Addressing reproductive healthcare challenges of IDPs

A Consultant Obstetrician and Gynaecological Surgeon at the Department Of Obstetrics and Gynaecology, University of Jos/Jos University Teaching Hospital Jos, Plateau State, Prof. Innocent A. O. Ujah, has made recommendations on how to address the reproductive healthcare challenges of internally displaced persons (IDPs). Ujah, in a paper, presented at the 2019 Prof. Okoronkwo Kesandu Ogan Memorial Lecture Series on held last week at the University of Nigeria Nsukka (UNN), Enugu Campus, said prevention of insurgency after combats must take cognizance of the three most important directions including securing some form of surrender or settlement, maintaining public order and reconstructing indigenous security forces as quickly as possible.

The guest lecture is titled “Reproductive Healthcare Challenges of the Internally Displaced Persons (IDPs) Following Insurgency and Humanitarian Crises in Nigeria.”Ujah, who was a former Director General of the Nigerian Institute of Medical Research (NIMR) Yaba, Lagos, said the management of reproductive health during insurgency and humanitarian disasters include:

*Provision of urgent and comprehensive reproductive health care services to IDPs, by increased collaborative effort between Non Governmental Organisations (NGOs), other international organisations, and the government.
*More field staff with expertise in reproductive and sexual health should be engaged for feasible strategies to start and keep reproductive health services in place.
*An intra-communication system within the IDP camps should be in place to establish some order in the camps, particularly in the provision of reproductive healthcare services.
*A set of priority reproductive health interventions in the initial, emergency phase of a refugee crisis must be provided while a more comprehensive package of services are put in place once the situation stabilizes. The Minimum Initial Service Package (MISP), for the reduction of death and ill health related to reproductive health should be used.
*The Provision of well-equipped Primary health care centres at each camp with requisite categories of staff to reduce the time to get to the healthcare facilities in times of emergencies while granting more decision making power to women to make decisions about their reproductive health.

*Effective training and retraining programme for skilled birth attendants should be part of the emergency preparedness to contain reproductive health challenges of the IDPs, while sensitizing women on the need to abstain from harmful health practices that affect their reproductive lives.

*The Nigerian Government must dedicate more resources to the problems of IDPs rather than waiting for the international community and donor Agencies. This approach will encompass sustainable reintegration (in the place of origin of IDPs) where feasible, sustainable local integration (in the place of refuge) and sustainable integration (in other parts of the country) which high level of political commitment at all levels

The reproductive health experts concluded: “IDPs exhibit unique reproductive health challenges that bother on limited access to ante natal care services, and contraceptive services that invariably lead to poorer maternal and perinatal indices. “The solutions to the health problems of IDPs lie first in tackling the root causes of wars and insurgency through a combination of diplomacy, good governance, infrastructural development, employment and other political measures.

“There must be an emergency preparedness plan including active surveillance, perhaps using an Emergency Operation Centres (EOCs) which should be activated in dealing with IDPs or when natural disasters occur, requiring proper coordination of such a plan for its success.

“Health services should be sensitive to identify new users of the services that are outside their catchment areas and promptly report if the number of such clients is increasing in an unexpected manner due to entry of IDPs Camps.

“Finally, prompt integration and resettlement of IDPs as quickly as possible should be done.”Prof. Okoronkwo Kesandu Ogan was the first Nigerian to qualify as an Obstetrician/Gynaecologist. He was also the pioneer President of The Society of Gynaecology and Obstetrics of Nigeria, an organisation that was formed in Lagos in 1965. In 1975, he was appointed as the Chairman, Federal Public Service Commission. Prof. Ogan, born in 1919, was trained in West London Medical School (1950-52), University of London Medical School (1952-54; 1956-58). The late Prof. Okoronkwo Ogan was from Bende Local Government Area of Imo state.

Ujah said several health risks are associated with human displacement. He said displacement of a population always affects health status and health care. The physician said in the epidemiological triad of host, agent and environment interaction, displacement exposes IDPs to new hazard dynamics such as: infectious agents and vectors might be present in the new environment, to which IDPs may lack immunity and or coping skills; poor quality of water and sanitation and overcrowding, as in temporary settlements, modify interaction with existing infectious agents.

Ujah said others include: absolute and relative food shortages occur due to disruptions in the production and supply systems; disrupted psychosocial balance being uprooted, insecurity, lacking meaningful employment; increase in hazardous behaviours (example promiscuity and sexual and/or intra-household violence); and vagaries of weather and other natural hazards may be present in the new environment.

Ujah said a study conducted at NIMR on Reproductive health services in IDP Camps was aimed at enhanced planning for effective reproductive health interventions for IDPs in Nigeria. The Study sites were in two states of Borno, Benue States and Federal Capital Territory, Abuja. Some of the findings were as follows: Pregnant women constituted one in seven women. Only 20.7 per cent of the pregnant women sought antenatal care and of these, 27 per cent of the pregnancies ended as miscarriage and 10.8 per cent ended as stillbirth.

He said the sexual history showed that about three-quarter of the respondents 455(76.1 per cent) have had sex since being in the camps, while remaining one-quarter was either not sexually active or had not had sexual intercourse since being in the IDP Camps.

The reproductive health expert said many women who are refugees or IDPs face unwanted, unplanned, and poorly spaced pregnancies, due to a lack of access to contraceptive services and supplies, overburdened providers with little time to educate or counsel clients, pressure from husbands or other family members to “rebuild” the population, and increases in rape and prostitution. Refugees are at higher risk than stable populations for sexually transmitted infections (STIs) and gender-based violence.

Research indicates that the availability of contraceptives has improved in stable refugee populations since the mid-1990s. Researchers know little about how the immediate aftermath of flight affects fertility preferences, but refugees’ fertility desires appear to revert relatively quickly to what they were before flight.

Rape and other forms of violent sexual assault have been used as weapons of war to demoralize communities (as in the former Yugoslavia) and even to alter the ethnic composition of a population (as occurred in both Rwanda and the former Yugoslavia). Border guards, soldiers, and fellow refugees may also perpetrate acts of violence against refugee women.

One study of more than 1,000 households in Sierra Leone during its eight-year civil war showed that as many as 11 percent of displaced women and girls experienced war-related sexual violence. Gender-based violence can have long-lasting, severe physical effects, including Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS), pregnancy, and miscarriage.

Ujah said STIs, including HIV/AIDS, can spread quickly in IDP camps, because of limited contraceptive supplies, such as condoms; the presence of military forces, who tend to have higher STI rates than civilian peacetime populations; refugees’ greater vulnerability to sexual and gender violence and sex work; greater exposure to inadequately screened blood transfusions; and the presence of populations with HIV.

He said sexual assault and unwanted pregnancies with the associated complications are also occurrences among IDPs. The use of contraception in the camps is quite low. War crimes perpetuated by militias or soldiers that are bereft of professionalism may be linked to sexual assault and violence against women. Ujah said the low uptake of contraception might be associated with poor access to barrier contraception, which may result in an increase in the incidence of STIs including HIV AIDs, Human Papilloma Virus, Hepatitis B and C among IDPs population.