Meeting the Reproductive Health Needs of Refugees

This 5-page article in PATH's Outlook, Vol. 17, No. 4 addresses the concerns of women escaping persecution, war, and violence, both as international and internally displaced refugees. According to the article, the breakdown of law and order, social norms, and family structures leads to high levels of violence against women and life-threatening reproductive health problems in the aftermath of conflict and flight. As stated in the article, refugee relief organisations have collaborated with reproductive health professionals to develop new strategies for meeting the reproductive health needs of displaced populations. They have developed the Minimum Initial Service Package (MISP).

MISP is a series of activities that requires advocacy, training, and the leadership of a reproductive health coordinator, as well as emergency supplies. It includes: •

• identifying lead organisation(s) and experienced individual(s) to coordinate and implement MISP; •
  
• preventing and managing the consequences of sexual violence; •
  
• reducing HIV transmission by enforcing universal medical precautions against HIV/AIDS (so that health workers do not take shortcuts under pressure of the emergency) and guaranteeing the availability of free condoms; •
  
• reducing neonatal and maternal mortality and morbidity by providing delivery kits for use by mothers, birth attendants, and midwives, and by developing a referral system for obstetric emergencies; and •
  
• planning for comprehensive reproductive health services, integrated into primary health care, as the situation permits.

From the article:

"Program and Policy Implications:

Offering basic reproductive health services during the earliest stages of a crisis minimizes serious illness and death, but it is just the first step in a larger commitment to refugee health care. The challenge for relief organizations is to create comprehensive health services to meet the needs of refugees who may be exiled for years and to ease their eventual return home. Standard elements of reproductive health care (including safe motherhood, family planning, and [sexually transmitted disease/infection] STD services) must be augmented with services addressing the violence, stress, and social disruption that refugees endure. Actively involving the refugee community in the design and implementation of services and making sure that women’s voices are heard can help ensure that services meet real needs, are culturally appropriate, and are acceptable to the community.

Emergency conditions pose a serious challenge to health care managers. Adequately trained and culturally sensitive staff, equipment and supplies, and infrastructure are all in short supply. Dozens of international, government, and non-governmental organization (NGO) relief agencies provide fragmented and overlapping services to each refugee population. Short-term funding, rapid turnover of relief workers, and the unpredictable future of displaced populations jeopardize the continuity of care and the sustainability of services.

Even in these conditions, organizations can create sustainable, high-quality services by drawing on local resources, tapping the experience of the wider public health community, and coordinating their efforts with other aid agencies. For example, international refugee, aid, and reproductive health organizations have joined together to create guidelines, needs assessment tools, training modules, and logistics management tools to improve health care services for refugees. These kinds of collaborative approaches, together with effective advocacy and leadership, are key to ensuring that refugees and displaced persons have access to quality reproductive health care."