Women’s Commission Women’s Commission for Refugee Women and Children: for Refugee Women and Children:

Making Reproductive Health a Priority Making Reproductive Health a Priority for Refugee Women and Childrenfor Refugee Women and Children

Bixby Program in Population and Bixby Program in Population and Reproductive Health, UCLA School of Reproductive Health, UCLA School of

Public HealthPublic Health

18 October 200518 October 2005

Four program areas:Four program areas:

• • Detention and Asylum (U.S.)Detention and Asylum (U.S.) •• Children and Adolescents Children and Adolescents •• Protection and Participation Protection and Participation •• Reproductive Health Reproductive Health

Detention and Asylum (I)Detention and Asylum (I)

Detention and Asylum (II)Detention and Asylum (II)

Detention and Asylum (III)Detention and Asylum (III)

Children and Adolescents Children and Adolescents (I)(I)

Children and Adolescents (II)

Protection and Participation Protection and Participation (I)(I)

Protection and Participation Protection and Participation (II)(II)

Reproductive HealthReproductive Health(I)(I)

Reproductive HealthReproductive Health(II)(II)

Reproductive HealthReproductive Health(III)(III)

Reproductive HealthReproductive Health(IV)(IV)

Reproductive HealthReproductive Health(V)(V)

Reproductive HealthReproductive Health(VI)(VI)

Reproductive HealthReproductive Health(VII)(VII)

Inter-agency Global 10-Year Evaluation Inter-agency Global 10-Year Evaluation of Reproductive Health (RH) Services of Reproductive Health (RH) Services for Refugees and Internally Displaced for Refugees and Internally Displaced

Populations (IDPs)Populations (IDPs)  

Initiated in October 2002Initiated in October 2002  

Final report published November 2004Final report published November 2004

Overall ObjectiveOverall Objective

To evaluate the provision of RH To evaluate the provision of RH services to refugees and IDPs, services to refugees and IDPs, based on the framework for based on the framework for implementation outlined in the implementation outlined in the Inter-agency Field ManualInter-agency Field Manual

Inter-agency Global Evaluation Inter-agency Global Evaluation of RH Services for Refugees of RH Services for Refugees

and IDPsand IDPs

Component 2: Evaluation of Coverage of RH Component 2: Evaluation of Coverage of RH Services for Refugees and IDPsServices for Refugees and IDPs

Heilbrunn Department of Population and Family HealthHeilbrunn Department of Population and Family Health

Mailman School of Public HealthMailman School of Public Health

Columbia UniversityColumbia University

PurposePurpose

Determine current situation Determine current situation regarding availability of RH services regarding availability of RH services to conflict-affected populationsto conflict-affected populations

Identify the gaps in service provisionIdentify the gaps in service provision

MethodologyMethodology

List of countries and displaced populations List of countries and displaced populations compiled.compiled.Countries with a minimum of 10,000 Countries with a minimum of 10,000 refugees or IDPs included.refugees or IDPs included.OECD countries excluded.OECD countries excluded.Key informants identified in each country.Key informants identified in each country.Data collection March – May 2003.Data collection March – May 2003.Data analysis with EpiInfo 2002.Data analysis with EpiInfo 2002.

ResultsResults

Distributed in 73 Distributed in 73 countriescountries

188 questionnaires 188 questionnaires from 33 countries in from 33 countries in Asia, Africa, Latin Asia, Africa, Latin America receivedAmerica received

Represents 8.5 million Represents 8.5 million peoplepeople

Proportion of population covered by responses who

are…

Availability of the following services was Availability of the following services was investigated:investigated:

Family planningFamily planningSafe motherhood, including emergency obstetric Safe motherhood, including emergency obstetric carecareSTI/HIV/AIDSSTI/HIV/AIDSSexual and gender based violenceSexual and gender based violenceCross-cutting: needs of adolescentsCross-cutting: needs of adolescents

Proportion of sites where Proportion of sites where Safe Motherhood is availableSafe Motherhood is available

68%

32%

45%39%

0%

20%

40%

60%

80%

100%

2- 4 elements of ANC Comprehensive ANC

Basic EmOC Comprehensive EmOC

Proportion of sites where Proportion of sites where FP is availableFP is available

96% 95% 89%

53%

36%

94%

0%

20%

40%

60%

80%

100%

OCPs Condoms InjectablesIUDs Sterilization Counseling

Proportion of sites where Proportion of sites where STI/HIV/AIDS services are availableSTI/HIV/AIDS services are available

Con

dom

s, 9

4%

Uni

v. p

reca

utio

ns,

90%

IEC,

89%

STI

trea

tmen

t, 8

5%

Part

ner

trea

tmen

t,

70%

VCT,

35%

PMTCT,

20%

ARVs,

6%

0%

20%

40%

60%

80%

100%

Proportion of sites where Proportion of sites where GBV services are availableGBV services are available

57% 59%64%

60%

79%

0%

20%

40%

60%

80%

100%

Prevention Response Counselling EC I EC

LimitationsLimitations

Limited to sites where key informant took Limited to sites where key informant took time to respond.time to respond.Primarily refugees (82%) in camps (76%).Primarily refugees (82%) in camps (76%).Assessed only availability, not quality, Assessed only availability, not quality, detailed accessibility or usage.detailed accessibility or usage.Yes/No questions could have been Yes/No questions could have been interpreted differently.interpreted differently.Info on IDPs more difficult to get.Info on IDPs more difficult to get.Population numbers differed between Population numbers differed between reported and key informants on the ground.reported and key informants on the ground.

DiscussionDiscussion

Coverage of RH appears fairly good.Coverage of RH appears fairly good.

Coverage decreases with the newness of Coverage decreases with the newness of the technical area:the technical area:

– GBV: newest, least familiar, lowest GBV: newest, least familiar, lowest coverage; coverage;

– ANC: most standard, highest coverage.ANC: most standard, highest coverage.

HIV/AIDS, EmOC could (and should) be HIV/AIDS, EmOC could (and should) be better.better.

ConclusionConclusion

Given RHR in 1993, results are promising;Given RHR in 1993, results are promising;Even if overestimation, wide range and Even if overestimation, wide range and meaningful number of sites provide RH meaningful number of sites provide RH services;services;

BUTBUTExperience shows that attention must be Experience shows that attention must be maintained; andmaintained; andRecommend updating this database Recommend updating this database regularly.regularly.