Carry that Weight: Reproductive Health in Refugee Settings
Note: This piece was originally posted on the London School of Hygiene and Tropical Medicine’s MARCH (Maternal, Adolescent, Reproductive and Child Health) Centre blog on April 1, 2016.
Pregnancy is a stressful time. Even in the UK, where the risk of a serious complication such as infant mortality is ten times less than the global average, bringing a healthy child into the world makes significant and unique demands on a woman’s body. Even when women are able to achieve sufficient caloric intake, take all the appropriate prenatal vitamins, and deliver in the presence of skilled birth attendants, pregnancy still conveys risks, and safe delivery is never guaranteed.
These risks are greatly compounded for refugee women, whether in transit, in camps, or in new host countries. The current civil war in Syria has catalyzed the largest refugee crisis since World War II. Over 4.8 million registered Syrian refugees have left their home country since 2012, and another 6.5 million are internally displaced. All of these refugees have a right to health, but women and girls are often disproportionately affected by displacement and violence in refugee settings. According to the UN High Commission on Refugees nearly half a million of these refugee women are currently pregnant.
Pregnancy can be awe-inspiring and powerful, but in times of turmoil it can also be isolating, scary, confusing and dangerous. For pregnant refugee women, health risks increase across the board, from sepsis and tuberculosis to malnutrition and chronic disease. Heightened rates of sexual violence during displacement increase the risk of pregnancy among adolescents; a group already predisposed to birth complications and higher rates of maternal mortality. Among female refugees of reproductive age, lack of access to sexual and reproductive health services is the primary cause of morbidity and mortality.
Conflict often exacerbates existing inequalities. Many women and girls already face gender-based violence, employment discrimination, reduced access to healthcare and limited freedom over their own sexual and reproductive choices; these risksincrease during displacement. Health services in Turkey, Lebanon and Jordan, thethree countries bearing the lion’s share of the refugee burden, are already stretched imperceptibly thin.
The international community has yet to meet the financial needs of the current crisis, and in a world of limited resources, funding almost invariably fails to meets humanitarian need. The current refugee response in Syria is underfunded, understaffed and overworked. Health services in Turkey, Lebanon and Jordan have been stretched to their breaking points, and are still unable to accommodate the more than 3.6 million refugees currently seeking asylum in these three countries alone.
In such a setting, limited resources must be used as efficiently as possible. Focusing on women and girls doesn’t merely protect an already marginalized group — it can multiply health benefits, maximizing limited resources to gain the greatest quality of health for the greatest quantity of people. Providing family planning services to women of reproductive age can save lives and reduce numbers of unwanted pregnancies so that families can focus on feeding the children they have. Despite contraceptive use among 60 per cent of Syrian women prior to the conflict, only halfof that number of Syrian refugees use family planning services during displacement. This drop isn’t due to diminishing demand for family planning, but rather a drop in continuous healthcare and reliable supply of contraceptive care. For women who are already pregnant, access to antenatal care and nutrition can reduce health complications of both the mother and her forthcoming child.
To improve access, affordability and equity, the first step is information. Women need to know where to find safe and affordable health services where they can seek help without fearing discrimination. Once in host countries, refugees often don’t speak the local languages, aren’t familiar with the locations of clinics, and don’t know what their legal rights are when seeking sexual and reproductive care. Respondents to the refugee crisis often view patients as victims, but when empowered with information, women can play an active role in their own survival and flourishing.
On the other side of the patient-provider relationship, healthcare workers need to know women’s medical history, a routine task that becomes a challenge when patients are constantly on the move. Finally, humanitarian providers need to know how many people are pregnant and how many are seeking family planning services so that they can adequately prepare.
By collecting and providing the right information, hospitals and humanitarian groups will be able to meet the sexual and reproductive health needs of women and girls. Information and access are fundamentally intertwined, and both are necessary to improve health for the 2.4 million women and girls currently seeking refuge from Syria alone.
Brooke Watson is a graduate student studying epidemiology at LSHTM and a volunteer with EmpowerHACK, a London-based organization that brings designers, developers and humanitarian workers together and to improve the health and wellbeing of of displaced women and girls.