Reproductive Health, Including HIV Prevention

Recent reports by researchers and humanitarian relief organizations indicate that women living in camps may actually benefit from better access to reproductive health services, including family planning, than women in the host country or in their country of origin.(49) Refugee populations often have a lower incidence of pregnancy-related problems than women living in the host community and origin countries. This is largely owing to improved access to health care in camp settings.(50) A 2004 global evaluation of 8.5 million displaced people found that almost all camps offered at least one family planning method, including oral contraceptives (96 per cent) and condoms (95 per cent). In addition, HIV prevention education was offered in 89 per cent of the sites, and diagnosis and treatment of STIs was available in 84 per cent of the sites.(51) Similarly, efforts to raise awareness of HIV/AIDS and other STIs are making an impact in some areas. In Kenya, refugees actually knew significantly more about preventing HIV than counterparts in their host community or their compatriots in southern Sudan: 72 per cent of the camp refugees knew about the three main methods of HIV prevention, compared to only 32 per cent of the local population.(52)

However, despite progress, displacement can, and still does, undermine reproductive health and rights-fundamental needs already in jeopardy in many situations. This is a serious issue owing to the fact that an estimated 25 per cent of refugee women of reproductive age will be pregnant at any one time.(53) Without access to reproductive health services, pregnancy and delivery-related complications can lead to maternal and infant mortality, low birth weight and other negative outcomes. Unprotected sex and teenage pregnancies are also common in refugee camps. Adolescents face particularly high risks of death during childbirth: In war-torn Southern Sudan, girls were found to be more likely to die in pregnancy and childbirth than finish primary school.(54)

Flight and displacement can lead to higher STI rates and HIV prevalence. Sex work, sexual exploitation and trafficking can increase transmission rates. This is perhaps best exemplified by the ongoing war in the Democratic Republic of the Congo (DRC). Before hostilities erupted in 1997, 5 per cent of the population was HIV positive. In 2002, that number had climbed to 20 per cent in the eastern parts of the country where conflict was most intense.(55) In other cases, prolonged crises may serve to temporarily slow the spread of HIV by isolating populations and disrupting transportation routes and rural-to-urban migration. This was the case of conflicts lasting many years in Angola, Sierra Leona and Southern Sudan, where HIV prevalence rates were found to be lower than those in neighbouring countries.(56) Once stability is restored, however, and people are again able to move freely, countries risk a post-conflict surge in HIV prevalence if prevention programmes are not forthcoming.

The international community is continuing to step up efforts. Today, many refugees are increasingly benefiting from reproductive health programmes. In 2005, UNFPA provided support in Benin and Ghana for refugees fleeing unrest in Togo-including supplementary food and immunization services to pregnant women and children, maternity health kits, male and female condoms, treatment for sexually transmitted infections, insect-treated mosquito nets and soap.(57) In the Sherkole camp for Sudanese refugees in Ethiopia, UNFPA supports the IRC in mobilizing elders, women's groups and other community leaders to raise awareness of family planning, maternal and child health and formulate strategies to change harmful practices.(58) In the Islamic Republic of Iran, UNICEF and WHO have supported the Assisting Marsh Arabs and Refugees (AMAR) International Charitable Foundation to train more than 100 female health volunteers to reach out to Iraqis living in refugee camps, as well as Afghan refugees in urban areas. The aim is to provide information on maternal health care, immunization and family planning.(59)

In Yemen, Marie Stopes International (MSI) has run reproductive health centres for Somali refugees and the local population since 1998. UNFPA and UNHCR-supported health education sessions have reached thousands of refugees.(60) Similarly, in the Yarenja camp for Sudanese refugees in Ethiopia, IRC and UNFPA-supported Anti-HIV/AIDS and Reproductive Health Clubs report at least 55 per cent of refugees aged 14 to 45 now know how to prevent STIs, including HIV. Girls clubs were particularly effective.(61)