Family Planning in Refugee Settings

BY HOLLY ROBINSON

Sixty-one million people needed humanitarian assistance in 2012.¹ The health of these refugees is often thought of as a short-term problem that can be solved by providing only food and water, and the goal is often to sustain refugee populations until they are able to move to a more permanent living situation. It is easy to forget that for many, refugee camps are a long-term living situation. Therefore, a more holistic approach to the healthcare needs of refugee populations is needed. Reproductive health is an issue that is very poorly addressed in refugee settings. In many camps, women struggle with unplanned or unwanted pregnancy, and the poor spacing of these pregnancies put women’s health at even further risk. As a result of these dangers, fifteen percent of pregnant women in refugee settings will experience a life threatening condition.¹ Though different refugee camps present unique challenges to reproductive health, unplanned pregnancies generally occur due to an absence of available contraceptives or a lack of information about reproductive health.

Family planning is viewed as a human right, and access to contraceptives and information should be guaranteed in refugee settings.² Family planning has been proven to improve the health of women by reducing unsafe abortions and rapid subsequent childbearing, both of which put the mother at risk of maternal death or disability. These results and their significance are no different in refugee settings. The Women’s Refugee Commission released the Statement on Family Planning for Women and Girls as a Life-Saving Intervention in Humanitarian Settings in May 2010, which makes the basic assertion that people’s reproductive health needs do not disappear upon their entering a refugee camp.³ In fact, those needs may become greater, as women and their families attempt to postpone pregnancy to avoid exposing an infant to the stresses of displacement. The Women’s Refugee Commission asserts, “At the onset of the emergency, it is important to make contraceptive methods…available to meet demand.”³

Family planning and reproductive health needs change over time as refugee camps stabilize and become long-term homes for displaced persons. At this stage in a refugee crisis, family planning must become more comprehensive. It is important to offer community education on reproductive health, especially as children mature into adolescents within the camps.³ After conditions stabilize, families continue to grow within refugee camps, just as they do outside them. Studies have shown that over the course of 20 years within a refugee camp, fertility rates remained relatively stable, with only minor fluctuations in fertility due to repatriation.⁴ The goal, therefore, is not to prevent pregnancy within refugee camps altogether, but rather to allow women to plan pregnancies for when conditions are relatively stable and to space the pregnancies in order to avoid health problems. Such timing and spacing of pregnancies is crucial to the health of both mother and child, especially in vulnerable settings. The health of children is often dependent on their mothers, and motherless children are nearly 10 times more likely to die prematurely than those whose mothers survive childbirth.³

According to the Women’s Refugee Commission, there is often resistance to contraceptive use in refugee settings. Even in camps with available family planning resources, women’s partners, community leaders, or peers often discourage them from using contraceptives. These attitudes prompt many of them—up to nearly 40% according to one study in Tanzania—to discontinue their family planning efforts.¹ Studies of Jordan’s Zaatari camp for Syrian refugees have shown that this active discouragement of family planning may be due to a community pressure for those in refugee camps to replace the population of adults dying in wars.⁵ The loss of friends and family members fuels a desire to have more children. Furthermore, more children could mean a larger shelter in many camps, a strong enough incentive for many to have rapid subsequent pregnancies.⁵ This pronatalist ideology further exacerbates the problems associated with limited family planning.

In other settings, women are not aware of the benefits of family planning, since no information is available about its importance. A lack of knowledge is also then compounded by the lack of access. Women may not know where to get contraceptives in refugee settings, but they are often not available at all. Compared to stable settings, refugee settings receive fifty percent less funding for family planning.¹ Therefore the problem in refugee settings is twofold. There is a reluctance to use family planning services due to feelings of pronatalism, but these services are also often unavailable due to a severe funding gap. This funding gap must first be closed in order to better meet the reproductive health demand in refugee settings, and women and girls in refugee camps must be empowered to engage with planning resources when available.

The problem of reproductive health in refugee settings is challenging to solve. It is not simply a matter of identifying the funding sources for contraceptives and family planning resources. Pronatalist ideologies within refugee camps are a barrier to care, but it is crucial both to understand the internal logic behind this ideology and to approach this in culturally sensitive ways. These ideologies may put women’s health at greater risk, but they have an important place in the culture of many displaced groups. It is important, therefore, to approach health interventions in refugee settings with sensitivity and understanding. Interventions should not serve to reduce the agency of displaced populations, but should rather empower them in healthy and beneficial ways. Family planning interventions have the power to achieve this.

Holly Robinson is a senior double majoring in Russian Literature and anthropology. She can be contacted at holly.robinson@yale.edu

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References:

1 Women’s Refugee Commission. (2016). Family Planning. Retrieved from https://www.womensrefugeecommission.org/srh/family-planning

2 UNHCR. (2011, November). Refocusing Family Planning in Refugee Settings: Findings and Recommendations from a Multi-Country Baseline Study. Retrieved from

3 Women’s Refugee Commission. (2010, May). A Statement on Family Planning for Women and Girls as a Life-saving Intervention in Humanitarian Settings. Retrieved from http://www.iawg.net/IAWG_%20FP%20Statement_Final.pdf

4 Randall S. (2004). Fertility of Malian Tamasheq Repatriated Refuees: The Imapact of Forced Migration. Washington D.C.: National Academies Press (US). Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK215674/

5 Adams, P. (16 April 2016). A Baby Boom in a Refugee Camp is a Mixed Blessing. NPR. Retrieved from http://www.npr.org/sections/goatsandsoda/2016/04/16/474213390/a-baby- boom-in-a-refugee-camp-is-a- mixed-blessing