Refugees Magazine Issue 95 (The international year of the family) - Birth spacing and health care for refugee women

Refugees (Issue 95, I - 1994)

Reproductive health care is urgently needed and wanted in refugee settings around the world.

By Ann Craig
Women's Commission for Refugee Women and Children, New York

Refugee women and children are at once war's most visible and its most neglected victims. While they provide the grimly poignant photographs that illustrate our daily news, their special needs go largely unstudied and unmet. Since the Bosnian conflict, with its horrifying accompaniment of widespread rape, the international community has awakened to the need for women's trauma counselling and social support services in the aftermath of civil strife.

But women displaced by war have other special needs as well, needs less newsworthy than trauma counselling, but just as specific to their lives. Chief among these is the need for family planning, prenatal and postnatal care, and other reproductive health services.

For some refugees, the lack of these services is a continuation of the conditions that existed before they were driven from their homes. For others, who were once able to take these services for granted, their absence merely adds to the list of their difficulties. But for all of them, the lack of these services poses a significant health risk.

Without pre- and post-natal health care, mortality rates for women and children are high. Without birth spacing services, refugee and displaced women are unable to avoid frequent, high-risk pregnancies in situations already adverse because of dislocation, physical danger, and minimal food, shelter, and sanitation.

In situations like Bosnia, where family planning was once commonplace, the sudden absence of services has caused the abortion rate to skyrocket. The lack of certain forms of contraceptives and accompanying information about AIDS and sexually transmitted diseases leaves women more vulnerable to infection.

Reproductive health care is urgently needed and wanted in refugee settings around the world. Hardly any humanitarian relief agencies are providing it. The reasons range from a "war/disaster mentality" that does not see the issue as a priority, to the trickiness of meshing reproductive health programmes with values and traditions of the population involved, to the strictly practical problems of cost and logistics. The result is a situation in which, despite a dawning awareness of the issue by relief officials, too little is known and too little is done.

To address this problem, the New York-based Women's Commission for Refugee Women and Children has launched an ambitious research project and has begun to map women's reproductive health needs in refugee and displaced populations around the world. Under a grant from the Mellon Foundation, members of the commission, and leading experts in women's health have begun a series of site visits to determine what kinds of reproductive health services women want and need, how successful the few existing programmes are, how much new programmes would cost, and what special logistical problems would be involved.

In the fall of 1993, a Women's Commission group visited refugee settings in Rwanda, Kenya, Côte d'Ivoire, Pakistan, Bosnia, and Croatia. Early this year, they will make trips to Thailand, Cambodia, Belize, and Hong Kong. Among the refugees interviewed by the end of the project will be women from Somalia, Liberia, Afghanistan, Myanmar, Laos, Viet Nam, Nicaragua, Bosnia-Herzegovina and Croatia.

A final report on the team's findings will be presented at the United Nations World Conference on Population in Cairo in September. This spring, members of the team will discuss their work at the International Health Conference in Virginia. This is only the first step in launching a public information and advocacy programme on behalf of the refugee women of reproductive age. The magnitude of their needs means that it is vital for us to get the information out to policy makers, donors and agencies to help ensure that needed services are available to all refugee and displaced women who request them. When they are battling hunger, cold, illness, and the loss of homes and loved ones, they should not also be without the kind of specific care they require as women.

Source: Refugees Magazine Issue 95 (1994)