A descriptive analysis of sexual and reproductive health services for refugees provided through minimum initial service package approach

Abstract

Objective: Sexual and reproductive health (SRH) is a priority public health emergency response for women during humanitarian crisis situations as they face the risk of being neglected in health care systems of the country of arrival. This study aimed to investigate Syrian women’s utilization of SRH services through Minimum Initial Service Package (MISP) approach, who received services from Women Health Counseling Units (WHCU) established as part of a collaborative Project in Türkiye. Methods: Questionnaires were administered face-to-face by Arabic-speaking female interviewers to 413 Syrian women who previously received services from the WHCU. Descriptive statistics were used and Pearson chi-square as well as Exact chi-square tests were conducted to analyse bivariate differences between categorical variables. Results: Child marriages were common among more than half (59%) of the participants. Majority of deliveries took place in the public hospitals (95%) and as attended by a doctor (93%). The percentage of participants using modern contraceptive methods was found to be 39.7% who were more frequently from younger age groups. However, the withdrawal method was relatively more prevalent among older participants. Conclusion: Despite the data being gathered from a limited population of Syrian women in Türkiye, the study offers descriptive, evidence-based insights on improving women’s access to high-quality SRH services in line with the MISP approach during humanitarian crisis situations.

Keywords

• Sexual and Reproductive Health
• MISP
• Syrian Women
• Humanitarian Crises

References

1. Samari G. Syrian Refugee Women’s health in Lebanon, Türkiye and Jordan and recommendations for improved practice. World Med Health Policy. 2017;9:255–274.
2. Centre for Transnational Development and Collaboration (CTDC). Syrian refugees in Türkiye: Gender analysis [online]. Available at: https://data2.unhcr.org/en/documents/download/54509. Accessed May 3, 2023.
3. United Nations (UN). Feminization of migration, remittances, migrants’ rights, brain drain among issues, as population commission concludes debate [online]. Available at: https://www.un.org/press/en/2006/pop945.doc.htm. Accessed April 27, 2023.
4. Çaman-Karadağ Ö, Bahar-Özvarış Ş. Uluslararası göç ve kadın sağlığı. Sağlık ve Toplum. 2010;4(3):13.
5. Adomako EB, Darkwa-Baffour F. Suffering in the hands of a loved one: The endemic to intimate partner violence and con-sequences on migrant female head-load carriers in Ghana. J Interpers Violence. 2019 Nov 7:0886260519888547.
6. Al-Maharma D, Safadi R, Ahmad M, Halasa S, Nabolsi M, Dohrn J. Knowledge, attitudes and practices of Syrian refugee mothers towards sexually transmitted infections. Int J Womens Health. 2019;11:607-615.
7. Inter-Agency Working Group on Reproductive Health in Crises (IAGW). Minimum initial service package (MISP) [online]. Available at: https://iawg.net/resources/misp-process-evaluation-tools-2017. Accessed May 4, 2023.
8. Lisam S. Minimum initial service package (MISP) for sexual and reproductive health in disasters. J Evid Based Med. 2014;7(4):245-248.

9. Inter-Agency Working Group on Reproductive Health in Crises (IAGW). Emergencies. Venezuela/Colombia [online]. Avail-able at: https://iawg.net/emergencies/venezuela-colombia. Accessed June 6, 2023.
10. CARE. CARE Rapid Gender Analysis Latin America & Caribbean: Venezuelan Migrants & Refugees in Colombia [online]. Available at: https://reliefweb.int/sites/reliefweb.int/files/resources/CARERapidGenderAnalysis_Colombia_May2019.pdf. Accessed June 6, 2023.
11. Balinska MA, Nesbitt R, Ghantous Z, Ciglenecki I, Staderini N. Reproductive health in humanitarian settings in Lebanon and Iraq: results from four cross-sectional studies, 2014–2015. Conflict Health. 2019;13:1-10.
12. Heslehurst N, Brown H, Pemu A, Coleman H, Rankin J. Perinatal health outcomes and care among asylum seekers and refugees: a systematic review of systematic reviews. BMC Med. 2018;16(1):1-25.
13. Singh NS, Aryasinghe S, Smith J, Khosla R, Say L, Blanchet K. A long way to go: a systematic review to assess the utilization of sexual and reproductive health services during humanitarian crises. BMJ Global Health. 2018;3(2):e000682.
14. United Nations (UN) Department of Economic and Social Affairs, Population Division. International Migration 2020 High-lights (ST/ESA/SER.A/452) [online]. Available at: https://www.un.org/en/desa/international-migration-2020-highlights. Accessed June 6, 2023.
15. Ministry of Interior, Directorate General of Migration Management (MoI, DGMM). Migration statistics. Temporary protec-tion [online]. Available at: https://www.goc.gov.tr/gecici-koruma5638 [Accessed May 3, 2024].
16. Austin J, Guy S, Lee-Jones L, McGinn T, Schlecht J. Reproductive health: A right for refugees and internally displaced per-sons. Reprod Health Matters. 2008;16(31):10-21.
17. United Nations (UN) Department of Economic and Social Affairs, Sustainable Development. Sustainable Development Goals [online]. Available at: https://sdgs.un.org/goals/goal3. Accessed May 4, 2023.
18. United Nations Population Fund - UNFPA. Accelerating the Promise: The report on the Nairobi Summit on ICPD25 [online]. Available at: https://www.unfpa.org/publications/accelerating-promise-report-nairobi-summit-icpd25. Ac-cessed May 4, 2023.
19. World Health Organization (WHO). World health statistics 2015. World health statistics report [online]. Available at: https://apps.who.int/iris/bitstream/handle/10665/170250/9789240694439_eng.pdf?sequence=1. Accessed May 4, 2023.
20. Hacettepe University Institute of Population Studies (HUIPS). 2018 Türkiye demographic and health survey Syrian mi-grant sample. Ankara: Elma Teknik Basım Matbaacılık Ltd. Şti, 2019 [online]. Available at: http://www.hips.hacettepe.edu.tr/tnsa2018/rapor/2018_TDHS_SR.pdf. Accessed May 4, 2023.
21. Hacettepe University Women’s Research and Implementation Center, HUWRIC. Unpublished final report of ‘Strengthen-ing access to sexual and reproductive health, and sexual and gender-based violence services for Syrian and other refu-gees through Women and Girl Safe Spaces (WGSS)/Women Health Counselling Units project’. 2019.
22. Cankurtaran Ö, Albayrak H. Suriye’den Türkiye’ye kadın olmak (Being a woman from Syria to Türkiye). Ankara: Elma Teknik Basım Matbaacılık Ltd. Şti., 2019 [online]. Available at: https://huksam.hacettepe.edu.tr/Turkce/suriyedenTürkiyeye_TR_210519.pdf. Accessed May 5, 2023.
23. Çöl M, Bilgili Aykut N, Usturalı Mut AN, Koçak C, Uzun SU, Akın A, Say L, Kobeissi L. Sexual and reproductive health of Syri-an refugee women in Türkiye: A scoping review within the framework of the MISP. Reproductive Health. 2020;17:99.
24. Çifçi S, Bayram Değer V, Ertem M. Suriyeli göçmenler ve önemli bir üreme sağlığı sorunu: erken yaş gebelikleri. Göç Dergisi (Journal of Migration). 2018;5(1):33-42.
25. Kahsay AB, Haftu AT, Nigusse AT. Factors affecting the implementation of the Minimum Initial Service Package (MISP) r reproductive health during crisis: the case of Eritrean refugees in northern Ethiopia. Research Square. 2020.
26. Inter-Agency Working Group on Reproductive Health in Crises (IAGW). (May 5, 2021). Unit 1: What Is the MISP for SRH? [online]. Available at: https://iawg.net/resources/minimum-initial-service-package-distance-learning-module/unit-one-misp-srh. Accessed July 21, 2023.