Women's Commission for Refugee Women and
On behalf of the Reproductive Health for Refugees Consortium
Currently, Zambia hosts more than 260,000 refugees; almost three-quarters come from Angola and the remainder are primarily from the Democratic Republic of Congo and other African countries including Rwanda, Burundi, and Somalia. Zambia continues to accept more refugees as conflicts continue in bordering nations.
The reproductive health of refugees is being addressed in Zambia as evidenced by the wideranging efforts of United Nations organizations and numerous local and international nongovernmental organizations in the country.
In general, most refugees - with the exception of the urban/peri-urban refugee population, which suffers from transportation and communication barriers - have good access to safe motherhood services. The extent of unsafe abortion demands additional study. The availability of the Minimum Initial Services Package in transit centers and other areas where arriving refugees cross into the country was not investigated. Both of these areas require further exploration to determine the level of need. Supplies for syphilis testing of pregnant women are not consistently available.
Community health workers play an active role in most camps to educate refugees about their family planning options, but there is a lack of community-based distribution of supplies which hinders refugees' access. Also, refugees are reluctant to use family planning methods due to the losses these communities have suffered from the ongoing conflicts in their countries.
Generally, there appears to be a good level of awareness concerning the prevention of sexually transmitted infections, including HIV/AIDS; however, perception of risk differs within the refugee population. Although there are numerous suspected HIV/AIDS cases, there are few diagnosed patients and still a persistent skepticism about the existence of the disease. Other concerns include untreated sexually transmitted infections causing sterility, male circumcision practices and lack of compliance with infection treatment protocols. In regard to services and supplies, condom availability is inconsistent, community distribution systems are not in place and voluntary counseling and testing services are not widely available or accessed.
Gender-based violence is a topic most people are reluctant to discuss. Domestic violence, exacerbated by alcohol and drug use/abuse, is reported to be the most common form of violence. Most health facilities lacked protocols to manage the consequences of rape. Victim Support Units are in place at some camp police stations but it is not clear that the units' staff are adequately trained to care for victims of violence. CARE is initiating gender-based violence prevention projects in two camps and other organizations have expressed interest in pursuing programming.
Reproductive health services for adolescents are limited and ad hoc at best. There are nascent efforts by nongovernmental organizations to establish youth-friendly centers, youth anti-AIDS clubs and use of peer educators to target the adolescent population. However, adolescents are clearly a sexually active population and are particularly vulnerable, given the lack of comprehensive services targeting their needs.
The chief recommendations of the assessment team are as follows:
- Establish a reproductive health working
group in Lusaka for implementing health agencies, including refugee representatives,
United Nations agencies and local and international nongovernmental organizations
to facilitate information sharing on reproductive health for refugees and
coordinate potential collaborations among partners.
- Ensure presence of a reproductive health
coordinating agency/coordinator to lead a working group in each camp.
- Increase Information, Education and
Communication materials in all camps.
- Safe Motherhood: Ensure emergency
transport in all camps; availability of the Minimum Initial Services Package
in all transit centers; and syphilis testing of all pregnant women.
- Family Planning: Improve demand
and supply for family planning services and supplies; increase access to
services and supplies for youth; involve men in programming; ensure consistent
supply and community-based distribution of male condoms and explore possibility
of supplying female condoms; and collaborate with capable partners on technical
- Sexually transmitted infections,
including HIV/AIDS: Ensure access to condoms through community distribution
channels; improve access to diagnosis and treatment for sexually transmitted
infections; monitor progress of voluntary counseling and testing in Zambia;
and target the needs of the commercial sex worker population.
- Gender-based Violence: All camps
should be aware of and consider training on clinical management of violence;
make emergency contraception available in all camps; identify and support
needs of Victim Support Unit staff; and address domestic violence and alcohol
abuse to reduce incidence of violence in camps.
- Adolescent Reproductive Health: Work with adolescents in separate gender groups; develop/obtain good assessment tools for adolescent reproductive needs; include adolescents in program development activities; and ensure access for youth to comprehensive reproductive health services.