Many people who flee their homes during periods of crisis do not have refugee status because they have not crossed an international border. These people, especially women and girls, often do not receive the reproductive health care they need.

A study conducted by Marie Stopes International, in the UK, and Columbia University, in the USA, on the RAISE Initiative to promote reproductive health for displaced people reviews the situation of women refugees around the world. The authors note that while approximately 33 million people have been forced to leave their homes due to conflict, or natural or human-made disasters, only one third have official refugee status. The rest comprise asylum seekers, stateless people, internal refugees who have not crossed international borders and refugees who have returned home.

Colombia, with between one and three million displaced people, has one of the largest refugee populations in the world. Only half are registered under the national health system while the remainder lack access to essential health care, including family planning. Many live in the Pacific region where travel is dangerous because drug traffickers control the roads and rivers. RAISE supports the efforts of a local charity to reach these isolated communities and provide them with sexual and reproductive health (SRH) services and general health care.

Women refugees, with limited access to health care, often have greater health needs than the general population. Widespread rape is a way of demoralising populations in times of conflict and leaves the victims with long-term psychological and physical injuries. Moreover, the desperate living conditions of refugees are linked to high levels of domestic violence. Teenagers are particularly at risk during periods of crisis because they no longer have the support of their families or of a stable society.

Other findings include:

• Displaced women have limited access to SRH services, leading to unsafe abortions, high maternal mortality and risk of sexually transmitted infections (STIs), including HIV.
• Girls are more likely to experience unsafe sex, early pregnancy, exploitation by older men and get STIs; in 1999 over a third of prostitutes in Sierra Leone were younger than 15.
• Those living in established refugee camps now have greater access to reproductive health care, but displaced people outside camps are still restricted from access.
• The most available services are basic family planning, condom distribution and antenatal services: services like STI treatment and emergency childbirth care are much less common.

An additional cause for concern is that funding for sexual health from international donors steadily decreased between the years 2000 and 2004. The study recommends:

• more comprehensive reproductive health care for internal refugees
• expanding reproductive health services to include emergency obstetric care, services specifically for young people, care for female victims of violence and treatment of STIs
• an increased commitment to reproductive health from governments and donors
• forging stronger links between reproductive health professionals and the relief community to provide better health care for refugees.

Source(s):
‘Reproductive Health: A Right for Refugees and Internally Displaced Persons’, Reproductive Health Matters 15 (31), pages 10 to 21, by Judy Austin, Samantha Guy, Louise Lee-Jones, Therese McGinn and Jennifer Schlecht, 2008

id21 Research Highlight: 2 November 2008

Further Information:
Judy Austin
The RAISE Initiative
Heilbrunn Department of Population and Family Health
Columbia University
60 Haven Avenue
B3 Room 314
New York
NY 10032, USA

Tel: +1 212 304 6164
Fax: +1 212 544 1933
Contact the contributor: ja2026@columbia.edu

The RAISE Initiative, Heilbrunn Department of Population and Family Health, Columbia University, New York, USA

Marie Stopes International
1 Conway Street
Fitzroy Square
London W1T 6LP, UK

Tel: +44 20 7636 6200
Fax: +44 20 7034 2370
Contact the contributor: info@mariestopes.org

Marie Stopes International, London, UK

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