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HOME: STATE OF WORLD POPULATION 2004: Reproductive Health for Communities in Crisis
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Reproductive Health for Communities in Crisis

Safe Motherhood
Family Planning
Sexual and Gender-based Violence
HIV/AIDS and Other STIs
Adolescent Reproductive Health
Gains and Gaps

Adolescent Reproductive Health

Young people separated from their families and communities are especially vulnerable to sexual exploitation and are more likely to engage in risky sexual behaviour. War-affected adolescents may be deeply affected by the breakdown of social and cultural systems, loss of access to education and health services, the disruption of school and friendships, exposure to violence and the loss of family members.

In Colombia, violence and displacement have been accompanied by a marked increase in teenage pregnancies and unsafe abortions. One study found that displaced girls were three times as likely as other girls to become pregnant before age 15.(5) In Liberia, where pregnancy among girls as young as 11 and 12 is common, a WHO representative estimated in 2002 that up to 80 per cent of displaced girls had undergone an induced abortion by age 15.(6)

Early pregnancy can have severe implications for the health and well-being of girls whose bodies are not sufficiently developed to withstand pregnancy and childbirth. Girls between ages 10 and 14 are five times more likely to die in pregnancy and childbirth than women between 20 and 24. Unsafe abortions also pose tremendous health risks.(7) In many conflict settings, young girls are extremely vulnerable to HIV and other STIs as well.

One of the most effective ways to protect the health of adolescents affected by disaster is to ensure they have access to sexual and reproductive health information and services. This includes the provision of youth-friendly information and support, and counselling, which can be especially important for victims of sexual violence.

With the support of Belgium, UNFPA is working with local partners to expand services and support for internally displaced youth in Burundi, Colombia, the Democratic Republic of the Congo, Liberia, the Occupied Palestinian Territory, Rwanda, and Sierra Leone.

In the Democratic Republic of the Congo, for example, UNFPA and a local NGO have established youth centres for displaced young people living outside camps or in big cities. The centres offer reproductive health services including voluntary counselling and testing for STIs. The project has also trained ten NGOs to provide adolescent reproductive health services and information. As demand increases for these services, more funding, resources and partnerships will be needed.


Even as reproductive health service coverage has improved for international refugees over the past decade, progress has lagged in providing services for people internally displaced within states, who outnumber refugees worldwide two to one.

In Angola, where hundreds of thousands remain displaced after nearly three decades of war, a severe lack of basic safe motherhood services has resulted in one of the highest maternal mortality ratios in the world. The situation is unlikely to improve without a massive, long-term effort including the reconstruction and re-supplying of health facilities, the training of health professionals, and the establishment of basic referral services and transportation for complications requiring emergency obstetric care.

Internally displaced persons in Liberia have also been without even minimum health services for more than a decade.

Internally displaced persons present a special challenge to the humanitarian community, particularly with regard to reproductive health service provision. National authorities often neglect the displaced, and are sometimes hostile to them. Agencies like UNHCR and UNFPA have expanded their mandates over the past decade to include internally displaced persons, and have made some progress in linking them to national health systems. But millions remain inaccessible to these organizations.

Governments in countries where displaced persons live must do more to recognize their rights, while donor countries have to increase funding and political pressure to ensure their needs are not ignored. See Sources

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