Conference Proceedings 2000
Findings On Reproductive Health Of Refugees
And Displaced Populations
Washington DC | December 5-6, 2000
Co-hosted by InterAction and The Global Health Council
Abstracts of Poster Presentations
| Presenter | Title of Presentation |
| Sara Casey | RHR Consortium survey of refugee and IDP reproductive health services |
| Elizabeth
Coker
Jill Brennick |
Findings from a pilot study to develop a comprehensive research agenda in the area of fertility and reproductive health among asylum seekers and refugees in Cairo, Egypt |
| Henia Dakkak | Using quantitative and qualitative research techniques to design a sustainable RH project for the Roma population in Shito-Rizari, Macedonia |
| Henia Dakkak | Current overview of reproductive health assistance in Albania for coordination and planning services through questionnaire survey |
| Degni Filio | Childbearing and birth control experiences among Somali refugee women in Finland: A social and cultural challenge |
| Ani Gurciyan | Providing minimum reproductive health services to refugee populations: Evaluation of the Minimum Initial Service Package (MISP) |
| Tracey Lee | A comprehensive family planning and sexually transmitted disease service for Karen refugees |
| Aimee Lehmann | Expanding reproductive health services in refugee settings: Post-abortion care in two Kenyan refugee camps |
| Jacinta K. Muteshi | Sexual and gender-based violence in the Dadaab refugee camps: The challenges of FGC |
| Sam Posner | Differences between refugee/internally displaced and local Azerbaijani women: A comparison of demographics, behavioral factors and reproductive history |
| Kavita Singh | Child mortality estimation techniques in refugee and host populations |
| RHR Consortium
survey of refugee and IDP reproductive health services
Abstract revision date: January 15, 2001 |
|
| Authors | Sara Casey,
Rachel K. Jones, Sandra Krause
Women's Commission for Refugee Women and Children |
| Presenter | Sara Casey |
| Background | The Women's Commission for Refugee Women and Children, on behalf of the Reproductive Health Response in Conflict Consortium, conducted a survey of U.S.-based international NGOs and schools of public health to determine which ones are directly providing or indirectly supporting reproductive health services to refugees and/or IDPs. |
| Purpose of study or program | The purpose for gathering this information was to target reproductive health for refugees advocacy initiatives, and to find ways to foster greater cooperation and collaboration in reproductive health service delivery to refugees and IDPs worldwide. |
| Data collection
methods |
In August 2000, the survey was sent to 165 NGOs and schools of public health culled from members of InterAction and the Association of Schools of Public Health. 70 NGOs and 11 schools of public health participated in the survey representing a 48% response rate. We included in this list many NGOs and schools whose mandate included health or reproductive health, but whose mission may not have involved work with refugees or IDPs, a likely contributor to the low response rate. |
| Study or program findings | The percentage
of respondents who provide or support specific reproductive health services
for refugees follows: family planning (26%), HIV/STD (22%), Maternal and Newborn Care
(19%), emergency obstetrics (12%), SGBV (9%), services to youth (8%), and
MISP (4%). The primary roles of respondents in supporting or providing
reproductive health services to refugees or IDPs follow: training (31%),
technical assistance (22%), direct service provision (19%), advocacy (12%),
research (10%), and policy development (6%). The geographical distribution
of sites where the respondent organizations provide or support reproductive
health services shows a heavy concentration in Africa (52 projects in 18
countries), with a high presence in Eastern Europe and the former Soviet
Union (30 projects in 10 countries), followed by Asia (22 projects in 6
countries), Central and Latin America (8 projects in 3 countries), and
the Middle East, primarily work with Palestinians (6 projects in 4 countries).
42% of those currently supporting reproductive health services to refugees and IDPs do not yet have a copy of the Inter-agency Field Manual for Reproductive Health in Refugee Situations. 54% of respondents expressed interest in participating in further discussions. |
| Conclusions
and program implications |
|
| For further information | Rachel K. Jones,
Women's Commission for Refugee Women and Children, 122 East 42nd Street,
New York, NY 10168 USA
Telephone 212-551-3112 Fax 212-551-3180 Email rachel@theIRC.org |
| Findings
from a pilot study to develop a comprehensive research agenda in the area
of fertility and reproductive health among asylum seekers and refugees
in Cairo, Egypt
Abstract revision date: January 15, 2001 |
|
| Authors | Elizabeth M.
Coker, Ph.D., The American University in Cairo
Jill Brennick, MPH, Forced Migration and Health Program, Columbia University |
| Presenters | Elizabeth M. Coker and Jill Brennick |
| Background | As of May 2000 there were 2,688 registered Sudanese refugees in Cairo. However, many thousands more have either been denied refugee status, or are "sitting out" a waiting period which can be as long as one year. Consequently, thousands of individuals and families struggle to survive on little or no formal assistance, employed in the informal sector. In short, these individuals and families exist "in limbo" socially, economically and culturally. |
| Purpose of study or program | The purpose of this pilot study was to develop a research agenda to study patterns of familial adaptation, negotiation of gender roles and reproductive health issues among asylum seekers and refugees in Cairo. A central theoretical focus is that childbearing and other fertility-related issues must be understood in light of their cultural meaning for the family and society in question. |
| Data collection
methods |
The data for the present project were collected in Cairo, Egypt during June and July 2000. The study yielded qualitative and quantitative data from the following sources: in-depth interviews with Sudanese men and women; interviews with midwives and other professionals providing healthcare to refugees; focus group discussions with pregnant Sudanese asylum seekers; and home visits with families in the Cairo area. Home visits were made to mothers of new babies and Sudanese families. |
| Study or program findings | A striking
finding of the present study was the stated desire to limit family size,
an attitude that is unique to the refugee context. Therefore, reproductive
decision-making is an important area of familial adjustment for this population.
Prior to migration to Cairo, the most commonly practiced forms of birth
control were breastfeeding and abstinence. Now, many Sudanese women are
considering modern methods of birth control for the first time, as traditional
birth-control practices have broken down. Breastfeeding habits are also
changing. Employment options are limited, and, as women are able to find
work more easily than men are, some women are decreasing the duration of
breastfeeding so they can return to work. In order to provide for their
families, women are starting to switch over to formula soon after birth
so that they can return to work.
(The use of the terms "modern" and "traditional" in reference to types of birth control is consistent with the Reproductive Health Response in Conflict Consortium assessment tool. In this case traditional may include, but is not limited to, breastfeeding, calendar method and coitus interruptus. Modern may include oral contraceptives, injections, IUDs and condoms.) |
| Conclusions
and program implications |
The results of this study contribute to the body of literature concerning gender and family roles under conditions of forced migration, as well as the growing body of literature on urban refugee reproductive health. Finally, through this research we have gained insight into the specific needs of the growing refugee population in Cairo. |
| For further information | Elizabeth M.
Coker, Ph.D., The American University in Cairo, Department of Sociology,
Anthropology, Psychology and Egyptology
Tel: (20) 2 797-6154 Email: emcoker@aucegypt.edu Jill Brennick, MPH, Forced Migration and Health Program, Columbia University Research Fellow, School of Humanities and Social Sciences, The American University of Cairo E-mail: jb922@columbia.edu |
| Using quantitative
and qualitative research techniques to design a sustainable RH project
for the Roma population in Shito-Rizari, Macedonia
Abstract revision date: January 30, 2001 |
|
| Authors | Juileta Calvo,
International Rescue Committee, Macedonia
Henia Dakkak, Columbia University, New York |
| Presenter | Henia Dakkak |
| Background | Shito-Rizari is a neglected neighborhood in Skopje, Macedonia. The population of Shito-Rizari consists of around 40,000 people, mostly of Roma ethnic background and newly resettled Roma refugees from Kosovo. There is little reproductive health data available in Macedonia, especially for the Roma population which has historically been neglected. There is no data regarding their knowledge, attitudes and behavior (KAPB) related to reproductive health. In the past, most health programs in Macedonia that targeted the Roma population have failed either due to mistrust by the Roma population towards authority or to insensitivity to their culture and beliefs. |
| Purpose of study or program | The purpose of the study was to gather baseline information about KAPB of the Roma population regarding reproductive health issues. The study also aimed to show how utilizing sensitive approaches in data collection and early involvement of the Roma community in the design of data collection methodology would guarantee success in getting vital information about knowledge, attitudes and behaviors regarding reproductive health. |
| Data collection
methods |
Household KAPB
survey questionnaire of 600 Roma women of reproductive age (15-49 years)
from the host and refugee community of Shito-Rizari.
Focus Group Discussions Facility and health providers checklist In-depth interviews of 200 Roma women above the age of 35 for cervical cancer screening. |
| Study or program findings | 10% of women
interviewed were pregnant at the time of the data collection.
75% of respondents had heard about or knew the meaning of family planning. 52% reported having used a family planning method at some point. 42% are using some family planning method. 32% of the respondents who are using any method of family planning are using natural methods (coitus interruptus). 10% of the respondents are using modern contraceptive methods. Pills are the most commonly used, with IUDs and condoms used equally among the respondents to a lesser extent. The study showed that there is a lack of modern contraceptive usage among the Roma population and very high illiteracy that should be taken into consideration in designing programs to improve access to modern contraceptives. |
| Conclusions
and program implications |
Combining more than one research methodology is very helpful in getting in-depth information about the target population. Utilizing sensitive data collection strategies is important in achieving research results which will play a significant role for future program design, monitoring and evaluation. The importance of involving and utilizing local capacity in the research design and implementation is vital for community acceptance and entry. Creating a consortium-like effort in the field of reproductive health in Macedonia helped in identifying gaps that could be addressed by civil society and ones that could be addressed by the government. This research was part of the effort and initiative created by some of the member organizations of the Reproductive Health Response in Conflict Consortium in Macedonia during the Kosovo refugee crisis and in the post-crisis return period. |
| For further information | IRC- Health
Unit (Mary Otieno or Richard Brennan)
122 East 42nd St. New York, NY USA Phone: 212-551-3000 Fax: 212-551-3185 E-mail: maryo@theIRC.org or rbrennan@theIRC.org |
| Current
overview of reproductive health assistance in Albania for coordination
and planning services through questionnaire survey
Abstract revision date: December 5-6, 2000 |
|
| Authors | Henia Dakkak,
Columbia University
Sameh Yousef, International Rescue Committee, Albania Arian Pano, International Rescue Committee, Albania Alexander Sallabanda, International Rescue Committee, Albania |
| Presenter | Henia Dakkak |
| Background | During the spring of 1999, Albania hosted more than half a million Kosovar refugees, most of whom returned to Kosovo after the NATO intervention. The influx of refugees had exacerbated the already bad situation that had existed since the civil war and unrest in 1997. There is a large number of IDPs in Albania due to mass population movement from rural to urban areas because of the civil unrest. |
| Purpose of study or program | To map what services in RH assistance programs exist in Albania. There is fragmented information especially after the Kosovo crisis. There was a big influx of international NGOs into Albania during the refugee crisis, some of whom had left and some still remained in the country. There is a lack of information about local NGOs working in reproductive health. The aim of the overview is to gather information about agencies working in reproductive health, in order to build a platform for coordination and future planning. |
| Data collection
methods |
Survey questionnaire was used consisting of 29 questions that were distributed to 90 organizations (local, international and UN). The questionnaire was reviewed and coordinated with the UNFPA head of mission in Albania. |
| Study or program findings | There is a lack of coordination of reproductive health activities in the country, due to lack of coordination with the Ministry of Health. There is a concentration of activities in Tirana and some other major cities, with a severe lack in rural and remote areas. Reproductive health is still understood only as family planning programs by many agencies. There is a lack of emergency obstetric programs by local and international organizations. Maternal and Newborn Care is still understood as maternal and child health, with emphasis on child health. Post-natal care is non-existent. Almost all agencies agreed that there is a big need for coordination of reproductive health activities. |
| Conclusions
and program implications |
The survey questionnaire was a helpful tool to document the present situation of reproductive health assistance programs in Albania. It was helpful to gather this baseline information after the refugee crisis in order to get a real picture of the situation in the field. The information helped in creating a consensus among agencies about the need for coordination for quality service delivery. Funding for reproductive health is going to be a major issue for a lot of organizations in order to continue working in Albania. |
| For further information | IRC- Health
Unit (Mary Otieno or Richard Brennan)
122 East 42nd St, 12th Floor New York, NY 10168-1289 USA Phone: 212-551-3000 Fax: 212-551-3185 E-mail: maryo@theIRC.org or rbrennan@theIRC.org |
| Childbearing
and birth control experiences among Somali refugee women in Finland: A
social and cultural challenge
Abstract revision date: January 15, 2001 |
|
| Author | Degni Filio, Åbo Akademi University, Finland |
| Presenter | Degni Filio |
| Background | According to the Finnish National Population Register Center's figures of January 1, 1999, there are 6000 Somalis in the country, of whom 45% are children under the age of 16 and the proportion of men and women are equal (Statistics, Finland 1999). In their resettlement in Finland, the women's genital organ mutilation, which may affect the sexual and reproductive health of the majority of them is the central question of discussion; to that were added their social status and number of children (6-7 children per woman). While the women's issues preoccupied the Finnish political and health care policy makers, conflicts resulting from the Somalis' tradition and religion versus the Finnish liberal culture of women's birth control by the use of contraception worried the men and religious leaders as gate-keepers of their cultural, tradition norms and religious beliefs within their community. |
| Purpose of study or program | The aim of this research was to study the childbearing and birth control experiences among the refugee Somali women in Finland. I also wanted to improve the understanding of the readers regarding the Somalis' social, cultural and religious meanings of childbearing and birth control in their country of origin and the reasons for changes in Finland. |
| Data collection
methods |
All the participants arrived in Finland between 1990 and 1998. They were living in the cities of Helsinki, Espoo, Turku and Tampere, where the interviews were conducted between March 1997 and June 1998. Two Somali interpreters were recruited to assist me to collect information. One hundred and seventy nine (179) persons participated. The female participants were selected according to their age (18-44 years old), single and married. The male participants were also selected based on the same criteria and were contacted by the male assistant. All interviews varied in length from two to six hours, depending on the respondents' time and willingness to talk about the research problems. Revelations of new beliefs and experiences characterized the data collection that was then analyzed using the Grounded Theory technique. The family planning medical professionals (34 persons) gynecologists, obstetricians, midwives and nurses involved with Somali women were interviewed. All the participants were assured of the confidentiality of any information they gave. The investigation with the medical professionals received approval from the Ethical Research Community of each municipality medical center. |
| Study or program findings |
|
| Conclusions
and program implications |
This study showed that a process of adaptation in which changes in the family structure are taking place as Somalis acquire new skills and new attitudes as a consequence of their exposure to a new and dominant culture. Somalis -- men and women -- are started to establish control over their lives by studying and acquiring a degree or profession to establish new social status and position in the household. These expectations have had an impact as the women attempt a reinterpretation of their traditional role of childbearing in Finland, though some explained that they could not regularly attend Finnish language courses because they were frequently pregnant. The striking findings were Somalis' new interpretation of gender relationships and childbearing experiences in Finland. The largest proportion of contraceptive users were the married women (with 4 to 7 children) with the consent of the husbands. |
| For further information | Degni Filio,
Ph.D. candidate, Population and Reproductive Health, Department of Social
Sciences
Åbo Akademi University, Piispankatu 15, 20500 Åbo/ Turku, Finland Tel +358 2 2153291 Fax +358 2 2154802 E-mail: fdegni@abo.fi |
| Providing
minimum reproductive health services to refugee populations: Evaluation
of the Minimum Initial Service Package (MISP)
Abstract revision date: January 15, 2001 |
|
| Authors | Ani Gurciyan, Mary Otieno |
| Presenter | Ani Gurciyan |
| Background | The Minimum
Initial Service Package (MISP) was designed by the Inter-Agency Working
Group on Refugee Reproductive Health spearheaded by the United Nations
High Commissioner for Refugees (UNHCR) and the United Nations Population
Fund (UNFPA) to respond to the reproductive health needs of populations
in the early phase of a refugee situation. The MISP is not just kits of
equipment and supplies; it is a set of activities that must be implemented
in a coordinated manner by appropriately trained staff. The objectives
of the MISP are to:
|
| Purpose of study or program | To evaluate the implementation of the MISP as part of the International Rescue Committee's (IRC) reproductive health program in Kenema District, Sierra Leone. The MISP includes 12 subkits, which can be ordered separately from the United Nations Population Fund (UNFPA). These subkits contain pre-packaged materials and supplies to suit the needs of the targeted population. IRC Sierra Leone procured subkits 0 to 5 related to: training and administration, condom use, clean delivery (individual), post-rape, oral and injectable contraception, sexually transmitted diseases, and delivery at health facility, in order to implement the MISP activities. |
| Data collection
methods |
Interviews with key informants: Reproductive Health Coordinator, administrators and community-based outreach workers. |
| Study or program findings | The work that IRC is doing in traditional birth attendant (TBA) training, family planning and sexual and gender-based violence was found to be working to address urgent and overwhelming needs. However, the lack of primary health care (PHC) services at the community level constrains the implementation of the MISP. The negative consequences of providing the MISP kits in rural communities where there are no primary health care services available should be carefully considered. |
| Conclusions
and program implications |
Although funds for comprehensive services are severely lacking, the program must expand, integrate with primary health care and collaborate more with other organizations and the Ministry of Health to meet the needs. The program is being revised accordingly. |
| For further information | Mary Otieno,
Reproductive Health Program Officer, International Rescue Committee, 122
East 42nd St., New York, NY 10168-1289 USA, Tel: 212-551-3000,
Fax: 212-551-3185
Email: maryo@theIRC.org |
| A comprehensive
family planning and sexually transmitted disease service for Karen refugees
Abstract revision date: December 5-6, 2000 |
|
| Authors | T. Lee, D.D. Cho, N. Lay Hter, R. McGready, and F. Nosten; Shoklo Malaria Research Unit |
| Presenter | Tracey Lee |
| Background | While international agencies advocate integration of reproductive health (RH) services into refugee assistance programmes, in practice, specific RH services that address family planning (FP) and sexual health needs are infrequently provided. |
| Purpose of study or program | In this paper we describe the initiation of an FP and sexually transmitted disease (STD) service in an essentially naive population of Karen, long-term displaced persons, on the western border of Thailand. |
| Data collection
methods |
From inception
of the service in May 1996 to August 1998, 1509 'clients' voluntarily sought
FP services at clinics adjoining established maternal and child health
clinics. Following education regarding FP options, interviews, counseling
and physical examination, clients chose a method of contraception. Follow-up
remained voluntary and all services were provided free of charge. Counseling
and treatment for sexually transmitted diseases (STDs) were provided on
the same basis.
Contraceptive method mix included: natural family planning; condom; monophasic oral contraceptive (30mcg Ethinyloestradiol); Depot medroxyprogesterone acetate (150mg, three monthly injection); NORPLANTÒ ; Intra Uterine Device (IUD, Multiload - 250Ò ); vasectomy and tubal ligation via mini-laparotomy. |
| Study or program findings | The cohort
comprised 1495 women and 14 men. Median age of clients was 26 (range, 14
- 46); 10% were adolescents and 14% thirty-five or older. Nulliparous women
comprised a small proportion of those seeking services (2%). Parous women
proportioned as follows: 1 child, 22.4%, 2-3 children, 39.6%, 4 or more
children, 36%.
Women sought to space their births by a median of 4 (1-10) years. Depo-provera was the most frequently requested contraceptive and NorplantÒ was more popular than IUDs for long-term contraception. 229 women stated they had finished their family, though almost 20% of these (n = 43) were afraid of undergoing sterilisation; 40% (n = 108) requested sterilisation and the remainder chose an alternative contraceptive method. Approximately 8% of women were using modern methods of contraception at the initial consultation. Within the first twenty-eight months of the programme, the contraceptive prevalence rate rose to almost 21%. Three-quarters of consultations were for contraceptive supply. Other reasons for utilising the service were to seek contraceptive advice or treatment for a range of medical conditions. Sexually transmitted diseases were infrequently noted in this community. |
| Conclusions
and program implications |
FP & STD services offered to this Karen population as a component of an established RH program, were well accepted and supported. Apart from contraceptive supply, the clinic served as a center for education, counselling and women's health. |
| For further information | Tracey Lee,
Shoklo Malaria Research Unit, PO Box 46, Mae Sot, Thailand 63110
Email: shoklo@cscoms.com |
| Expanding
reproductive health services in refugee settings: Post-abortion care in
two Kenyan refugee camps
Abstract revision date: December 5-6, 2000 |
|
| Author | A. Lehmann, K. Otsea, Ipas |
| Presenter | Aimée Lehmann |
| Background | Complications from unsafe abortion are well documented as one of the major contributors to maternal morbidity and mortality worldwide. Through displacement and resettlement, refugee women may be at higher risk of unwanted pregnancy and unsafe abortion given the disruption of cultural and social networks, increased risk of sexual violence, lack of health care structure and limited or nonexistent provision of contraceptive supplies. Recent recommendations for abortion care have been included in refugee literature, based on the 1994 ICPD program of action that states: "In circumstances where abortion is not against the law, such abortion should be safe. In all cases women should have access to quality services for the management of complications arising from abortion. Post-abortion counseling, education and family planning services should be offered promptly which will also help to avoid repeat abortions." |
| Purpose of study or program | The purpose of the program was to establish integrated post-abortion care (PAC) into existing refugee reproductive health services, based on the available health care providers and infrastructure of the two camps. PAC implementation focused on training doctors and mid-level providers in Manual Vacuum Aspiration (MVA), counseling skills and management of complications. MVA was promoted as a non-surgical, low-technology resource for these settings, and training was designed to link clients to other reproductive health information and services. |
| Data collection
methods |
Based on the recommendations for incorporation of PAC services into refugee reproductive health services, Ipas trained twenty-two health care providers in two refugee camps in Kenya in the treatment of post-abortion complications, family planning provision and linkages to other reproductive health services. |
| Study or program findings | MVA was proven an appropriate post-abortion care technology for these refugee settings. Providers were able to increase on-site reproductive health services to the refugee women, and provide links to other services, including contraception. Training and implementation of services was done in collaboration with local government and non governmental organizations and was supported by providers, clients and administrators. Specific challenges to implementing PAC services in refugee settings were also noted, especially issues of high medical staff turnover, the need for on-the-job training (OJT) to maintain sustained services, and a lack of client information and education around available reproductive health services. |
| Conclusions
and program implications |
Post-abortion care can be provided on-site in refugee settings along with other existing reproductive health services using appropriate technology and focusing on mid-level health care providers. A specialized training approach should be considered to address issues of staff turnover. Community education on PAC and RH services should be included in such interventions. |
| For further information | Aimée
Lehmann and Karen Otsea
Ipas 300 Market St, Suite 200 Chapel Hill, NC 27516 USA Tel. 919-967-7052 Fax 919-929-0258 Email: Lehmanna@ipas.org or Otseak@ipas.org |
| Sexual and
gender-based violence in the Dadaab refugee camps: The challenges of FGC
Abstract revision date: January 15, 2001 |
|
| Authors | Jacinta K.
Muteshi, Ph.D. (CARE-International)
Susan M. Igras, MPH (CARE-USA Health Unit) Saida Ali, BSW (CARE-Kenya Refugee Assistance Program) |
| Presenter | Jacinta Muteshi |
| Background | Recognizing Female Genital Mutilation (FGC) as a human rights issue and harmful traditional practice with short- and long-term psychological and physical health effects upon girls and women, a multi-country project and concurrent operations research study was developed. Baseline research findings from the Dadaab refugee camps in Kenya are presented, of communities where CARE and the National Council of Churches of Kenya (NCCK) have begun to expand prior NCCK activities on FGC. |
| Purpose of study or program | Using an experimental research design, the effectiveness of an education program using behavior change communication approaches in one camp will be compared to an education program coupled with community-level advocacy activities in a second camp. Education and advocacy interventions are designed to improve awareness of, create debate and support actions to combat the harmful effects of FGC, eventually leading to abandonment of the practice. |
| Data collection
methods |
Two rounds of qualitative research occurred: the first focused on knowledge, beliefs, attitudes, and values associated with FGC; the second focused on how people defined human rights, rights to health, rights of women and children. CARE designed an Operations research study and a randomly sampled survey of 1298 Dadaab refugee men and women was conducted, establishing a quantitative baseline. |
| Study or program findings |
|
| Conclusions
and program implications |
The underlying principle of FGC abandonment strategies is that change has to come from within the community. Outreach activities need to provoke debate and discussion while providing information and new ideas (e.g., rights related to health) to inform debates and decisions. Reinforcing positive, unharmful reasons and values associated with circumcision are important. |
| For further information | Dr. Jacinta
Muteshi, (Regional Study Co-ordinator-CARE), P.O. Box 43864, Nairobi, Kenya.
Phone: (254-2) 724628 Fax: (254-2) 728493 Email: muteshi@care.or.ke Susan Igras Email: igras@care.org Saida Ali Email: care-ddb@nbnet.co.ke |
| Differences
between refugee/internally displaced and local Azerbaijani women: A comparison
of demographics, behavioral factors and reproductive history
Abstract revision date: December 5-6, 2000 |
|
| Authors | SF Posner,
Centers for Disease Control and Prevention, National Center for Chronic
Disease Prevention and Health Promotion
J Kerimova, Relief International J Schmidt, S Hillis, CDC, National Center for Chronic Disease Prevention and Health Promotion S Meikle, National Institutes of Health J Lewis, CDC, National Center for Infectious Disease A Duerr, CDC, National Center for Chronic Disease Prevention and Health Promotion |
| Presenter | Sam Posner |
| Background | In most refugee crises international aid organizations prioritize efforts to provide for health care and other services to refugees. Previous reports suggest that the host populations often have less access to health care and development programs than the refugees they are hosting. |
| Purpose of study or program | The purpose of the present study was to compare local and internally displaced (IDP) women living in Azerbaijan with respect to economic, demographic characteristics and reproductive health outcomes. Nearly one million people were displaced for the past 6 years because of the conflict with Armenia. |
| Data collection
methods |
A total of 701 local and IDP women who attended one of four reproductive health clinics participated in this study. Bivariate analysis was conducted to identify disparities between the local and IDP women. The internally displaced women lived in newly built settlements or other existing buildings rather than controlled access camps. |
| Study or program findings | There were few differences among IDP and local women on behavioral and demographic factors. The IDP women reported significantly worse economic indicators including employment status, income, home ownership and not having enough money for food (p < 0.01 for all comparisons). The two groups of women reported similar reproductive histories. The local women were: 1) more likely to report using Ministry of Health hospitals for abortion services, 2) self report lower abdominal pain in the last year, and 3) be diagnosed with PID at the study visit using a modified version of Hager's criteria (p < 0.05 for all comparisons). IDP women were more likely to be diagnosed with bacterial vaginsosis and trichomoniasis (p < 0.01 for both comparisons). |
| Conclusions
and program implications |
The data collected in this study suggest that IDP women in this chronic setting are economically disadvantaged, have less access to Ministry of Health services and are at higher risk for most sexually transmitted diseases (STDs). This study demonstrates the need for ongoing efforts to provide access to reproductive health care for both local and IDP women. Furthermore, intervention programs to reduce risk for STDs among these women are urgently needed. |
| For further information | Sam Posner,
Centers for Disease Control and Prevention, National Center for Chronic
Disease Prevention and Health Promotion, 4770 Buford Highway Mail Stop
K-34, Atlanta, GA 30341-3724 USA
E-mail: shp5@cdc.gov |
| Child mortality
estimation techniques in refugee and host populations
Abstract revision date: December 5-6, 2000 |
|
| Authors | Kavita Singh, Unni Karunakara, Gilbert Burnham and Kenneth Hill, The Johns Hopkins School of Hygiene and Public Health |
| Presenter | Kavita Singh |
| Background | Because children comprise a large proportion of refugee populations and because they suffer high mortality, it is imperative that their health needs be addressed. Current methods of under-five mortality calculation have tended to rely upon hospital and burial records and population counts, though they are acknowledged to be unreliable. I propose the use of three indirect techniques - The Brass Indirect Method, The Time Since First Birth Technique and The Preceding Birth Technique. These techniques do not suffer from selection bias, which is found in hospital and burial data, and they render independent population counts unnecessary. They can be used in conjunction with some simple migration data to obtain estimates pertaining to women living in particular residential arrangements and to women stratified by their migration status. |
| Purpose of study or program | Precise under-five mortality rates could give donors and relief workers an idea of how to best allocate resources and plan health intervention programs. |
| Data collection
methods |
Data for this
paper comes from The Demography of Forced Migration Project, a study aiming
to understand how migration affects fertility, mortality and violence in
refugee and host populations. Fieldwork for the project was conducted in
Arua District, Uganda and Yei River District, Sudan between September 1,
1999 and March 4, 2000. A multi-stage sampling frame was employed to administer
questionnaires to men and women in six study populations: 1) Ugandans living
in the absence of refugees, 2) Ugandans living in the presence of settled
refugees, 3) Ugandans living in the presence of self-settled refugees,
4) Sudanese refugees living in a settlement, 5) Sudanese refugees who are self-settled, and 6) Sudanese living in Sudan. A total of 3,354 interviews were conducted. |
| Study or program findings | Findings for this paper are still being analyzed. However, preliminary results suggest that refugees and nationals in Uganda have had similar mortality in the past five years, while Sudanese children in Sudan suffer higher mortality. The data is currently being stratified so that mortality rates can be calculated for women by particular migration and residential status. |
| Conclusions
and program implications |
This paper has the potential to improve upon current methods of mortality estimation in displaced populations. The paper will also yield data on how migration affects mortality and how residential arrangement impacts mortality in refugee and host populations. Data on these issues is virtually non-existent so this paper hopes to make a significant scientific contribution. |
| For further information | Kavita Singh,
3501 St. Paul St., Apt. 948, Baltimore, MD 21218 USA
Tel. (410) 366 0296, Email: ksingh@jhsph.edu |
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