A Systematic Review of Refugee Women's Reproductive Health
Gagnon, Anita J., Merry, Lisa, Robinson, Cathlyn, Refuge
Resettling refugee women may be at greater risk than other women for several harmful reproductive health outcomes as a result of their migration experience. The objective of this study was to determine differences in reproductive health status between refugee women in countries of resettlement and non-refugee counterparts. A systematic review of the literature culled from five electronic databases and web searching of international agencies and academic centres focusing on refugees was conducted. Of the forty-one high quality studies identified, fourteen looked at refugees exclusively; only nine of the fourteen focused on the reproductive health of refugees; six of the nine directly compared refugee to non-refugee women's health. There is a paucity of population-based data to support or refute claims of greater reproductive health risks for resettling refugee women.
There are currently fifteen million refugees and asylumseekers worldwide, (1) a percentage of whom will resettle in host countries. The health of resettling refugees is not well known since health data are rarely reported for refugees separate from all immigrants combined. Refugees, individuals forced from their homeland and unable to return for a period of time due to socio-political instability (paraphrased from UNHCR (2)), and asylum seekers arriving in resettlement countries are thought to be at greater risk than the general population for several harmful health outcomes as a result of their migration history. Anecdotal reports from professionals suggest that childbearing and other aspects of reproductive health add an additional burden on female refugees, which places them in a particularly disadvantaged position. These suppositions have not been systematically examined.
Reports would suggest that screening and care provided to resettling refugees is anything but systematic. (3) Policy makers and program planners, however, generally see knowledge of health "events" (including illness episodes and health/social services use) as required for optimal health planning. (4) The extent and nature of health "events" and their determinants in resettling refugee women and their infants becomes even more relevant when the role of development from birth to six months of life on future health outcomes is considered. (5)
Review of the Literature
Refugee Women's Reproductive Health Prior to Resettlement
Refugee women experience several challenges to their health. Published review articles and case studies describe the experience of refugees in transit or in camps. The issues considered can be grouped into five broad categories: (1) fertility regulation, (2) sexually transmitted infections, (3) sex and gender-based violence, (4) pregnancy and childbirth, and (5) health services availability and use.
There are differing opinions of the effects of migration on fertility and family planning. (6) One suggests that forced migration increases fertility as refugees satisfy their desire to repopulate, in order to replace deceased children or soldiers and as migration produces a healthier, more stable environment (for example, in some camp situations) with improved health care services and nutrition. The opposing opinion suggests that migration decreases the fertility rate of refugees because of perceived uncertainty of the future, economic instability, and marital separation. Fertility rates have also been found to vary with knowledge and availability of contraception. In sum, there are no known common fertility patterns of refugees.
Refugee women appear to be at greater risk than other women for sexually transmitted infections (STIs), including human immunodeficiency virus (HIV), for a variety of reasons. (7) Migration often occurs without the accompaniment of spouses, thereby increasing the likelihood of sexual activity outside stable relationships. Military operations have been found to be associated with an increase in STI transmission and many refugees are fleeing war-torn areas or must travel through or encamp in those areas. …