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Frequently unasked questions - reproductive health needs during war

What are the reproductive health needs of people affected by conflict? How important are reproductive health issues to these communities? How can relief agencies improve their accountability to the beneficiaries of international aid during conflict? A study by Oxfam and the London School of Hygiene and Tropical Medicine investigated these issues in southern Sudan.

The rapid appraisal found that reproductive health needs are important to these people, but there is a mismatch between the views of service providers and the community. The perception of need also varies according to age, sex, and whether the community is displaced. Strategies are needed to overcome a lack of supplies and barriers to accessing services.

Humanitarian agencies are increasingly concerned that aid sometimes has negative consequences for the intended beneficiaries. Programmes often lack an awareness of local contexts or the capabilities of the community.

The 1994 international conference on population and development recognised specific reproductive health problems for populations affected by conflict. Service planning by the UN and other agencies is often hampered by a lack of information on how beneficiaries prioritise reproductive health.

Since 1983 an estimated 1.2 million people have been killed in the Sudanese civil war. Around four million people are internally displaced. The study area was in the hands of rebels and under constant threat from aerial bombardments. The study ran for six weeks and involved 20 interviews with key informants, 14 in-depth interviews and 23 group discussions in two towns and nine surrounding villages in the area. Results showed that:

Sexually transmitted infections (STIs), such as syphilis and gonorrhoea, are the biggest reproductive health concern. Miscarriages are another important issue.
There are conflicting views on the incidence and importance of sexual violence, abortions and problems during labour.
Groups within the communities hold different views. Older men in the settled community are least likely to think reproductive health problems are common.
Health has a higher priority for people in the settled community. Displaced people are often more concerned about food supplies.
Communities complain about a lack of medical supplies. Other barriers to accessing services include transport difficulties, reluctance to admit to STIs, traditional beliefs and conflicting demands on women.

If relief agencies do not fully understand a society, they will not provide the best service and may lose the trust of the people. Involving the community in programme planning could:

overcome the limitations of assessments based on consulting with leaders by providing insights on the perceptions, values, and priorities of community members
reveal the relative importance of reproductive health issues to different groups
provide information about traditional beliefs and other attitudes that decrease use of health services
increase awareness of the issues among the community and encourage their ideas for solutions.

The report concludes that rapid appraisal could be useful as a first step in including communities in needs assessments and service planning.

Source(s):
'Rapid appraisal of needs in reproductive health care in southern Sudan: qualitative study' by C. Palmer, British Medical Journal 319 (1999)

Funded by: Central Research Fund of London University; Global Reproductive Health Policies Group

id21 Research Highlight: 15 August 2001

Further Information:
Celia Palmer
Health Policy Unit
London School of Hygiene and Tropical Medicine
Keppel Street
London WC1E 7HT
UK

Contact the contributor: celia.oliver@akc.quik.co.nz

London School of Hygiene and Tropical Medicine, UK

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