General Reproductive Health

Key Messages

• Reproductive health (RH) is a human right articulated in international law.[1]
• RH problems are the leading cause of women’s ill health and death world-wide.[2]
• RH care and rights afford women and young people opportunities to overcome poverty.[3]
• RH care for displaced persons is not a luxury but a primary health care necessity, which saves lives and dramatically reduces ill health.
• In displaced settings, it is imperative that comprehensive RH services are in place to prevent compounding the suffering of displaced women.
• Reproductive health services entail much more than rudimentary maternal and child health services often provided in displaced settings, including family planning, emergency obstetric care, post-abortion care, preventing gender-based violence and providing care to survivors, and prevention and management of sexually transmitted infections (STIs) including HIV.
• Women bear a disproportionate amount of the hardships that affect families in displaced settings as well as the greatest burden of reproductive ill health.
• Internally displaced populations (IDPs) and refugees not living in camps are particularly neglected groups and should be specifically targeted for RH care and services.

Overview

Forced displacement from homes, exposure to violence, poverty and separation from families and communities cause refugees and IDPs to face extraordinary difficulties that affect their reproductive health. They often lack sufficient protection, access to health care and education, livelihoods and community support. They are more vulnerable to sexual violence by armed forces and others and face increased risk to exploitation in the absence of traditional socio-cultural constraints.  While significant progress has been made in advancing and raising awareness about RH in conflict-affected settings in recent years, poor RH is a significant cause of death and disease in camp settings once emergency health needs have been met. Lack of quality RH services, faced by most displaced women and girls, can lead to high mortality rates among women and children, an increase in the spread of STIs, including HIV/AIDS, an increase in unsafe abortions and increased morbidity related to high fertility rates and poor birth spacing. Women and girls fleeing conflict also lack access to safe childbirth and emergency obstetric care.

Facts

Global Statistics

• Every minute one woman dies of pregnancy-related causes adding up to half a million mothers lost each year leaving millions of children without their primary care taker. Ninety-nine per cent of these deaths occur in developing countries.[4]
• Even in stable situations, sexual and reproductive ill health account for one third of the global burden of disease among women of reproductive age and one fifth of the burden of disease among the overall population.[5]
• An estimated 120 to 150 million women who want to limit or space pregnancies are still without the means to do so effectively.[6]
• Twenty million unsafe abortions occur every year—55,000 each day—resulting in some 80,000 deaths and hundreds of thousands of disabilities.[7]
• The leading cause of death among teenage girls in developing countries is pregnancy and childbirth. Each year one million babies born to young mothers and 70,000 girls under 20 years old die in childbirth related complications.[8]
• Women who experience domestic violence by their partners have a 50 percent increased risk of contracting HIV.[9]
• The total fertility rate (average number of births per woman) has fallen from over six in the 1960s to under three per woman today in developing countries. However, in the least-developed countries, fertility remains high at five births per woman.[10]

Refugee/Internally Displaced/Conflict-affected Statistics

• Approximately 80 percent of refugees are women and children.[11]
• High birth rates and a high incidence of HIV/AIDS are among the key factors that predispose a country for civil conflict. Countries with access to adequate RH care and education for girls have more stable populations and are far less likely to experience civil unrest.[12]
• Ninety percent of all victims of conflict are civilians, and the poorest one-sixth of the world’s population experiences 80 percent of the world’s civil wars.[13]
• An estimated 20 percent of women of reproductive age in a refugee population will be pregnant at any one time.[14]
• Fifteen percent of all pregnant women, including displaced women, suffer from unforeseen complications of pregnancy and delivery that require essential obstetric care.^[15]
• A recent report indicates that 33 out of 50 countries affected by conflict rank lowest in mother and children's indicators of well-being, including health, contraceptive use and infant mortality.[16]
• Reproductive health-related causes were the leading cause of mortality (at 22 percent) among Afghan refugee women of reproductive age in Pakistan.[17]
• Research shows that infant and maternal deaths among Burundian refugees in Tanzania accounted for 15 percent of all deaths during the study period.[18]
• Reproductive health outcomes in refugee and internally displaced populations in post-emergency phase camps are better than those of their respective host country and country-of-origin populations.[19]

Case Studies

Health education helps prevents early marriage and teenage pregnancy
Salimatu, a 13-year-old Sierra Leonean refugee girl in Liberia, woke up one morning and saw her underwear and bed sheet spotted with blood. She started to scream for fear that she was wounded and went to her stepmother for help. Sali’s stepmother told her that she must have had sex the day before in order for her to bleed in that manner, and therefore must identify the man involved. Sali burst out into tears, not understanding her stepmother’s reaction. The stepmother further told Sali her marriage arrangement would be made as soon as the man was identified.

During this process, a peer counselor from an NGO, Reproductive Health Group, stopped by to talk to Sali about the situation. Sali explained with anxiety and fear her stepmother’s remarks. After their discussion, the peer counselor explained to Sali and her stepmother that menstruation is a normal part of the female reproductive process. She also explained the importance of personal hygiene and what girls should expect after beginning to menstruate. She later referred Sali and her stepmother to the nurse-counselor for detailed information on the sexual development process. The nurse explained to Sali and her stepmother the dangers of early marriage with subsequent teenage pregnancy. In addition, she recommended the use of condoms to protect against STI/HIV/AIDS and unwanted pregnancies and described other family planning methods.

Making a difference with reproductive health services in Sierra Leone
Comfort is 20 years old and lives in Sierra Leone. She was forced to turn to sex work when her husband was killed in the civil war and she fled her home, afraid of reprisals by the rebels. She is the sole caretaker of her 3-year-old son. Before the Marie Stopes International (MSI) clinic began providing services close to Comfort's home, she didn't have anywhere to go for health care for her or her son. Comfort says she is at ease talking about her problems and concerns with the local MSI team that provides RH services in her area. In addition to receiving care for her son, she is also able to obtain contraceptive pills, condoms, treatment for STIs and information on how to protect herself from STIs such as HIV/AIDS. "MSI cares for people like us; before we had nowhere to go, no one understood that we had health care needs and they looked down on us," she says.

Resources

Click here for more resources on general reproductive health.

Updated September 2006