Closing the Gap: Ensuring Access to Reproductive Health Services for Syrian Refugee Women in Lebanon
By Jannath Kaur Chhokar
The Syrian refugee crisis has resulted in a surge of refugees in Lebanon, predominantly women and children. Syrian refugee women encounter various obstacles in accessing reproductive health services essential to women’s health. These obstacles arise from economic, social, and political factors. This piece emphasizes the significance and urgency of providing access to reproductive health services for Syrian refugee women in Lebanon. Evidence-based recommendations are presented in this analysis to improve access to reproductive health services for this vulnerable population.
Introduction
Since the start of the conflicts in Syria in 2011, more than 13 million Syrians have been displaced, with 1.5 million taking refuge in Lebanon, making it the country with the highest number of Syrian refugees per capita. This has significantly strained Lebanon’s current overburdened healthcare system, leaving many refugees vulnerable to health risks associated with displacement. Women are particularly vulnerable in times of conflict and displacement, facing limited access to often overlooked reproductive health services. Access to reproductive health services is a fundamental right for all women, including refugees. However, Canada’s Feminist International Assistance Policy has outlined various obstacles to accessing these services, such as financial, cultural and social barriers and limited availability of services. Lebanon’s lack of access to essential reproductive health services, including family planning, prenatal care, and safe delivery services, puts the health and well-being of refugee women at risk and has severe implications for their families, communities, and society. This puts them at risk of unplanned pregnancies, unsafe abortions, sexually transmitted infections, maternal mortality and morbidity under challenging conditions during displacement.
Access to reproductive health services for Syrian refugee women in Lebanon is a critical issue for several reasons:
- Everyone has the right to access quality reproductive health care regardless of background.
- Reproductive health services are essential for women’s overall health and well-being, especially in conflict and displacement, where women are at higher risk of sexual and gender-based violence.
- Improving access to reproductive health services for Syrian refugee women can improve health outcomes, promote economic and social stability in host communities, and benefit society.
- Syrian refugee women in Lebanon have higher maternal mortality and morbidity rates than Lebanese women, highlighting the urgent need to improve access to reproductive health services.
The reproductive healthcare services available to Syrian refugee women in Lebanon are crucial for their health and well-being. However, a 2018 study by United Nations Women found that although 65% of Syrian refugee women in Lebanon were aware of the services, only 34% accessed and utilized them. This indicates significant gaps in the utilization of reproductive services. Moreover, 53% of women reported that their health needs were only partially met, and 5% reported that they were not. The study also revealed that unmarried women and those living in formal settlements were less likely to use these services. In addition, many women could not, despite wanting to access reproductive healthcare services. Therefore, policymakers and healthcare providers must work to improve the availability, accessibility, and quality of reproductive healthcare services for Syrian refugee women in Lebanon.
The COVID-19 pandemic and the economic crisis have further exacerbated the situation, with many women in Lebanon unable to access reproductive healthcare services due to mobility restrictions and a lack of resources. For example, a recent study showed that 84% of women were affected regarding access to antenatal care due to the economic crisis. These challenges and the existing shortcomings in reproductive services put women at risk for adverse health outcomes.
There is currently no national strategy in Lebanon to address the healthcare needs of Syrian refugees. As a result, the United Nations High Commissioner of Refugees (UNHCR) works with relevant ministries and NGOs to cover up to 75% of referral care costs for refugees. While Lebanon has adhered to its policy of not setting up official refugee camps, almost 900,000 registered Syrian refugees have settled in different parts of the country, including cities, villages, and informal self-built tented settlements. However, the government has prohibited the creation of formal refugee camps or field hospitals, placing the entire medical responsibility on Lebanon’s previously overburdened healthcare system. In addition, only a limited number of mobile clinics and medical centres offer primary healthcare services to Syrian refugees, which the UNHCR and its affiliates provide. However, these facilities do not provide secondary or tertiary services.
It is essential to address these issues urgently to improve the health and well-being of Syrian refugee women in Lebanon. Thus, policymakers should work together to ensure that reproductive healthcare services are accessible, of high quality, and meet the needs of Syrian refugee women. It is imperative to ensure these women have access to the care they need to make informed decisions about their reproductive health and lead healthy and fulfilling lives. These efforts align with the United Nations Sustainable Development Goals (SDGs), specifically, SDG 3, which focuses on achieving good health and well-being for all, while SDG 5 emphasizes gender equality and empowerment for women and girls.
As the available evidence suggests, the limited access to reproductive health services for Syrian refugee women in Lebanon can be attributed to several factors. First, many Syrian refugee women in Lebanon cannot afford reproductive health services due to low income and high healthcare costs, leading to delays or avoidance of care. Additionally, Lebanon’s healthcare system has experienced a significant decline, with medication prices increasing as government subsidies have been reduced, resulting in many families being unable to afford healthcare. Reproductive health services are not widely available in some areas of Lebanon, particularly in rural regions where most refugees reside. This lack of availability is further compounded by a lack of awareness among Syrian refugee women about the available services due to insufficient outreach and information. In addition, the healthcare infrastructure in these areas is insufficient to meet the demand for reproductive health services. Finally, Syrian refugee women may face cultural barriers that prevent them from accessing reproductive health services. Some women are not permitted to see male healthcare providers, while others are not allowed to leave their homes without a male guardian.
There are several policy recommendations to improve reproductive health services for refugees. One suggestion is to increase funding for health programs and establish health insurance schemes to provide financial support. Initiatives for female refugees, for example, have focused on funding for health program activities in conflict settings. Allocating funds to these programs can promote and enhance safe reproductive practices and the availability of necessary healthcare materials for Syrian refugee women in Lebanon. Investing in such initiatives can empower and protect reproductive health and well-being. Providing free or subsidized services and transportation vouchers can also improve access to reproductive health services. Another recommendation is to establish mobile health clinics and increase the number of female healthcare providers in areas with high refugee populations. Outreach programs can also be expanded to improve availability. In addition, community-based education programs should be implemented to address cultural barriers and dispel misconceptions. Initiatives for unregistered pregnant Syrian refugee women, for example, have focused on implementing a community-based program that utilizes peer educators and mobile technology to address the risks of negative maternal and neonatal outcomes in Baqaa, Lebanon. Again, this recommendation is relevant to this paper’s context because it suggests the possibility of expanding outreach programs in Lebanon to improve the accessibility of care for all Syrian refugee women. Finally, healthcare infrastructure can be strengthened by renovating facilities, increasing healthcare providers, and improving service quality to meet the demand for reproductive health services.
Conclusion
The lack of access to reproductive health services has significant implications for the health and well-being of Syrian refugee women in Lebanon. For example, women are at a higher risk of pregnancy-related complications and maternal mortality without adequate reproductive health services. Additionally, inadequate access to family planning services can lead to unintended pregnancies, which can have adverse social and economic consequences for women and their families. Therefore, improving access to reproductive health services for Syrian refugee women in Lebanon is crucial for promoting gender equality, empowering women, and enhancing the health and well-being of women and their families. However, addressing Syrian refugee women’s challenges in accessing reproductive health services requires a comprehensive and coordinated approach involving policymakers, healthcare providers, and community leaders. By implementing evidence-based recommendations, policymakers and healthcare providers can ensure that Syrian refugee women in Lebanon have access to the reproductive health services they need to lead healthy and productive lives.
Jannath Chhokar is a graduate student at McMaster University pursuing a Master of Science in Global Health.
