|
Study or
program findings |
-
The Roma population consisted of 550 women
of reproductive age, which represented 24% of the total refugee population.
-
40% of the women had delivered at home
in Kosovo with lay attendants, despite the official Yugoslav statistics
showing 100% facility delivery. Roma in the Macedonia camps were more likely
to deliver in facilities.
-
Refugee women reported complex histories
of induced abortion.
-
There was high interest in family planning
methods among women 25-49.
-
Women aged 25-49 had high incidence of
gynecological problems.
-
Women were married and became sexually
active early in life.
-
"Law in Yugoslavia does not permit marriage
at a young age - that means all young people who get married do not register
with the government."
-
Early marriages led to: early start of
sexual activity, high rate of home deliveries in Yugoslavia since unregistered
couples could not seek medical assistance in government hospitals, a tendency
to change sexual partners as they get older.
|
Conclusions
and program
implications |
The RH program developed included
Maternal/Newborn Care classes, family planning counseling and care, treatment
of STDs, condom distribution and an education campaign.
The study helped in registering pregnant
women among Roma refugees. Monitoring indicators established early in the
program showed increased utilization of family planning methods and a decrease
in morbidity/mortality statistics compared to baseline information.
In stable refugee settings, medical
records may be used to document previous health history, which is useful
as a research tool for measuring the impact of health services.
|
For further
information |
Henia Dakkak, Women's Commission for
Refugee Women and Children, 122 East 42nd Street, 12th floor, New York,
NY 10168-1289 USA
Fax 212-551-3180
Email hdakkak@theIRC.org
|
|
| How-To Guide: Monitoring and evaluation
of sexual and gender-based violence programs
Abstract revision date: January 15,
2001
|
| Authors |
Beth Vann, UNHCR consultant
|
| Presenter |
Beth Vann
|
| Background |
In 1998, UNHCR was awarded a $1.65
million grant from the United Nations Foundation - funds provided by Ted
Turner - to strengthen sexual and gender violence (SGV) programming in
refugee situations. In Tanzania, a multi-sectoral prevention and response
programme is being implemented in 11 refugee communities with 480,000 refugees
from Burundi and the Democratic Republic of Congo. The programme involves
8 NGOs, UNHCR staff in all sectors, Tanzanian authorities and the 11 refugee
communities.
|
Purpose of study
or program |
UNHCR deployed a consultant (the author)
in early 2000 to assess program monitoring and facilitate development of
systems for multi-sectoral monitoring and evaluation of the program. |
Data collection
methods |
The first step was to gather information
on the specific SGV issues in this setting, program objectives and activities,
data collection and analysis systems, reporting/referral systems, and mechanisms
for program development, monitoring, and evaluation. Methods used to gather
this information included camp visits, stakeholder interviews, group discussions
and record reviews. UNHCR, NGOs, refugees and host government authorities
were involved in these discussions and reviews. |
Study or program
findings |
There is a broad array of activities
underway for prevention and response to SGV in all 11 camps. In general,
activities have been response-driven with less attention to the analysis
of data to guide prevention and target program strategies. There was no
consistent system for compiling data to analyze problems and plan program
activities. Each NGO and UNHCR field office classified and counted incidents
of SGV differently. Intended outcomes of program activities in each sector
and program-wide were not clearly defined or measured.
In general, it was impossible to review
reports and gather a clear picture of SGV in the camps in Tanzania - prevalence
rate, types, contributing or causative/risk factors, survivor and perpetrator
details, and outcomes.
Participatory meetings and workshops
were conducted with actors in all sectors to facilitate resolution of these
problems. With the emphasis on participatory design and active engagement
of all actors, program monitoring and evaluation mechanisms were developed.
Implementation of the new systems began in April 2000.
|
Conclusions and
program implications |
The Tanzania experience is not a unique
one. Similar observations concerning the challenges of data collection
and analysis and program monitoring and evaluation have been made in SGV
programs in other countries.
This How To Guide was developed
to offer the Tanzania experience as an example for other programs worldwide.
Hopefully, this will trigger dialogue and further steps in developing standard
definitions and prevalence calculations, designing program strategies and
evaluating outcomes and impact of multi-sectoral SGV programs in refugee
settings.
|
For further
information |
Beth Vann Bethv007@aol.com
Kate Burns, UNHCR, CP 2500, 1211 Geneva,
Switzerland
Telephone 41 22 739 8003
Fax 41 22 739 7371
Email burns@unhcr.ch
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Closing
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