Women's Sexual and Reproductive Health in Post-Socialist Georgia: Does Internal Displacement Matter?

Article excerpt

CONTEXT: Persons displaced by armed conflicts, natural disasters or other events are at increased risk for health problems. The Republic of Georgia has a substantial population of internally displaced women who may face elevated risks of STIs and pelvic inflammatory disease (PID).

METHODS: The 1999 Georgia Reproductive Health Survey was used to examine the prevalence of self-reported STI and PID diagnoses among displaced and nondisplaced sexually experienced women. Multivariate analyses were conducted to determine whether displacement is associated with these diagnoses differ between internally displaced women and the general population.

RESULTS: In models that controlled for behavioral factors only, displacement was associated with elevated odds of PID diagnosis (odds ratio, 1.3), but the relationship was only marginally significant when socioeconomic factors were added (1.3). Displacement was not associated with STI diagnosis.The factors associated with STI and PID diagnoses among displaced women generally differed from those in the general population, but access to medical care and previous STI diagnosis were associated with PID diagnosis in both groups. Among nondisplaced women, residing in the capital city was associated with increased odds of STI diagnosis (2.2) but reduced odds of PID diagnosis (0.8).

CONCLUSIONS: These findings highlight the importance of displacement status in determining a woman's reproductive health risks, and underscore the complex relationships between behavioral and socioeconomic variables and the elevation of STI and PID risk.

International Family Planning Perspectives, 2008, 34(1):21-29

Events such as armed conflicts, natural disasters and persecution based on cultural or social identities can force people to migrate, dramatically altering their habitual activities and social relations, interrupting their social support systems and diminishing their access to medical care. Most forced migration takes place in developing countries, leading to declines in already challenging living conditions. Women, children and the elderly are typically over-represented among forced migrants. Although some migrants cross international borders (and are referred to as "refugees"), others remain in their country of origin; because of sovereignty concerns, these individuals, known as "internally displaced persons," often lack access to the international aid and services provided to refugees. (1)

Internally displaced persons may face unique health challenges, the impact of which is thought to vary depending on the reason for displacement, the stages and duration of displacement, and the site of resettlement. The high proportion of females among displaced persons underscores the importance of examining how behavioral changes and difficulties in access to health care influence the reproductive health of internally displaced women. In this study, we examine the link between internal displacement status and two important sources of preventable reproductive morbidity in women, STIs and pelvic inflammatory disease (PID). (2)

BACKGROUND

Internal Displacement and Women's Health

The displacement process can influence health in several ways. Research linking forced migration and reproductive health outcomes has focused on the impact of psychological stress, economic hardship, social dislocation and challenges to the maintenance of cultural norms. (3), (4) For example, migration--and forced migration in particular--provokes stress and anxiety, which in turn can lead to negative health behaviors and alter sexual behavior. (5) Similarly, the changes in socioeconomic status and in access to health services experienced by internally displaced individuals can have a detrimental impact on their health. (6) In addition, because information networks tend to weaken during displacement, displaced persons may lack awareness of available health services. …