Reproductive Health in Emergencies Conference 2008 by decree

VIEWS: 418 PAGES: 55

									                          Reproductive Health in
                          Emergencies Conference 2008
Reproductive Health in
Emergencies Conference 2008
June 18 – 20, 2008 • Speke Conference Centre • Kampala, Uganda




Conference Abstracts
                                                                                                                              TABLE OF CONTENTS


                                                                                                                              Addressing Fistula: Process and Partnerships with Ministry                                             Preventing HIV and Ensuring Antiretroviral Continuity:
                                                                                                                              of Health and Non-Governmental Organisations ............. 1                                           AMPATH’s Response to Internally Displaced HIV-Positive
                                                                                                                                                                                                                                     Persons in Kenya ..................................................................... 12
                                                                                                                              Enhancing Women’s Utilization of Reproductive Health
                                                                                                                              Services Through Integration of Sexual and Gender-Based                                                Reproductive Health Development Agency Provides
                                                                                                                              Violence Prevention and Response Activities ................... 1                                      Emergency Response to Cyclone-Affected Women and
                                                                                                                                                                                                                                     Children in Bangladesh .......................................................... 13
                                                                                                                              Issues in Training Post-Abortion Care Service Providers in
                                                                                                                              Uganda: Personal Experience ................................................ 2                         Desperate and Alone: Reproductive Health Needs of Iraqi
                                                                                                                                                                                                                                     Refugees in Jordan ................................................................. 13
                                                                                                                              Clinical Management of Traumatic Fistulas in the Eastern
About the Organisers                                                                                                          Democratic Republic of Congo .............................................. 3                          The Use of a Standard Questionnaire as a Tool to
                                                                                                                                                                                                                                     Investigate the Cause of Spontaneous Abortions
RAISE Initiative                                                 RHRC Consortium                                              Implementing a Training Centre in the South for People                                                 and Stillbirths ...........................................................................14
The Reproductive Health Access, Information and Services         The Reproductive Health Response in Conflict (RHRC)          Living in Fragile States: Successes and Challenges of the
in Emergencies (RAISE) Initiative is a joint programme of the    Consortium seeks to increase access to a range of quality,   RAISE Training Centre at Marie Stopes Kenya .................. 3                                       Maternal and Newborn Health in Refugee Camps in
Columbia University Mailman School of Public Health and          voluntary reproductive health services for refugees and                                                                                                             Ethiopia: What a Difference Political and Financial
Marie Stopes International.                                      internally displaced persons around the world.               Voices from the Field: Community Research on the                                                       Commitment Can Make ......................................................... 15
RAISE is catalysing change in global reproductive health         Members work together in areas including service             Experiences of Survivors and Perpetrators of Sexual
service delivery for refugees and internally displaced persons   provision, training, research, advocacy, the documentation   Violence ....................................................................................... 4     Challenges in Emergency Obstetric Care Training for Health
through technical support, clinical training, emergency          and dissemination of information, and support to local                                                                                                              Workers in Conflict Areas in Africa ....................................16
funding, advocacy, research, and documentation and               organisations.                                               Acceptability and Utilization of Clean Delivery Kits in
dissemination.                                                   The RHRC Consortium comprises the American Refugee           Cyclone-Affected Unions in Bangladesh ............................. 5                                  Capacity-Building and Multi-Sectoral Collaboration of Safe
RAISE and its partners work to ensure that the full range        Committee, CARE, Columbia University, the International                                                                                                             Motherhood Advocates: A Strategy for Reducing Maternal
of reproductive health care is available to refugees and         Rescue Committee, JSI Research and Training Institute,       Promoting Access to Reproductive Health Products and                                                   Mortality in Nigeria .................................................................16
internally displaced persons as part of the standard             Marie Stopes International, and the Women’s Commission for   Services in Conflict/Post-Conflict Countries ..................... 5
humanitarian response.                                           Refugee Women and Children.                                                                                                                                         Youth and HIV-Positive People Support in a Conflict
                                                                                                                              Improving Coverage and Quality of Antenatal Care in                                                    Setting: Experiences of Timor-Leste ................................ 17
                                                                                                                              Kerenik Internally Displaced Persons’ Camp in West Darfur,
                                                                                                                              Sudan ............................................................................................ 6   Assessing Reproductive Health Needs in Crisis Settings by
                                                                                                                                                                                                                                     Using the Reproductive Health Assessment Toolkit ......18
                                                                                                                              Monitoring the Availability and Utilization of Emergency
                                                                                                                              Obstetric Care Services in West Darfur, Sudan: Using the                                               Implementation and Results of a Reproductive Health
                                                                                                                              United Nations Process Indicators ....................................... 7                            Survey Conducted in Darfur ................................................ 19

                                                                                                                              New Methodologies to Measure Maternal Morbidity,                                                       Emergency Obstetric Care in a Chronic Conflict Setting in
                                                                                                                              Mortality, and Health Service Delivery in Emergencies . 8                                              Kaga Bandoro, Central African Republic ......................... 20

                                                                                                                              Promotion of Family Planning and Reproductive Health                                                   Clinical Management of Rape Survivors in Emergencies:
                                                                                                                              Knowledge in Post-Conflict Lofa County, Liberia ............. 8                                        Looking Beyond Health Care Providers—UNFPA Zimbabwe
                                                                                                                                                                                                                                     Experience ............................................................................... 20
                                                                                                                              Restoring the Right to Dignity as the Basis for Promotion
                                                                                                                              of Sexual and Reproductive Health of Internally Displaced                                              Ensuring Access to Family Planning Information and
                                                                                                                              Adolescents in Colombia ......................................................... 9                    Services Through Capacity Building in War-Affected
                                                                                                                                                                                                                                     Regions ......................................................................................21
                                                                                                                              Women’s Sexual and Reproductive Health Rights in the
                                                                                                                              Occupied Palestinian Territory ............................................10                          Community Perspectives and Programs on Gender-Based
                                                                                                                                                                                                                                     Violence and Human Rights Programming Among
                                                                                                                              Reproductive Health Status of the Rohingya in Myanmar:                                                 Conflict-Affected Populations in Rwanda ........................ 22
                                                                                                                              Challenges in the Returnee/Reintegration Phase .......... 11
                                                                                                                                                                                                                                     Comprehensive HIV/AIDS Programming Among
                                                                                                                              Gaps in Systematic Approaches to Data Collection for                                                   Conflict-Affected Populations in Rwanda ........................ 23
                                                                                                                              Evidence-Based Reproductive Health Programming in
                                                                                                                              Emergencies ............................................................................. 11
Health Facility Assessment Report, South Kordofan                                                   Promoting Community Reconciliation                                                                   Introducing Maternal Death Audit at a Provincial                                                  Access to Sexual and Reproductive Health Services by
State, Sudan ............................................................................ 23        Through Health Activities .................................................... 36                    Hospital in Sierra Leone: A Review of Twelve Months’                                              Internally Displaced Persons in Kitgum and Pader Districts,
                                                                                                                                                                                                         Experience ................................................................................49     Northern Uganda .................................................................... 61
Implementing Reproductive Health Services in                                                        Delivering Sexual and Reproductive Health
the Northern Ugandan Context: Challenges and                                                        Services Through Community Partnerships                                                              Evaluating the Needs for Reproductive Health Services:                                            Impact of Training Community-Based Health Workers
Opportunities .......................................................................... 24         in Northern Ethiopia ...............................................................37               The Situation of Five General Reference Hospitals in the                                          on the Use of the Partograph on Maternal and Perinatal
                                                                                                                                                                                                         Democratic Republic of the Congo .....................................49                          Mortality and Morbidity in a Post-Conflict, Resource-
Reproductive Health Logistics in the Democratic Republic                                            Knowledge and Use of Family Planning Among Women                                                                                                                                                       Constrained Setting ................................................................62
of Congo ................................................................................... 25     in Northern Uganda: Findings from a Population-Based                                                 Rapid Gender-Based Violence Response to the
                                                                                                    Survey . ...................................................................................... 38   Post-Election Violence in Kenya ......................................... 50                      Increasing Access to Reproductive Health Services in
Determining Donor Commitment Through Policy Analysis:                                                                                                                                                                                                                                                      Emergencies Through Partnerships in the Philippines .63
Examining the Policy Environment for Reproductive Health                                            Adolescent Reproductive Health and Rights in Rural Post-                                             Discrepancy in Knowledge of and Attitudes on Condom
in Crisis Settings ..................................................................... 26         Conflict Settings ..................................................................... 38           Use by Burundian Refugees in Mtendeli Refugee Camp,                                               Tracking Official Development Assistance for Reproductive
                                                                                                                                                                                                         Kibondo, Tanzania ................................................................... 51          Health in Conflict- and Crisis-Affected Countries ...........63
Leveraging Case-Building Research to Increase Awareness                                             We Want Birth Control: Reproductive Health Findings from
of Emergency Contraception in Palestine ....................... 26                                  Northern Uganda ....................................................................39               Partnering with Grassroots Organizations to Deliver                                               Qualitative Study on Maternal Referrals in Rural Tanzania:
                                                                                                                                                                                                         Reproductive Health Services in Conflict-Affected Districts                                       Decision-Making and Acceptance of Referral Advice ... 64
The Sexual and Gender-Based Violence and HIV/AIDS                                                   Good Practices in MISP Implementation from Darfur .. 40                                              in Uganda .................................................................................. 51
Situation and Response in Liberia ......................................27                                                                                                                                                                                                                                 Gender-Based Violence and Health:
                                                                                                    Logistics Management of Reproductive Health Emergency                                                Psychological Support and Health Behaviour in Women                                               Making Collaboration Work in Emergency Response ....65
Monitoring Reproductive Health Services Through a                                                   Kits in Tsunami-Affected Sri Lankan Communities ....... 40                                           Survivors Living with HIV After the Genocide: The Case of
Standardised Health Information System ....................... 28                                                                                                                                        Rwanda-Village Concept Project in Mpungwe Village ...52                                           Whose Choice? Results of a Survey of Knowledge,
                                                                                                    Delivering Youth-Friendly Services in Internally                                                                                                                                                       Attitudes, and Practices About Abortion with Program
Improving Access to Emergency Obstetric Care in Eastern                                             Displaced Persons Camps in Uganda Through                                                            Challenges to Availability and Utilization of Clinical                                            Managers and Policymakers Working in Crisis
Burma ........................................................................................ 29   Strategic Partnership ............................................................. 41               Management of Rape Services in Northern Uganda .....53                                            Settings in Nine African Nations ........................................ 66

Managing Reproductive Health Aid in Emergency                                                       The MOM Project: Delivering Maternal Health                                                          Tracking and Improving Pregnancy Care in Rwanda .... 54                                           Misoprostol at the Community Level: A Feasible
Situations ................................................................................. 29     Services Among Internally Displaced Populations in                                                                                                                                                     Postpartum Hemorrhage Treatment Option Over the
                                                                                                    Eastern Burma .........................................................................42            Establishment of a National Fistula Project in Liberia 54                                         Long Term? .............................................................................. 66
Fistula Survivor and Midwife ............................................... 30
                                                                                                    Research with Women War Torture Survivors in                                                         Impact of the Reproductive Health Project on Care for                                             Unmet Need for Abortion Services:
Mental Distress and Intimate Partner Violence Outside of                                            Luwero District, Uganda: Health Inequalities and                                                     Rape Victims in Southern Kivu Province ..........................55                               The Case of Internally Displaced Women of Angola ......67
Bogotá, Colombia .................................................................... 31            Policy Implications ..................................................................43
                                                                                                                                                                                                         Psychosocial Effects of Sexual Violence in Conflict                                               Access to Comprehensive Health Services for Internally
Increasing Demand for and Use of Modern Contraceptive                                               Increasing Family Planning Uptake Through                                                            Situations ................................................................................. 56   Displaced Persons .................................................................. 68
Methods in Mornie and Kerenic Internally Displaced Person                                           On–the-Job/Hands-On Training at Two Refugee
Camps, West Darfur, Sudan .................................................. 31                     Settlements in Uganda ..........................................................43                   Between Two Fires: Ensuring Sexual and Reproductive                                               Uptake of the Lactational Amenorrhea Method in West
                                                                                                                                                                                                         Health and Rights Among Internally Displaced People in                                            Kasai Province, Democratic Republic of Congo ............. 68
Mainstreaming HIV/AIDS and Reproductive Health in                                                   Improving Access to Family Planning Services Through                                                 Gulu District, Northern Uganda .......................................... 56
a Food Aid Project in a Conflict-Affected Area, Central                                             Community-Based Providers .............................................. 44                                                                                                                            Is Family Planning a Sufficient Intervention for Meeting
Sulawesi .....................................................................................32                                                                                                         The Role of Logistics in Programme Life Cycle and                                                 Reproductive Health Needs?............................................... 69
                                                                                                    Rapid Assessment of Gender-Based Violence Among                                                      Effectiveness ............................................................................57
Reaching Reproductive Health to the Unreachable:                                                    Internally Displaced Persons in Baidoa, Somalia ........... 45                                                                                                                                         Mifepristone and Misoprostol: The Promise of
UNDP-Initiated Mobile Medical Teams and Partnerships 33                                                                                                                                                  Importance of the Information System in Profamilia ... 58                                         New Reproductive Health Technologies in
                                                                                                    Reproductive Health Service During Conflict in Nepal:                                                                                                                                                  Emergency Situations ......................................................... 70
Improved Access to Obstetric Fistula Management in                                                  Policy, Practice, and Achievement .................................... 45                            Sexual Violence in Colombia ............................................... 58
Conflict Zones ..........................................................................33                                                                                                                                                                                                                Misoprostol: A Promising Reproductive Health Technology
                                                                                                    Identifying Survivors of Sexual Violence: Challenges                                                 Sexual and Reproductive Health in Marginal Areas:                                                 in Emergency Situations ..................................................... 70
A Strategy to Deal with the Great Impact on Reproductive                                            in the Field ................................................................................ 46     The Situation of Displaced Women in Colombia .............59
Health Service Delivery of Refugee Resettlement to                                                                                                                                                                                                                                                         Assessing the State Capacity for Operationalizing First
Third Countries ....................................................................... 34          Reproductive Health for War-Affected Youth ..................47                                      Challenges of Maintaining Human Resources to Address                                              Referral Units in Gujarat .................................................... 71
                                                                                                                                                                                                         Reproductive Health in Emergency Situations .............. 60
Emergency Contraception in Emergencies: Assessing                                                   Committing to Quality and Coherence in Emergency                                                                                                                                                       “Midwives on Bikes” in Timor-Leste: An Innovative
Progress, Identifying Challenges ........................................35                         Response ...................................................................................47       Perceptions and Experiences of Women with Abortion                                                Approach to Reproductive Health in Crisis ...................... 71
                                                                                                                                                                                                         Complications Within the Post-War Context of South Sudan:
Adolescent Reproductive Health Service Package:                                                     Blood Transfusion Service: An Integral Component of                                                  Preliminary Results ................................................................ 61
A Guide for Field Practitioners ........................................... 36                      Emergency Obstetric Care .................................................. 48
Comprehensive HIV Prevention as Part of Tsunami                                              Vulnerability of Adolescents to Sexual and Reproductive                                    Addressing Fistula: Process and Partnerships with Ministry of Health and
Response in Indonesia ....................................................... 72             Health and Rights Problems: Prevention Through Culturally
                                                                                             Sensitive Education, Services, and Empowerment .......... 83
                                                                                                                                                                                        Non-Governmental Organisations
The Basic Package of Health Services in Post-Conflict
Countries: Implications and Challenges for Reproductive                                      Mobile Service Units for Immediate Provision of Maternal                                   Rogaia Abdelrahim Abuelgasim
Health Services .................................................................... 73      and Child Health/Reproductive Health Services: UNFPA’s                                     United Nations Population Fund, Somalia
                                                                                             Experience from the Pakistan Earthquake of 2005 ......... 84                               E-mail: abuelgasim@unfpa.org
Differences in HIV-Related Behaviors at Lugufu Refugee
Camp and Surrounding Host Villages ............................... 73                        Access to Social Justice for Victims of Sexual Violence in                                 Background: To date, there has been little experience in addressing fistula in emergency settings; reliable data is lacking
                                                                                             Conflict Situations ................................................................. 84   and few programmes have addressed the issue, leading to a lack of replicable good practices. However, the United Nations
Traumatic Fistula: A Consequence of Sexual Violence ... 74                                                                                                                              Population Fund’s (UNFPA’s) experience in safe motherhood and gender-based violence (GBV) programmes makes it
                                                                                             Integrative Asylum Policy Within South Africa:                                             uniquely qualified to tackle the challenge of fistula in fragile contexts. UNFPA is working to strengthen obstetric fistula
Prevention of Mother-to-Child HIV Transmission Program in                                    Investigating Access to Antiretroviral Treatment                                           programmes in emergency and transitional settings, opening the door to additional work and partnership in the areas of
Tham Hin Camp, Thailand ................................................... 75               Services for Refugees and Asylum Seekers Within a                                          skilled birth attendance, emergency obstetric care (EmOC), and GBV. In Somalia, where a 17-year civil conflict has resulted
                                                                                             Complex Urban Environment ............................................... 85               in the breakdown of social services and infrastructure as well as deterioration of security and economy, untold numbers of
Assessment of Sex Work in Refugee Camps .................... 75                                                                                                                         women suffer due to limited access to basic health services. UNFPA has established offices and strong partnerships with
                                                                                             Family Planning Saves Lives ................................................ 86            Ministries of Health and local non-governmental organisations (NGOs) in the three regions: Somaliland, Puntland,
HIV Evidence-Based Programming for Displaced Persons in                                                                                                                                 and South Central Somalia.
the Southern Caucasus ....................................................... 76             Female Condom Networking on the Thai-Burma Border 86
                                                                                                                                                                                        Purpose: This presentation will outline the process followed, successes, and lessons learned by UNFPA in partnership
Assessing Operational Barriers to Family Planning Services                                   Adolescent Reproductive Health Network on the                                              with Ministries of Health and national NGOs in addressing the issue of fistula in two different environments within Somalia:
for Refugees and Internally Displaced Persons ............... 77                             Thai-Burma Border ................................................................ 87      the post-conflict region of Somaliland and the volatile region of Puntland.

Partnering with Local Organizations to Expand                                                Building Capacity Through Partnership ............................. 88                     Methods: In Somaliland, a partnership with the Ministry of Health and a national NGO enabled UNFPA to facilitate
Access to Emergency Contraception in the Thai/Burma                                                                                                                                     the provision of direct surgical treatment and counselling for the first time in the country, through a November 2007
Border Zone .......................................................................... 78    Comprehensive HIV Services in a Low-Resource Setting 88                                    outreach services campaign. Skills transfer through south-south cooperation established a capable team that continues
                                                                                                                                                                                        to address simple cases in the absence of international experts. In Puntland, through an established medical center,
Re-Establishing Reproductive Health Care in Emergency                                        Contraceptive Use Among Women Refugees in Kyaka                                            minimal additional support has been required to dramatically increase the capacity to provide ongoing surgical treatment
Situations: The Aceh Tsunami Experience ....................... 78                           Refugee Settlement, Kyenjojo District, Uganda ................ 89                          and counselling for fistula patients.

Amid Conflict: Nepal’s Female Community Health                                               SPRINT: An Initiative to Address Sexual and Reproductive                                   Findings: Due to the protracted nature of the emergency, women do not know where to go to seek care. Experienced
Volunteer Program ............................................................. 79           Health in Asia-Pacific ........................................................... 90      surgeons exist in country, but lack equipment, partners, or specific surgical skills to provide comprehensive treatment.
                                                                                                                                                                                        The presence of interested and dedicated experts is an essential element to service provision. Patient follow-up in
Fertility Desire and Family Planning Need Among                                                                                                                                         emergency settings, especially amongst internally displaced persons (IDPs), is difficult to impossible. Post-operative
HIV-Positive Men and Women in Ethiopia ......................... 80                                                                                                                     health education and counselling, and funds for return transportation to the hospital for follow-up, could improve
                                                                                                                                                                                        long-term surgical outcomes.
Coordinating Relief and Development: Opportunities and
Challenges ............................................................................ 81                                                                                              Conclusion: Although fistula surgical treatment requires specialised training, local resources can be upgraded to
                                                                                                                                                                                        alleviate the backlog of patients. It is possible to provide assistance to affected women in conflict areas by upgrading
Reproductive Health Needs Among Female Sex Workers in                                                                                                                                   the available resources when the security situation does not allow external technical support.
Afghanistan .......................................................................... 81

The Use of Epidemiological Data to Recommend
                                                                                                                                                                                        Enhancing Women’s Utilization of Reproductive Health Services Through Integration
Reproductive Health Interventions in
Post-Conflict Liberia ............................................................ 82                                                                                                   of Sexual and Gender-Based Violence Prevention and Response Activities

                                                                                                                                                                                        Judith Elsie Adokorach, Mary Faustina Kamanzi, Rose Amulen, Polly Phillip Okin,
                                                                                                                                                                                        Edward Sembidde
                                                                                                                                                                                        CARE Uganda
                                                                                                                                                                                        E-mail: Adorach@careuganda.org

                                                                                                                                                                                        Background: Insecurity, poverty, and separation of families in northern Uganda exponentially increase women and
                                                                                                                                                                                        children’s vulnerability to sexual and gender-based violence (SGBV). Survivor access to services is compromised by
                                                                                                                                                                                        unequal decision- making power, lack of information, discrimination, stigma, and poverty.




                                                                                                                                                                                                                                  RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                1
Purpose: The purpose is to improve the well-being and health status of internally displaced persons (IDPs) in the              materials as well as equipment to be used for PAC in health facilities; lack of cooperation from some political organs;
targeted districts by establishing community and institutional mechanisms that prevent and respond to SGBV and to              misinterpretation of the whole concept of abortion services due to lack of knowledge amongst the community; lack of
increase women’s access to, and utilization of, reproductive health services in IDP camps in northern Uganda.                  cooperation from some district officials; lack of competent trainers; and excessive expectations from participants in the
                                                                                                                               form of training allowances, which were not accommodated in the initial budget.
Methods: The program approach was to build community and institutional mechanisms that prevent and respond to
SGBV while improving access to quality services. CARE supported health unit rehabilitation, increased drug supplies,           Conclusion: The current environment for conducting training in PAC across Uganda is rather difficult. Without
trained health workers, and increased community awareness of SGBV. In addition, community leadership and local                 community and political support for addressing this issue medically, those working on reproductive health will continue
stakeholders were mobilized to establish protection structures against SGBV in each of the IDP camps as well as to             to face challenges to implementation. It will be essential for those in the field to consider the importance of training
arrange provision of psychosocial and referral services through counseling units staffed by trained case workers. CARE,        service providers.
in collaboration with the district authorities, organized and provided capacity-building training and support supervision to
partner agency staff.
                                                                                                                               Clinical Management of Traumatic Fistulas in the Eastern Democratic
Findings: SGBV impacts women’s access to, and utilization of, available reproductive health services. Increased survivor
access to SGBV care services requires that health units integrate SGBV programs and build capacity to respond. SGBV            Republic of Congo
programs that target couples rather than individuals can play a major role in ensuring safe motherhood and fighting
domestic violence. SGBV services such as psychosocial and legal services should be within easy reach of survivors and          Longombe Ahuka
at no cost to improve access. The quality of services is dependent on the capacity of staff employed at all levels, and        Doctors on Call for Service
thus there is the need to invest in human resources. Deliberate efforts should be made to transform community attitudes        E-mail: albahuka@yahoo.fr
to respect the fact that SGBV is not only unacceptable but a serious criminal offense. Partnership with the community,
government, and other agencies enhances reach, coverage, and establishment of agreeable frameworks. Working through            Background: Armed conflict in the eastern Democratic Republic of Congo (DRC) has led to widespread and extreme
partnerships can build consensus and maximize resources, but it can also slow decision-making and implementation.              sexual violence. One health consequence has been the occurrence of urogenital fistulas (UGF), or traumatic fistulas.

Conclusion: Interventions that prevent and respond to SGBV greatly contribute to reducing barriers to effective                Purpose: Our objective is to highlight the prevalence and etiologies of traumatic gynecological fistula and to discuss
utilization of reproductive health services. Therefore, reproductive health programs need to have a participatory              clinical management in our setting.
approach involving key stakeholders at all levels and should strengthen health delivery structures and integrate SGBV
prevention and response activities.                                                                                            Methods: This study was conducted from April 1, 2003 to December 31, 2005 at the Doctors on Call for Service (DOCS)
                                                                                                                               Learning Center in Goma, DRC. We received 3,826 cases of sexual assault and rape, amongst which were 436 cases
                                                                                                                               with gynecological traumatic fistula and recto-vaginal fistula. During the same period of study, 179 cases with vesico-
Issues in Training Post-Abortion Care Service Providers in Uganda:                                                             vaginal fistula (VVF) of obstetrical origin were also admitted, giving 4,005 cases in total. All of the cases with VVF (615)
                                                                                                                               underwent surgery for UGF. We collected demographic and clinical information for each of the patients. We used the
Personal Experience
                                                                                                                               Statistical Package for the Social Sciences (SPSS) for analysis of our data.

Janet Rose Adongo                                                                                                              Findings: Rape caused 70.8% of traumatic UGF, whereas only 29.2% were of obstetrical origin. Of the total, 7.8%
Marie Stopes Uganda                                                                                                            had extra genital lesions. Only 97 (2.5%) patients received post-exposure prophylaxis (PEP) against HIV following the
E-mail: janet.adong@mariestopes.or.ug                                                                                          incident. In total 3,390 survivors of sexual violence received social support and medical help, and 436 cases underwent
                                                                                                                               surgery for VVF repair. For the 615 VVF cases, the average age of victims was 28.6 years, with a range from 6 to 73 years.
Background: Marie Stopes Uganda (MSU) has implemented comprehensive reproductive health (RH) services within                   Additionally, 10.1% of the women were aged less than 18 years.
Uganda for the past 17 years. The organization works to provide services at static and mobile clinics, trainings, and local
advocacy on issues of family planning and post-abortion care (PAC). Despite government efforts, the availability of quality    Conclusion: War atrocities are the most common cause of traumatic fistula in army conflict areas of the DRC. Rape
PAC services and family planning remains limited in many districts in Uganda.                                                  victims seen at health facilities represent only the tip of the iceberg. PEP is available for only a few victims.

Purpose: A PAC strategy aims to improve women’s health by expanding access to quality services at all levels of the
health care system. This requires a multidimensional approach that involves support from the community level to the
                                                                                                                               Implementing a Training Centre in the South for People Living in Fragile States:
health system and policy levels.
                                                                                                                               Successes and Challenges of the RAISE Training Centre at Marie Stopes Kenya
Methods: MSU has implemented two trainings and six advocacies with the District Health Teams on PAC in 11 districts
in Uganda over a period of six months under the RAISE and PACE projects. Training lasted 12 days and covered topics            Fred Akonde, Pamela Ochieng, Lilian Mumbi
such as abortion complications leading to maternal mortality, clinical assessment of patients with abortion, post-abortion     The RAISE Initiative/Marie Stopes Kenya
family planning and counseling, infection prevention, manual vacuum aspiration, and many more. Trainees are identified,        E-mail: fred.akonde@eastleigh.mariestopes.or.ke
through ministry structures, from health facilities not currently providing PAC services. Trainings are provided in both
development and post-conflict settings, with a goal of achieving equity of service delivery.                                   Background: Through the RAISE Initiative and under the umbrella of Marie Stopes Kenya (MSK), a training centre was
                                                                                                                               created at the Eastleigh Nursing Home to address the reproductive health (RH) training needs of health professionals
Findings: PAC training is intended to equip health workers with knowledge and skills of PAC and family planning, support       working for humanitarian and development agencies in emergency settings.
improvement in quality of care delivered at health facilities by use of manual vacuum aspirators, and improve the referral
network for PAC services through the mobilization of MSU’s existing outreaches and community health workers’ network.          Purpose: The RAISE Training Centre programme seeks to train and support appropriate health providers to give quality
Experience shows that training on PAC still remains a challenge for numerous reasons, including: lack of qualified health      RH services. The centre collaborates with humanitarian agencies in the field by training their staff in order to improve
workers in the health facilities of Health Centre IIIs and IVs where PAC services can be established; lack of training         access to comprehensive RH services.
2           RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                            RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                    3
Methods: In collaboration with other experts in RH care, training curricula on family planning, emergency obstetric              Acceptability and Utilization of Clean Delivery Kits in Cyclone-Affected
care (EmOC), and post-abortion care (PAC) have been developed, tested, and revised. So far, the trainings offered are
competency-based, practical, and clinical. The team provides hands-on training and experience. A partnership with the
                                                                                                                                 Unions in Bangladesh
national hospital provides enough cases for all participants. The partner agency selects trainees amongst their field
health employees. Evaluation of the effectiveness of the transfer of skills is undertaken through pre- and post-training         Ribka Amsalu, Ferdousi Begum, Ireen Chowdhury Akhter
theory tests and followed up through supervision visits and review of logbooks.                                                  Save the Children USA
                                                                                                                                 Email: ramsalu@savechildren.org
Findings: The restrictive nature of national guidelines for RH in conflict settings, particularly relating to procedures
performed by midlevel providers, is one of the major challenges identified. In general, there is a lack of continuous training   Background: Bangladesh was battered by cyclone Sidr on November 15th, 2007. An estimated 8 million people were
and education in new procedures and techniques for service providers. Staff turnover is particularly challenging in conflict     affected, and more than 3,000 deaths have been reported so far. Save the Children USA, as part of its emergency
settings. Already, participants trained at Eastleigh in 2007 have left their posts. Due to volatile security in the field,       maternal and newborn health response, distributed clean delivery kits (CDK) to visibly pregnant women in 15 unions in
training follow-up is often delayed, thereby hindering our capacity to support the trainees. On the plus side, the centre has    Borguna and Patuakhali districts. The majority of deliveries in Bangladesh take place at home, in the absence of a skilled
received requests from a number of agencies to utilise its resources and expand access to RH training to a larger number         birth attendant.
of humanitarian actors. Participants reported satisfaction with the acquisition of new skills and showed motivation to
improve access to family planning services. The diverse clinical and cultural backgrounds of participants, who shared            Purpose: The aim of this specific intervention is to reduce unhygienic delivery practices. The Minimum Initial Service
experiences in a variety of settings, created a positive, stimulating learning environment.                                      Package (MISP) for reproductive health in crisis situations promotes the provision of CDK to visibly pregnant women in
                                                                                                                                 order to reduce unhygienic delivery practices. In developing country contexts, the utilization of CDK, with appropriate
Conclusion: Competency-based training of RH care providers has increased the motivation and knowledge of health                  counseling on the use of the kit, has been associated with a reduction in the risk of cord infection, perineum infection, and
providers and will consequently improve provision of RH services in emergencies. There is an increasing demand from              sepsis. The impact has been high in situations where CDK provision was associated with counseling on birth plan (where
partner agencies to receive on-site training of trainers for providers who cannot come to Nairobi. This is one way in which      and by whom) and training of birth attendants on how to use the CDK. There is no documented evidence in crisis situations
the number of trainees could be increased.                                                                                       (to the knowledge of the author) regarding whether the distribution of CDK where there is limited
                                                                                                                                 opportunity for counseling on its use would increase the appropriate utilization of such kits or lower the risk of
                                                                                                                                 infection (cord and puerperal).
Voices from the Field: Community Research on the Experiences of Survivors and
                                                                                                                                 Methods: Save the Children registered visibly pregnant women in its impact area of Borguna and Patuakhali districts,
Perpetrators of Sexual Violence                                                                                                  identifying a total of 8,315 pregnant women. By the end of January, a total of 3,672 pregnant women had been provided
                                                                                                                                 with CDK. The CDK distributed are produced locally and have instruction regarding use in Bangla on the package.
Harriet Akullu                                                                                                                   Community health volunteers distributed the CDK with advice to pregnant women on how to use the kit. The Community
United Nations Development Fund for Women                                                                                        health volunteers conducted postnatal visits within 24 to 48 hours after delivery in order to provide a newborn kit; advise
E-mail: cngongo@engenderhealth.org                                                                                               mothers on immediate breastfeeding, thermal care, and hygienic practices; and check for maternal complications. This
                                                                                                                                 study aims to evaluate if provision of CDK was associated with increased and appropriate utilization of the kits, comparing
Background: The past 20 years of war in northern Uganda have led 90% of the population of Gulu, Kitgum, and Pader                cord infection rates among users and non-users of CDK, as well as the practice among users of the disposal of kit
districts to live in protected camps. Life in the camps is characterized by poor sanitation and health conditions,               contents after utilization.
idleness, and insecurity.
                                                                                                                                 Findings: The program will be evaluated in April 2008.
Purpose: This community research aimed to determine the magnitude of sexual violence experienced by women in
Ugandan camps for internally displaced persons (IDPs). Testimonies that highlight the incidence of rape and traumatic            Conclusion: The findings of the evaluation will provide information on strategies on how to distribute CDK, what
fistula within the camps should alert the authorities and civil society organizations to improve conditions.                     messages to include, and the effectiveness of their provision to pregnant women in reducing infection in the newborn and
                                                                                                                                 mother. Lessons learned will be of use in future emergencies for effective implementation of a critical component of the
Methods: This qualitative study focused on oral testimonies from sexual violence survivors. Written records from the             MISP for reproductive health in emergencies.
police, local councils, and camp authorities were reviewed. Senior gynecologists from hospitals serving the internally
displaced were interviewed by telephone. Organizations and individuals based in northern Uganda provided secondary               Promoting Access to Reproductive Health Products and Services in
data on documented traumatic fistula cases.
                                                                                                                                 Conflict/Post-Conflict Countries
Findings: Sexual violence is on the rise in camps for the internally displaced in northern Uganda. Current methods of
estimating the magnitude of the problem are inadequate. Incidents of abuse are under-documented by police, health                Dana Aronovich, Youssouf Ouedraogo, Alexa Stipkala
units, local councils, and camp leaders. Survivors are often reluctant to report. Women may be defiled in exchange for           John Snow, Inc.
protection, and girls abducted by the Lord’s Resistance Army have been repeatedly raped or turned into sex slaves.               E-mail: daronovich@jsi.com
Abducted boys have been forced to commit crimes, some of which are sexually violent in nature and may result in
traumatic fistula. This study documented compelling testimonies from both victims and perpetrators. There is evidence            Background: The United Nations Population Fund (UNFPA) received funding from the European Commission to work in
that programs to address the security, health, educational, and psychological needs of survivors are inadequate.                 17 priority conflict and post-conflict countries in sub-Saharan Africa and the Caribbean to promote access to reproductive
                                                                                                                                 health (RH) products and services. UNFPA sub-contracted John Snow, Inc. to help achieve project objectives.
Conclusion: Traumatic fistula is not a familiar phenomenon in health facilities. Survivors of sexual violence often do not
report to authorities, perhaps due to stigmatization, fear of revenge, loss of privacy, distrust of authorities, and a lack of   Purpose: Using advocacy to create a positive political climate in countries, the goal is to promote reproductive health
awareness of the reporting process. The impunity of perpetrators of sexual violence must be addressed for the future             commodity security (RHCS), where every person is able to choose, obtain, and use quality RH commodities whenever he/
protection of women and girls.                                                                                                   she needs them. National RHCS steering committees are created and strategic plans are drafted to solicit commitment
                                                                                                                                 from national and international stakeholders.

4           RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                              RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                  5
Methods: Major activities include: carrying out national RHCS situational analyses, development of RHCS strategic             Findings: At the start of the Save the Children program, the majority of the deliveries were conducted at home and
plans, advocacy, and sensitization to RHCS, capacity building in RHCS and logistics management for RH commodities.            attended by TBAs, and the awareness of the community regarding the importance of ANC was very poor. The ANC
International, regional, and national consultants were used to motivate stakeholders working in RH to commit human            coverage (defined as at least one visit before delivery) has since increased significantly to 83% from a baseline of 50%.
and financial resources to strengthen RH programs. National and international stakeholders include Ministries of Health,      The acceptance and knowledge among the community regarding the importance of ANC has also increased significantly
Finance and Planning; social marketing programs; the private sector; donors; and non-governmental organizations (NGOs)        over the last three years. Quality of care check lists and clinic data analysis demonstrate that the essential elements of
working in RH. Success is measured by the adoption of a national RHCS strategic plan, a functioning RHCS coordinating         quality ANC are provided by health personnel in the Kerenik health center.
committee and the creation of a national budget line for RH commodities.
                                                                                                                              Conclusion: High ANC coverage and quality are achievable in crisis situations. Engagement of the community in raising
Findings: Countries in conflict/post-conflict face additional challenges in achieving RHCS where governments are              awareness on the importance of ANC and individual counseling of pregnant women were found to be good approaches to
reorganizing and rebuilding public infrastructure and health systems. Equity issues must be strongly considered when          increase demand and service utilization. Trainings, on-the-job supervision, and availability of drugs and medical supplies
proposing strategies for RHCS in these countries, including developing legal frameworks to ensure RHCS, access to             were key in ensuring the quality of ANC service provided and in increasing skilled attendance at birth.
quality products and services, and equity across the population, especially poor, rural, and marginalized populations.
Focus groups, stakeholder interviews, and workshops offer an opportunity for advocacy and education regarding
the importance of RHCS. Creating a network of informed and committed stakeholders can create a positive political,
                                                                                                                              Monitoring the Availability and Utilization of Emergency Obstetric Care Services in
legislative, and social environment for increasing access to and use of RH services and commodities. Coordination by
UNFPA, the United States Agency for International Development (USAID), and other stakeholders leverages funding and           West Darfur, Sudan: Using the United Nations Process Indicators
synchronizes RHCS efforts. National stakeholders and international partners must take ownership of the activities and
outputs to ensure that final work plans are approved and implemented and that support is maintained over time. Even           Sarah Ashraf, Ribka Amsalu, Shihab Ibrahim, Yousif Adam
in countries in conflict/post-conflict, the private sector (commercial and NGO) can play a critical role in ensuring RHCS.
                                                                                                                              Save the Children USA
These stakeholders must be sensitized and included in assessments and strategic planning. A whole market approach will
                                                                                                                              Email: sashraf@savechildren.org.sd
increase options and opportunities for expanding access.

Conclusion: The approach used to assess RHCS status and mobilize resources is the “Strategic Pathway to RH                    Background: The Safe Motherhood National survey conducted in Sudan in 1999 indicated West Darfur as one of the
Commodity Security” or SPARHCS. This approach and the SPARHCS framework have been used by dozens of countries                 states with low reproductive health (RH) indicators: total fertility rate per woman was 6.5; and pregnancy outcomes were
and can be adapted for use with any RH commodities or programs, including HIV/AIDS. The approach builds stakeholder           86.8% live births, 0.9% stillbirths, 11.9% spontaneous abortions, and 0.6% induced abortions. Only one-third (33.3%) of
consensus and commitment to agreed-upon strategic plans.                                                                      all deliveries were attended by trained health personnel.

                                                                                                                              Purpose: Save the Children USA has had a Comprehensive Reproductive Health (CRH) program in West Darfur, Sudan
                                                                                                                              since 2004. The overall purpose of this study was to quantitatively measure the availability and utilization of key
Improving Coverage and Quality of Antenatal Care in Kerenik Internally Displaced                                              reproductive health services in ten Save the Children supported/managed health facilities from November 2006 to
Persons’ Camp in West Darfur, Sudan                                                                                           October 2007. Specific objectives included: 1) to monitor progress in utilization and availability of emergency obstetric
                                                                                                                              care (EmOC) by calculating United Nations process indicators in facilities that were providing EmOC over the last year and
Sarah Ashraf, Yousif Adam, Shihab Ibrahim, Ribka Amsalu                                                                       2) to provide baseline data against which progress can be measured for new EmOC centers that are being established. In
                                                                                                                              addition, Save the Children assessed the quality of the signal functions provided in the facilities.
Save the Children
E-mail: naffash75@yahoo.com
                                                                                                                              Methods: The CRH program of Save the Children is designed to improve the quality and utilization of EmOC, family
                                                                                                                              planning (FP), post-abortion care (PAC), gender-based violence (GBV), and HIV/AIDS services. The reproductive health
Background: West Darfur is one of the states in Darfur that has been severely affected by the conflict in Sudan. The          program began in 2004, and over the years several components have been added to expand program components,
Sudan national Safe Motherhood survey conducted in 1999 reported that of all births in West Darfur, in only 33% had the
                                                                                                                              expand program coverage, and improve quality. Currently, a total of twelve health facilities provide reproductive health
mother received at least one antenatal care (ANC) visit. Save the Children USA’s Comprehensive Reproductive Health
                                                                                                                              service, out of which seven have EmOC. The methodology used to conduct the facility-based assessment was based on the
(CRH) program has, in the last four years, increased access to, and utilization of, quality ANC among internally displaced
                                                                                                                              facility assessment tool of the RAISE Initiative; in addition, individual patient records and quality checklists were used to
persons (IDPs) in Kerenik IDP camps.
                                                                                                                              assess the quality of signal functions provided in Kerenic.

Purpose: The main objective of Save the Children’s program is to reduce morbidity and mortality among pregnant                Findings: The data from the facility-based assessment is currently being analyzed. It will provide information on the five
women in Kerenik IDP camps by promoting and increasing access to quality ANC as part of the CRH program.
                                                                                                                              UN process indicators: the number of EmOC services available, the proportion of all births in EmOC facilities, the met need
                                                                                                                              for EmOC services, cesarean section as a percentage of all births, and obstetrics case fatality rate. The findings from the
Methods: The community component includes conducting health messaging activities and raising awareness on ANC at              quality checklist on signal functions and post-abortion care provided in Kerenic are being collated and analyzed.
women’s committees and disseminating messages targeting influential groups, which include traditional birth attendants
(TBAs) and sheikhs. ANC provided at the facility level includes: individual counseling and establishment of initial contact
                                                                                                                              Conclusion: While past reproductive health programs in crisis situations have been cautious about promoting EmOC
with pregnant women; assessment of maternal and fetal health; identification and treatment of current illnesses; detection
                                                                                                                              services at the basic health center level, the experience of Save the Children in West Darfur shows that basic EmOC
and management of pregnancy-related complications; creation of birth plans; prevention of illness, including provision
                                                                                                                              services can be provided at this level and that the UN process indicators can be applied to measure progress in crisis
of insecticide-treated nets (ITNs), intermittent preventive therapy in pregnancy (IPTp), and tetanus toxoid; and health
                                                                                                                              situations. The challenges and lessons learned in setting up EmOC services in crisis situations will be shared.
promotion. Pregnant women are encouraged to attend ANC by distributing soap and blankets during visits. The methods
used to measure ANC coverage and quality included analysis of clinic data and a quality of care check list and review of
data from two population-based surveys done in 2005 and 2006.




6           RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                          RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                   7
New Methodologies to Measure Maternal Morbidity, Mortality, and                                                                Purpose: The programme aimed to increase contraceptive prevalence and reproductive health (RH) knowledge among
                                                                                                                               women in Foya District, Lofa County. Specific objectives were to establish a team of 20 skilled community health workers
Health Service Delivery in Emergencies                                                                                         (CHWs) across ten rural communities trained in commodity distribution and HIV/AIDS education and to ensure affordable
                                                                                                                               contraceptive supply to women of reproductive age.
Linda Bartlett1,2, Oona Campbell3, Wendy Graham2,4
1 Johns Hopkins Bloomberg School of Public Health                                                                              Methods: Pentecostal Mission Unlimited (PMU) Liberia trained 20 CHWs in family planning and HIV/AIDS prevention. Two
2 IMMPACT Programme, University of Aberdeen                                                                                    CHWs—one female and one male—were selected from each of the 10 target communities based on two criteria: literacy
3 Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine                               and community support. Each CHW was equipped with contraceptives and a bicycle. A small-scale baseline survey was
4 Department of Obstetrics and Gynaecology, University of Aberdeen                                                             conducted in 10 target communities to assess community knowledge of family planning and HIV/AIDS. The survey will be
E-mail: lbartlet@jhsph.edu                                                                                                     repeated at an appropriate interval to measure change. Progress was monitored by tracking a set of key output indicators,
                                                                                                                               including the number of CHWs trained and number of commodities distributed.
Background: Reproductive health (RH) in emergencies, including maternal morbidity and mortality, has been recognized
as an important issue that needs to be addressed. Yet few studies of maternal outcomes in emergencies have been done,          Findings: The programme had a visible impact in the target communities. CHWs reported a substantial increase in
due in part to a limited choice of measurement methods that could be used for a relatively rare event in complex settings.     contraceptive prevalence and knowledge about HIV/AIDS and other sexually transmitted infections (STIs). Notably,
Advances in methods have been developed that may be applicable for use in emergencies.                                         they observed an increase in male support for family planning. School teachers reported that fewer teenage girls were
                                                                                                                               dropping out of school due to pregnancy. CHWs began to extend their coverage areas beyond the communities where
Purpose: The purpose is to describe new methods developed by IMMPACT to measure maternal outcomes and service                  they resided because they were sensitive to the demand for family planning information and services. Their high level of
quality and their potential usefulness in emergency settings.                                                                  motivation was a major ingredient of the programme’s success. CHWs found that sharing their own experiences of
                                                                                                                               condom use was an effective strategy for undermining the negative perception that condoms are only used by sex
Methods: The new methods were assessed for feasibility and usefulness in emergencies.                                          workers. Based on the success of the CHWs in family planning promotion, PMU began to make preparations to train
                                                                                                                               traditional birth attendants in safe motherhood. Maternal and infant mortality was an immediate and pressing concern
Findings: Collecting data in emergencies poses substantial epidemiological challenges, including obtaining a sample            to community members.
size adequate to provide acceptable statistical precision, particularly important when measuring relatively rare events
like maternal mortality (MM), and implementing a representative sampling plan that may not be feasible in a mobile and         Conclusion: Investment in training and supplies for a small team of CHWs was a cost-effective means of reaching women
insecure setting; optimizing data accuracy to reduce over- and under-counting of deaths when respondents may be under          of reproductive age across more than 10 communities. This is a strategy that can be replicated by other organizations
severe stress, or may not know the location or survival of their family members; and simplifying data management. New          operating in post-conflict settings where health infrastructure has collapsed and health status is in crisis.
methods that may address these issues include Sampling at Service Sites (SSS), which utilizes a short, direct sisterhood
questionnaire to estimate MM. It may help to address sampling issues as it employs a convenience sample, in which
women in public places are interviewed to quickly acquire the required sample size. In emergency settings, registration        Restoring the Right to Dignity as the Basis for Promotion of Sexual and
areas, clinics, and food distribution centres may be feasible data collection sites. One limitation of this method, however,
is the timeframe of the MM estimate, which reflects the maternal mortality ratio (MMR) from 0 to 5 years previously
                                                                                                                               Reproductive Health of Internally Displaced Adolescents in Colombia
and thus may not be suitable in very short-term emergencies. A Retrospective Ascertainment Process for Institutional
Deaths (RAPID) is a method to identify facility-based deaths. RAPID and Tracing Adverse and Favourable Events in               Marleen Bosmans1, Fernando Gonzalez2, Marleen Temmerman1
Pregnancy Care (TRACE) gather quantitative and qualitative information on maternal deaths and near-misses to guide             1 International Centre for Reproductive Health—Ghent University
service delivery. Maternal Death From Informants (MADE-IN) and Maternal Death Follow-On Review (MADE-FOR) are                  2 United Nations Population Fund Colombia
complementary methods whereby community informants report deaths among women, which are investigated using a                   E-mail: marleen.bosmans@ugent.be
simplified verbal autopsy on personal digital assistants (PDAs) with geographic information system (GIS) capability. This
method may be suitable where settlements of forced migrants become established. Furthermore, using PDAs streamlines            Background: In Colombia, internally displaced persons (IDPs) often live in illegal settlements. Although official
data management and permits GIS analyses.                                                                                      registration entitles them to free health services, stigmatization, combined with poor availability of and accessibility to
                                                                                                                               appropriate health services, makes adolescents particularly vulnerable in their sexual and reproductive health.
Conclusion: These new methods for measuring maternal outcomes and assessing services can be useful in emergencies
and help to guide prevention efforts.                                                                                          Purpose: To describe lessons learned from a program for sexual and reproductive health rights of internally displaced
                                                                                                                               adolescents based on the empowerment of the adolescents through the restoration of their right to dignity.


Promotion of Family Planning and Reproductive Health Knowledge in                                                              Methods: The identification of lessons learned was one of the terms of reference of the external evaluation of the
                                                                                                                               program in August 2005. A qualitative methodology was used, comprising briefing meetings (2); semi-structured focus
Post-Conflict Lofa County, Liberia                                                                                             group discussions with adolescent beneficiaries of the program (2); semi-structured interviews with key stakeholders (11);
                                                                                                                               exchanges with program beneficiaries (3); site visits (8); regular feedback meetings; and a debriefing of the preliminary
Matina Kumba Borbordee, Mamai K. Hallie, Jacob B. Zubah                                                                        project results.
Pentecostal Mission Unlimited Liberia
E-mail: jaczubah@yahoo.com                                                                                                     Findings: The program focused on promoting youth organizations. Through the use of arts and bodywork for acquiring
                                                                                                                               and disseminating sexual and reproductive health information, the adolescents regained respect for their bodies and
Background: Fourteen years of civil conflict had a devastating impact on health services in Lofa County, including a           gradually succeeded in regaining their self-esteem as well as respect for the other. The aim was to break prevailing
breakdown in the supply of modern contraceptives. A 2007 survey found that contraceptive prevalence in Lofa County             taboos and prevailing concepts about male dominance, sex and sexuality, and to empower them to claim their rights. Arts
stood at 3.3 percent in rural areas.                                                                                           and bodywork were also used in the sexual and reproductive health workshops organized for all stakeholders involved
                                                                                                                               in the implementation of the program. Public health staff received additional training in medical aspects of adolescent
                                                                                                                               sexual and reproductive health, and in the organization of adolescent-friendly services. Actions were developed to

8           RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                            RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                   9
incorporate sex education in the school curriculum. The program gave rise to a new sense of unity in the settlements.          Reproductive Health Status of the Rohingya in Myanmar:
Parents started organizing themselves and insisted on being included in the program. Governmental support, however,
remained insufficient. Access to health services was still a major problem and the sustainability of the program remained
                                                                                                                               Challenges in the Returnee/Reintegration Phase
a challenge.
                                                                                                                               Ann Burton, Khin Oo Zin, Herve Isambert
Conclusion: The right to sexual and reproductive health is often conceived in terms of availability, accessibility,            United Nations High Commissioner for Refugees
acceptability, and affordability of sexual and reproductive health services. Restoring the right to dignity proved to          E-mail: burton@unhcr.org
be crucial for the adolescents. They felt empowered as human beings—able to take care of themselves and to refuse
unwanted sexual relations. Such programs require a long-term commitment because of the high mobility of the IDP                Background: Significant progress has been made in assessing, identifying, and addressing the reproductive health
population, continuous turnover of health staff and various barriers impeding implementation of government policies.           (RH) needs of displaced populations in the emergency, post-emergency, and care and maintenance phases. However,
                                                                                                                               little attention has been given to the returnee and reintegration stage of the displacement cycle; in some settings this
                                                                                                                               phase presents many challenges to the provision of comprehensive RH services. Since 1992, over 236,000 Rohingya
                                                                                                                               refugees have returned from Bangladesh to Northern Rakhine State (NRS), a geographically isolated area of Myanmar.
Women’s Sexual and Reproductive Health Rights in the                                                                           The total population of NRS is over 800,000, of whom 675,000 are Rohingya Muslims who lack citizenship and
Occupied Palestinian Territory                                                                                                 mainly live in the two townships of Maungdaw and Buthidaung.


Marleen Bosmans1, Dina Nasser2, Umiyeh Khammash2,3, Patricia Claeys1, Marleen Temmerman1                                       Purpose: A joint United Nations High Commissioner for Refugees (UNHCR)/United Nations Population Fund (UNFPA) RH
                                                                                                                               assessment was conducted in 2006. The objectives were to document RH services, examine factors affecting RH-related
1 International Centre for Reproductive Health - Ghent University
                                                                                                                               morbidity and service delivery, analyze gaps, and propose appropriate strategies to address these.
2 Juzoor Foundation for Health & Social Development
3 United Nations Relief and Work Agency for Palestine Refugees in the Near East
                                                                                                                               Methods: Assessment tools were adapted from the Reproductive Health in Refugee Situations Inter-agency Field Manual
E-mail: marleen.bosmans@ugent.be
                                                                                                                               and consisted of key informant interviews, focus group discussions, and facility checklists. Two gender-balanced teams
                                                                                                                               carried out the assessment.
Background: The Palestinian health system is highly dependent on external donor support, which is mainly inspired by
short-term humanitarian aid strategies. Main health providers are: the Ministry of Health (MOH, 60%), non-governmental
                                                                                                                               Findings: The main findings were: only 7 to 22% of women had received antenatal care; the maternal mortality ratio
organizations (NGOs, 31%), and the United Nations Relief and Work Agency for Palestine Refugees in the Near East
                                                                                                                               was estimated at 380/100,000 live births (Myanmar average of 230); in Maungdaw, only 2% of deliveries took place in
(UNRWA, 9%). UNRWA services are only accessible for registered refugees, who constitute 39.8% of the population. The
                                                                                                                               an EmOC facility (target >15%) and only 0.6% of expected deliveries in Maungdaw and 0.3% in Buthidaung underwent
outbreak of the second Intifada in September 2000 is characterized by severe mobility restrictions impeding access to
                                                                                                                               cesarean section (target 5-15%); moreover only 6% of women in Maungdaw and 9% in Buthidaung were using family
health services. Even women in labor are denied passage at military checkpoints.
                                                                                                                               planning. Infection prevention in health care settings, including blood safety, was unsatisfactory. Domestic violence
                                                                                                                               was purportedly very common but rarely reported; the prevention of, and response to, gender-based violence needed
Purpose: To highlight that the complexity of the Israeli-Palestinian conflict is seriously affecting the sexual and
                                                                                                                               strengthening in most sectors. Pervasive poverty, marked gender inequalities, and lack of citizenship and its attendant
reproductive health rights of women in the Occupied Palestinian Territory.
                                                                                                                               restrictions all have serious consequences for the RH of this population. In response, increased financial and technical
                                                                                                                               resources were allocated, coupled with advocacy at national level. Though initial results show some progress in both
Methods: The study was conducted in the West Bank and Gaza in September 2002. A total of 19 in-depth open interviews
                                                                                                                               access to and uptake of RH services, significant context-specific challenges remain.
with a wide array of national and international key informants, two focus group discussions, and eight site visits to health
facilities and refugee camps were carried out.
                                                                                                                               Conclusion: In conclusion, failure to adequately meet the RH needs of returnees and host communities on return
                                                                                                                               threatens to undermine the significant progress made in the earlier phases of the refugee cycle. Efforts to strengthen RH
Findings: Since the start of the second Intifada, access to sexual and reproductive health services had become a
                                                                                                                               services of displaced populations need to be inclusive of all phases of the displacement cycle and systematic assessments
huge problem for patients, health staff and humanitarian agencies. Use of antenatal and postnatal care services had
                                                                                                                               should be integrated into the return process.
decreased significantly. There were indications of women asking more frequently for induced delivery or caesarian
section. Emergency measures had been developed, such as midwife training for attending home deliveries and a hotline
for assisting deliveries. Movement restrictions combined with the geographical separation between the West Bank and
Gaza impeded the implementation of the National Reproductive Health Guidelines. Poor donor interest was said to be the         Gaps in Systematic Approaches to Data Collection for Evidence-Based
main reason for cutbacks in reproductive health programs. Family planning was becoming an increasingly sensitive issue         Reproductive Health Programming in Emergencies
and had to be promoted as birth-spacing. Deliveries at military checkpoints and serious indications of increased violence
against women were no priority for human rights organizations; the violation of women’s rights was considered to be of
                                                                                                                               Sara Casey, Sonia Navani
secondary importance given the political situation.
                                                                                                                               The RAISE Initiative
Conclusion: Lack of access to reproductive health services is the most visible aspect of the conflict’s impact on the          Email: sn2341@columbia.edu
sexual and reproductive health of both refugee and non-refugee women. Little attention is paid to a less visible impact,
whereby women’s sexual and reproductive health rights are subordinated to the political situation. Failures to address         Background: Striking an appropriate balance between obtaining practical, useful and attainable reproductive health
these rights might create a false perception that given the harsh political situation their violation is inevitable,           (RH) data and the capacity of service providers to deliver acutely needed health services has been a constant struggle
and thus acceptable.                                                                                                           in humanitarian settings. Discussions often revolve around the need for good data for evidence-based programming
                                                                                                                               to leverage advocacy efforts at global and national levels, to demonstrate value added by service agencies to external
                                                                                                                               stakeholders, to guide programmatic decision-making internally, and to improve facility services. Establishing systems
                                                                                                                               to collect useful data to meet these needs remains difficult. The RAISE Initiative partners with several non-governmental
                                                                                                                               organizations (NGOs) to collect data on RH service delivery programs in conflict-affected sites.



10          RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                           RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                 11
Purpose: A baseline facility assessment was conducted by each partner in RAISE-supported health facilities. The                 to gender-based violence should be incorporated in all care. Collaborating with other agencies for experience-sharing can
facility assessment as well as routine data collection aim to monitor the use and quality of RH service delivery through        improve the quality of care for displaced populations.
standard indicators.

Methods: The facility assessment included a record review in which 12 months of RH data were collected at each health           Reproductive Health Development Agency Provides Emergency Response to
facility supported by RAISE partners. Similar data are collected by partners from these same facilities on a quarterly basis.
                                                                                                                                Cyclone-Affected Women and Children in Bangladesh
Findings: Among the health facilities assessed, very few had systems in place to enable accurate collection of key RH
data. Analysis of data from some 70 health facilities show that some data are collected on a routine basis (e.g., number        Mohammad Hussain Choudhury
of deliveries, family planning users, treatment of reproductive tract infections). However, the data are often not available    Marie Stopes Clinic Society
in an accessible format that is useful for decision-makers. In addition, some data that are collected are not useful            E-mail: mhc@mariestopesbd.org
for monitoring services or quality of care. Data from two RH technical areas, in particular, were consistently lacking:
emergency obstetric care and gender-based violence. Little of the data needed to calculate standardized indicators were         Background: Marie Stopes Clinic Society (MSCS) provides reproductive health (RH) services to men, women, and
available to providers or project staff.                                                                                        children across Bangladesh. The majority of team members are clinic staff, including doctors, nurses, and midwives. In
                                                                                                                                November 2007, nature unleashed her wrath in the form of cyclone Sidr which swept across southern Bangladesh, leaving
Conclusion: The last decade has been a time of impressive growth towards standardized responses in emergencies and              a trail of death and destruction in her wake.
field-friendly tools to operationalize those standard elements of basic, quality RH services. Despite these improvements,
data collection and analysis at the field level to guide program decisions is often still viewed as a competing rather than     Purpose: As an RH service-delivery organisation, MSCS had little experience responding to an emergency. However, like
complimentary priority in emergencies. The RAISE Initiative is supporting partners to improve data collection at health         many others, MSCS could not sit by, and so decided to mount a response to ameliorate the suffering.
facilities and train staff to use these data to monitor their own services or project implementation.
                                                                                                                                Methods: The team at MSCS observed responses to the crisis and realised there was a gap in RH services being provided.
                                                                                                                                Based on its expertise as a pioneer in RH services, using outreach to provide services to remote areas, MSCS decided
Preventing HIV and Ensuring Antiretroviral Continuity:                                                                          to focus its efforts on provision of RH services. Although they have little experience in mobilising resources for a rapid
                                                                                                                                response, the team members were able to raise funds from local and international sources.
AMPATH’s Response to Internally Displaced HIV-Positive Persons in Kenya
                                                                                                                                Findings: Operating beyond its usual scope, the MSCS relief effort included distribution of food, provision of medical
Cleophas Chesoli, Jackline Sitienei, Catherine Gichunge, Judy Njumwah                                                           services, and distribution of winter clothes. The teams worked with local health officials, joint forces, and the Upzilla
Academic Model for the Prevention and Treatment of HIV                                                                          executive officer to ensure coordination of the relief effort. A total number of 3,931 clients in four districts were served in
E-mail: cleophaswanyonyi@yahoo.com                                                                                              a three-week period. The majority of these came for antenatal or postnatal care, urinary tract infections, and reproductive
                                                                                                                                tract infections. Clients were provided with treatment and psychological support as required. Cases requiring referral
Background: After Kenya’s disputed post-election results, about 1,000 people were killed and more than 300,000                  were challenging, due to the poor transport, and the devastation of referral facilities. In addition, MSCS distributed 5,600
others were displaced. Approximately 15,000 of those displaced were HIV positive.                                               blankets and 3,000 pieces of winter clothes. The team found the response felt like a drop in the ocean and that their
                                                                                                                                efforts were small compared to the needs.
Purpose: The Academic Model for the Prevention and Treatment of HIV (AMPATH) responded to the post-election
violence through providing material and financial assistance, voluntary counseling and testing (VCT), and follow-up for         Conclusion: Like many development organisations, MSCS provides health services in a region which can be hit by
clients on antiretroviral drugs (ARVs). The intention of the follow-up was to minimize the risk of drug resistance.             environmental disaster at any time. The team could not just sit and watch the devastation caused by cyclone Sidr without
                                                                                                                                providing a much-needed medical response. RH services are often forgotten in the immediate response to a disaster, yet
Methods: AMPATH operated its emergency assistance programs in 11 camps in five districts in Western Kenya with over             are essential. Despite challenges, MSCS found that by working with local authorities and agencies more used to operating
100,000 internally displaced persons (IDPs). To reach displaced clients on ARVs, AMPATH initially placed notices in the         in an emergency, it was able to reduce some of the suffering.
media and created a telephone hotline. Through “snowball” communications, AMPATH identified those on ARVs living
in the camps, and provided information and referrals to nearby service providers for persons displaced outside of the
catchment areas. In addition to treatment, AMPATH offered psychological and trauma counseling. Through partnerships
                                                                                                                                Desperate and Alone: Reproductive Health Needs of Iraqi Refugees in Jordan
with other agencies, AMPATH also provided training in disaster management, sexual violence, and the Sphere standards.
As the situation stabilized, AMPATH undertook VCT counseling to monitor the number of new infections over the
                                                                                                                                Sarah Chynoweth, Megan McKenna
January-March period.
                                                                                                                                Women’s Commission for Refugee Women and Children
Findings: Over 1,000 AMPATH patients were displaced during the skirmishes, with over 60% being women. Women and                 E-mail: sarahch@womenscommission.org
children were most affected, and about 10 rape and defilement cases were reported among clients. There was a high risk
of HIV infection and re-infection due to sexual exploitation and abuse, compromised livelihoods, and idleness. Population       Background: The war in Iraq has spurred one of the greatest displacements of people since WWII—over 4.5 million
movement from rural to urban areas and increased sexual activity in the camps were also high risk factors. There was fear       people as of January 2008. Despite this mass exodus, little attention has been given to the reproductive health (RH)
of drug resistance due to patients defaulting on treatment as a result of stigma and discrimination evident in the camps.       needs of Iraqi women and youth.

Conclusion: While neither VCT nor ARV provision is a part of the Minimum Initial Service Package (MISP) for                     Purpose: The Women’s Commission for Refugee Women and Children (Women’s Commission) conducted a mission to
Reproductive Health, the monitoring of new HIV infections through VCT has yielded more data on the impact of                    Jordan to gain a snapshot of the RH situation of Iraqi refugee women and youth in Jordan in order to bring their issues to
displacement on HIV incidence. Furthermore, the effort to provide ARVs in acute emergencies is still relatively new;            the attention of policymakers and humanitarian actors.
yet AMPATH’s work has shown that innovative approaches can be taken to reduce treatment gaps and the risk of drug
resistance. In camps, special care should be given to women due to their unique needs and vulnerabilities, and response

12          RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                             RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                  13
Methods: Three Women’s Commission staff members travelled to Amman, Jordan to collect stories and case studies from              Conclusion: The questionnaire is an ideal qualitative tool to identify gaps in the quality or level of prenatal services.
Iraqi women, men, and young people about their RH needs during each phase of displacement—including their experiences            It will help in identifying causes of spontaneous abortions or stillbirths, and therefore programs can design relevant
at home during the war, during flight, and as refugees. The field team interviewed United Nations officials, local and           interventions to target these causes.
international non-governmental organization (NGO) staff; we also spoke with eight Iraqi families and approximately 30
individual Iraqi refugees about their plight. We used snowball sampling to gain a snapshot of the situation on the ground.
Informed consent was provided by all participants and strict confidentiality continues to be maintained.
                                                                                                                                 Maternal and Newborn Health in Refugee Camps in Ethiopia:
Findings: Significant gaps in RH services available to Iraqi refugees were found. In particular, prevention of and response      What a Difference Political and Financial Commitment Can Make
to sexual violence were absent. Clinical care for rape survivors was not available at any of the clinics visited, and sexual
exploitation was reportedly on the rise. Psychosocial support services were very limited. Other forms of gender-based            Nadine Cornier, Dejene Kebede, Mohamed Qassim, Christopher Haskew,
violence (GBV), particularly domestic violence and marital rape, were reported. Safe motherhood services, including              Carmen Aramburu, Paul Spiegel
emergency obstetric care (EmOC), were free for refugees; however, the presentation of a marriage certificate was
                                                                                                                                 United Nations High Commissioner for Refugees
required to receive care. Some contraceptive supplies were available over the counter, but many of the interviewed Iraqi
                                                                                                                                 E-mail: cornier@unhcr.org
women said they could not afford them and that pharmacies would not sell them to unmarried women or adolescents.
Iraqis said that refugees wished to delay having children due to their stressful and uncertain circumstances. HIV
                                                                                                                                 Background: Ethiopia hosts approximately 100,000 refugees. Most have lived in camps for more than a decade
prevalence was low among both refugees and the host population, and health care workers were reportedly trained in
                                                                                                                                 and remain wholly dependent on humanitarian assistance from the international community. Resource shortfalls
universal precautions, although condoms were not made available for refugees.
                                                                                                                                 and competing priorities among health care providers have hindered the implementation of reproductive health (RH)
                                                                                                                                 activities. In 2007, the United Nations High Commissioner for Refugees (UNHCR) allocated additional funding to the
Conclusion: This information may be useful to humanitarian organizations implementing health services for Iraqi
                                                                                                                                 Ethiopia refugee programme to address existing critical gaps, including access to and coverage of maternal and
refugees in Jordan and can help guide RH programming. In particular, comprehensive GBV services, in conjunction with
                                                                                                                                 newborn health care.
livelihoods programming to minimize sexual exploitation, should be prioritized.

                                                                                                                                 Purpose: The study objectives were to document improvements in the RH status of refugees, following high-level
                                                                                                                                 commitments and an increase in earmarked resources to maternal and newborn health services.
The Use of a Standard Questionnaire as a Tool to Investigate the
Cause of Spontaneous Abortions and Stillbirths                                                                                   Methods: A systematic review of the Health Information System (HIS) RH indicators was conducted, in light of UNHCR’s
                                                                                                                                 increased resource allocations and consequent RH programme implementation, for the period from January to December
                                                                                                                                 2007. Two key outcome indicators (proportion of births attended by skilled health workers and proportion of births
Christine Connor, Melel Bekainyogoto
                                                                                                                                 taking place in health centres) were reviewed, along with two impact indicators (neonatal mortality ratio and incidence
International Rescue Committee                                                                                                   of obstetric complications). Information on resource contributions was obtained from High Commissioner Special Project
E-mail: christine.connor@theirc.org                                                                                              financial and progress reports.

Background: In 2004, the International Rescue Committee (IRC) and the United Nations High Commissioner for                       Findings: The proportion of births taking place in health centres in camps increased from an average of 14.4% [2.9% in
Refugees (UNHCR) established the Oure Cassoni refugee camp in northeastern Chad, near the Sudan border. There are                Sherkole; 33.3% in Dimma] to 90.3% [68.2% in Sherkole; 100% in Dimma]. Births attended by skilled health personnel
approximately 28,035 refugees hosted at the camp, nearly 90 % of whom are women and children under the age of 18.                increased from an average of 13.4% in January 2007 [2.9% in Sherkole; 33.3% in Dimma] to 89.1% in December 2007
                                                                                                                                 [68.2% in Sherkole; 100% in Dimma]. Service utilisation increased rapidly following the employment of female midwives,
Purpose: The reproductive health (RH) program provides safe deliveries, prenatal and postnatal consultations, post-              the renovation of infrastructure to improve privacy and quality of services, an investment in medical equipment, and a
abortion care, family planning, sexually transmitted infection (STI) treatment, and supplemental food distribution in the        promotion of services at the community level. No statistically significant difference in neonatal mortality or incidence of
Oure Cassoni camp. The RH services program provides, on average, 100 prenatal and postnatal consultations and trained            obstetric complications was detected within this short period.
providers assist with approximately 40 births per month.
                                                                                                                                 Conclusion: The Ethiopia programme has made remarkable improvements in its safe motherhood services. The increase
Methods: In 2007, the reproductive health staff treated, on average, five women per month for spontaneous abortions,             in service utilisation and proportion of safe deliveries occurring in health services can be explained by improvement
or miscarriage, and there were a total of 12 stillbirths. The cause of these cases was unknown. In order to investigate the      in service quality that was made possible through funding from the High Commissioner’s Special Project. Political and
cause of spontaneous abortions and stillbirths, IRC Chad developed a questionnaire to interview reproductive health staff        financial commitment is essential to the improvement of maternal and newborn health and survival. This must be followed
and women who have aborted or delivered a stillborn infant. The questionnaire contains a series of questions regarding           by strong programme implementation.
results of prenatal care, medical history, and reported illnesses or trauma during pregnancy.

Findings: The abortion and stillbirth questionnaire was first used in October 2007, and is used with each case treated in
the reproductive health center (RHC). The initial finding was that involving RHC staff in the interview process increased
their assessment skills, and they were more likely to ask these questions with the next case. The questionnaire enabled
the staff to identify causes such as reported fevers during pregnancy, sustained trauma, or non-compatible blood groups.
By investigating the cause of the abortions or stillbirths, RHC staff are able to identify gaps in prenatal consultation,
and the specific needs for community health education on safe motherhood. This has enabled the management staff to
improve prenatal services, and develop training to build the capacity of refugee staff. Further interviews are needed to
test the reliability of the questionnaire as a tool for identifying the cause, but it has been shown to be a valid qualitative
tool in evaluating program service delivery.




14          RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                              RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                 15
Challenges in Emergency Obstetric Care Training for Health Workers in                                                        multi-sectoral collaboration among individuals, private and civil society organizations to program more effectively on safe
                                                                                                                             motherhood has been identified as a critical impetus to drastically reduce maternal death in Nigeria.
Conflict Areas in Africa
                                                                                                                             Methods: With financial support from the MacArthur Foundation in the last four years, the Nigerian Partnership for
Blami Dao1, Barro Drissa1, Zerbo Aoua2                                                                                       Safe Motherhood (NPSM) has been involved in capacity building of safe motherhood advocates in six project states of
1 Centre Hospitalier Universitaire Souro Sanou, Bobo Dioulasso, Burkina Faso                                                 the Federation, representing each of the six geopolitical zones of Nigeria. There is an increased membership drive for
2 Ministry of Health, Ouagadougou, Burkina Faso                                                                              safe motherhood champions through multi-sectoral collaboration and effective partnering with relevant stakeholders at
E-mail: bdao@fasonet.bf                                                                                                      local, state and national levels, as well as civil society, comprised of women leaders, religious/traditional leaders, mass
                                                                                                                             media, schools, communities and NGOs, etc. Other activities undertaken included: conducting training needs assessments,
Background: Cote d’Ivoire and the Democratic Republic of Congo (DRC) have been affected by civil war. To increase            development and validation of a safe motherhood training curriculum, formation of a safe motherhood advocacy network,
the access to quality reproductive health services, the United Nations Children’s Fund (UNICEF) in Cote d’Ivoire, and        advocacy visits to relevant stakeholder, publication of safe motherhood newsletters, organization of public lectures to
RAISE in DRC, have decided to train health workers in Emergency Obstetric Care (EmOC) using the expertise of a               commemorate national safe motherhood day, formation of an online Yahoo group forum, and monitoring visits to evaluate
training center in Burkina Faso.                                                                                             the progress of safe motherhood advocacy activities at the grassroots level.


Purpose: The purpose is to discuss the challenges and findings in training in EMOC for service providers working in          Findings: More than 180 individuals were trained in the six project states as safe motherhood advocates. After the
conflict-affected areas, and to review the difficulties facing trainees in implementing their newly acquired knowledge and   training, the safe motherhood advocates formed a network in their respective states. More than 350 individuals and
skills in their daily work.                                                                                                  corporate organizations from all facets of life registered as members of the NPSM across the country. Thus, safe
                                                                                                                             motherhood leadership training has created a core of active advocates for safe motherhood who can work at the
Methods: The training in EmOC had three components: 1) a knowledge update; 2) skills standardization; and 3) a follow-       community level to mobilize resources for the promotion of safe motherhood. Also, local participation, community
up visit. The trainees (physicians, nurses, midwives and anesthesiologists) working in conflict areas were selected by       mobilization, and a multi-sectoral approach have been recognized as a critical mass towards the promotion of safe
UNICEF and RAISE. At the end of the first two phases, each team of participants (comprising a physician, nurse/midwife,      motherhood in Nigeria.
and anesthesiologist from the same health center) had to implement an action plan, which would be assessed by the
training team during the follow-up visit. The team also needed to put into practice the new knowledge and skills learned     Conclusion: Combining capacity building and multi-sectoral collaboration with programmatic issues vastly increases
during the training. This was assessed through direct observation.                                                           the effectiveness of individuals and community organizations, and thus promotes synergy among relevant stakeholders.
                                                                                                                             It further enhances service delivery at local, state, and national levels and facilitates program sustainability and
Findings: Health workers in conflict areas are enthusiastic about gaining new knowledge and skills. Short-term               development. Scaling up of the project should be extended to other states for maximum impact and to generate
improvement of the quality of care is noticed. Follow-up visits are essential for the implementation of new knowledge and    a large-scale effect.
skills. Implementing training requires strong support from the sponsoring organizations. Sustainability of EmOC activities
is difficult once the sponsoring organization withdraws.
                                                                                                                             Youth and HIV-Positive People Support in a Conflict Setting:
Conclusion: Training in EmOC for providers working in conflict areas leads to an improvement in the quality of care.
There should be a sustainability plan at the beginning of the project based on an agreement between sponsoring
                                                                                                                             Experiences of Timor-Leste
organizations and ministries of health.
                                                                                                                             Antonieta Magno de Arauju, Daniel Marcal, Titin Rejeki, Rima Irmayani,
                                                                                                                             Michael Koeniger, Maurice A. Bloem
Capacity-Building and Multi-Sectoral Collaboration of Safe Motherhood Advocates:                                             Church World Service, Timor-Leste
                                                                                                                             E-mail: titin@cwsindonesia.or.id
A Strategy for Reducing Maternal Mortality in Nigeria
                                                                                                                             Background: Timor-Leste is vulnerable to horizontal conflict. The last major conflict, in May 2006, destabilized the country
Olukunle Daramola1, Bene Madunagu2, Friday Okonofua3, Mairo Bello4,                                                          and crippled its security situation. Tens of thousands of people were displaced and injured. This further worsened the
Nike Adeyemi5, Moji Odeku5                                                                                                   already weak economic growth, poor service delivery, and high unemployment, all of which increased the risk of violence.
1 Nigerian Partnership for Safe Motherhood
2 Girls’ Power Initiative                                                                                                    Purpose: This program was intended to increase the capacity of vulnerable youth and HIV-positive people to cope with
3 Women’s Health and Action Research Centre                                                                                  difficult circumstances in order to prevent violent conflict. Delivered as a peace-building strategy, this program focused on
4 Adolescents’ Health and Information Project                                                                                increasing livelihood access for people living with HIV, and provided a media outlet for youth interests and needs.
5 Federal Ministry of Health Nigeria
E-mail: damol_kbe@yahoo.co.uk                                                                                                Methods: Church World Service (CWS) tried to link its HIV and AIDS program with peace-building activities for out-of-
                                                                                                                             school youth and HIV-positive people. The program targeted 200 youths coming from barracks and conflict areas, as
Background: Since the launch of a safe motherhood initiative, the maternal mortality ratio has remained unacceptably         well as conflict-affected HIV-positive people. The program provided young people with the opportunity to receive lessons
high in Nigeria, despite the implementation of several programs by national agencies, multilateral organizations and         in computer literacy, English, car repair, driving, and secretarial courses. This capacity building was also supported by
non-governmental organizations (NGOs). Available statistics indicate that about 54,000 maternal deaths occur in Nigeria      internship programs to equip the youths with on-the-job experience. HIV-positive individuals also participated in income-
annually, which account for nearly 10% of the annual global estimate of maternal death.                                      generating activities. Both young people and HIV-positive participants were involved in HIV awareness activities through
                                                                                                                             information sessions, mass campaigns, and capacity-building trainings.
Purpose: One of the factors responsible for this scenario is that programs implemented over the years were largely
hospital-based, while a few were community-based. However, involvement and active participation of relevant
stakeholders in safe motherhood programs had been neglected in all states of the Federation. Thus, capacity building and


16          RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                         RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                17
Findings: Around 120 youths and 15 HIV-positive individuals participated in the program. Through a focus group                     Implementation and Results of a Reproductive Health Survey Conducted in Darfur
discussion, young people reported there was a great need for this kind of capacity-building activity and that such
opportunity was rare in Timor-Leste. Young people from conflict areas met and interacted with each other during the
                                                                                                                                   Dayal Debnath1, Bahja Abbo Ibrahim1, Samir Hadziabdlui1, Assayed Daoud2,
program activities, creating an opportunity to foster communication and good will. The favorite topic for discussion
                                                                                                                                   Melissa Sharer3, Katie Anfinson3
amongst the young people was “how to prepare for the future”. They reported that involvement in the various activities
helped to release tension. Young participants also requested more variation in activities. HIV-related information helped          1 American Refugee Committee
to increase their awareness of this infection. In the program, young people and HIV-positive participants also had an              2 American Refugee Committee
opportunity to meet with each other, increasing the possibility of creating an enabling environment. The young people              3 American Refugee Committee
showed an interest in being actively involved in HIV prevention, for example, by being facilitators in HIV sessions.               E-mail: dayalc@arc-sudan.org


Conclusion: In conflict situations, the psychosocial needs of the HIV-positive population must be considered and                   Background: The crisis in Darfur has displaced millions of people and destroyed infrastructures including health
addressed. Programs for youth should not be limited to an HIV focus, but should also emphasize reproductive health                 facilities, resulting in poor access to health services, especially reproductive health (RH) services. In response to this
issues, such as contraceptives, sexuality, etc. Incorporating HIV issues in peace-building efforts could be a potential            dire situation, the American Refugee Committee (ARC) started providing essential RH services to improve RH care and
strategy in conflict settings.                                                                                                     availability of RH services in South Darfur.

                                                                                                                                   Purpose: In an effort to establish a baseline to plan for and evaluate project activities, ARC conducted a population-
                                                                                                                                   based survey in Safia and Gereida towns, which was adapted by RAISE from the Centers for Disease Control and
Assessing Reproductive Health Needs in Crisis Settings by Using the
                                                                                                                                   Prevention (CDC) RH Toolkit. The information gathered included RH knowledge, attitudes, and practices. Additionally, ARC
Reproductive Health Assessment Toolkit                                                                                             will document and disseminate the findings to the field of public health.

Stacy De Jesus1, Marianne Zotti1, Michelle Hynes2, Van Tong1                                                                       Methods: The population-based survey was translated and adapted to cultural sensitivities and pilot-tested prior to
                                                                                                                                   implementation. The instrument had 10 sections related to RH topics. A sample size was selected for Safia using proportionate
1 Centers for Disease Control and Prevention
                                                                                                                                   stratified random sampling, and in Gereida, multi-stage cluster sampling was used. A total of 922 women of reproductive age
2 Emory University
                                                                                                                                   were interviewed (506 in Gereida and 416 in Safia). The survey staff included 4 ARC staff, 2 Ministry of Health (MoH) staff,
E-mail: sdejesus@cdc.gov
                                                                                                                                   6 supervisors, 22 interviewers, and 8 locators. Training for all staff was conducted prior to implementation. Survey staff
                                                                                                                                   cooperated with community leaders and members throughout the implementation of the survey.
Background: Assessing reproductive health (RH) needs in crisis settings is vital to ensuring that quality reproductive
health services are available. The Reproductive Health Assessment (RHA) Toolkit for Conflict-Affected Women provides
                                                                                                                                   Findings: Results from the survey show:
tools to collect RH data in crisis settings for program and policy action.
                                                                                                                                    • Harmful traditional practices are prevalent: child marriage is common, with 82% of women in Safia and 80% in
                                                                                                                                      Gereida reporting their first marriage before 18 years of age (median marriage age is 15). Almost half reported
Purpose: The RHA Toolkit was developed by the Centers for Disease Control and Prevention (CDC) in response to the
                                                                                                                                      that their husbands have other wives. Additionally, female genital cutting is widely practiced in both areas. 96% of
growing demand for quality population-based data. The RHA Toolkit data enable field staff to identify RH needs, prioritize
                                                                                                                                      respondents in Gereida and 93% in Safia reported genital cutting.
services, and evaluate outcomes. Data can also support advocacy and fundraising efforts.
                                                                                                                                    • Use of antenatal and postnatal care is common, with 65% of women in Gereida and 60% in Safia receiving antenatal
                                                                                                                                      care, while around 25% in both areas received a postnatal checkup by a medically trained person.
Methods: The RHA Toolkit allows mid-level field staff with limited epidemiology skills to conduct a reproductive health
                                                                                                                                    • Use of modern family planning methods is low, only 0.7% in Safia and 2% in Gereida. Among currently pregnant
assessment in conflict-affected communities. It provides a training manual, sampling instructions, and pre-programmed
                                                                                                                                      women, 35% in Safia and 47% in Gereida did not want to be pregnant, thus suggesting a large unmet need for
data entry and analyses programs. It assesses the reproductive health needs of conflict-affected women ages 15 to 49
                                                                                                                                      family planning.
through a standardized quantitative survey instrument. Data can be used to compare a population across points in time or
across populations. The RHA Toolkit was pilot-tested among refugee and internally displaced women in three countries in
                                                                                                                                   Conclusion: The study yielded an important source of information for RH programming and research in Darfur. Using
Africa and Latin America.
                                                                                                                                   this valuable data, ARC will design programs which emphasize issues such as family planning, institutional delivery,
                                                                                                                                   mortality reporting, and interventions for traditional practices. Other organizations will also benefit from this in-depth
Findings: The RHA Toolkit provides indicators about safe motherhood, family planning, sexual history, HIV/AIDS
                                                                                                                                   data on RH issues.
knowledge, and gender-based violence. Examples of findings from the countries participating in the pilot testing showed
women who received at least 1 antenatal visit ranged from 85% to 95%. Current use of any method of family planning
ranged from 5% to 45.5%. Women experiencing conflict-related gender-based violence ranged from 11% to 45% and
intimate partner violence ranged from 8% to 47%.

Conclusion: The RHA Toolkit allows field organizations to assess key reproductive health needs among conflict-affected
women by providing a quantitative survey, training manual, and analysis guide with remote assistance from the CDC. It
also allows field workers to build their capacity to conduct assessments and to rapidly generate reliable population-based data.




18           RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                               RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                  19
Emergency Obstetric Care in a Chronic Conflict Setting in                                                                     Methods:
                                                                                                                               • Pre-training questionnaires administered to health professionals.
Kaga Bandoro, Central African Republic                                                                                         • Specific aspects of limited knowledge on the subject and poor working relationships with other stakeholders identified.
                                                                                                                               • A mix of participants from various sectors included with some trainees serving the role of facilitators in their
Goulo Diallo1, Bisimwa Ruhana-Mirindi1, Lieve Van der Paal2                                                                      field of expertise.
1 International Rescue Committee, Central African Republic                                                                     • A multi-sectoral training curricula adapted from the UNHCR/UNFPA training curricula.
2 International Rescue Committee                                                                                               • Training on medical aspects and the importance of a multi-sectoral response was delivered in simple language and
E-mail: lieve.vanderpaal@theirc.org                                                                                              through, carefully designed group work by experts.
                                                                                                                               • Impact of training measured by pre- and post-test questionnaires and level of satisfaction expressed for each session.
Background: This study aims to evaluate the results of the International Rescue Committee’s (IRC) reproductive health
program in Kaga Bandoro hospital, in the northern province of Nana Gribizi, Central African Republic (CAR). This area has     Findings:
suffered from chronic conflict and political instability, resulting in weak infrastructures and lack of reproductive health    • 24/30 participants reported the training to be informative.
services. IRC started supporting the hospital in February 2007, with emphasis on providing quality reproductive health         • 20/30 participants felt the training was comprehensive.
services, including emergency obstetric care (EmOC), to the population in Kaga Bandoro town and on the Ouandago Axis           • Health professionals did not have any reservations about attending training with other professions, and recommended
who were most heavily affected by the recent war. The total catchment population of the hospital was estimated                   similar trainings in the future for a wider audience.
at 80,000.                                                                                                                     • The presence of media professionals in the training helped provide media coverage for the event and provided a sound
                                                                                                                                 basis for further advocacy on the subject .
Purpose: To assess the availability, uptake, and quality of EmOC available in Kaga Bandoro hospital.                           • Knowledge gained will be utilised by non-governmental organisations (NGOs) in mainstreaming clinical management of
                                                                                                                                 rape survivors in all their related training.
Methods: We analyzed routine data collected in the hospital between January 1 and December 31, 2007. We estimated              • A multi-sectoral perspective on each issue in discussion was welcomed by all participants.
the number of births as 4% of the total target population and the need for treatment of obstetric complications as 15% of      • Helped forensic department to revisit their rape kits and obtain suggestions for their improvement.
the total estimated births in the target population.                                                                           • Assisted forensic and legal departments to field-test their latest medical affidavits.


Findings: During the study period, there were no health facilities on the Ouandago Axis, with some of the villages            Conclusion:
up to 50 kilometers away from the hospital without an adequate referral mechanism. At the Kaga Bandoro hospital,               • UNHCR/UNFPA training curriculum on clinical management of rape survivors is easy to adapt in the field.
comprehensive EmOC was available, with the exception of vacuum extraction and forceps. There were a total of 783               • Trainings for diverse stakeholders are well received and have a positive and synergistic effect.
deliveries (24.5% of the total estimated births for the catchment population), with 231 obstetric complications treated        • Similar training can be mainstreamed into GBV-related trainings.
(48.1% of needs met), and 48 cesarean sections (a coverage of 1.5 %, less than the minimum recommended level of 5%).
There were three maternal deaths among women presenting with obstetric complications, giving a case fatality rate
of 1.3% (3/231).                                                                                                              Ensuring Access to Family Planning Information and Services Through
Conclusion: Destruction of all health facilities in Nana Gribizi and a lack of referral mechanisms lead to the                Capacity Building in War-Affected Regions
underutilization of the existing EmOC facility. There is a need to re-establish health facilities providing basic EmOC in
Nana Gribizi and to put in place an effective referral system for obstetric complications in peripheral health units.         James E. Ebube, Abie Joy Sulae
                                                                                                                              Chibuzor Human Resource Development Organization
                                                                                                                              E-mail: abiejoy2@yahoo.com
Clinical Management of Rape Survivors in Emergencies: Looking Beyond
                                                                                                                              Background: Kono District was one of the regions most devastated by Sierra Leone’s civil war. Following the conflict,
Health Care Providers—UNFPA Zimbabwe Experience                                                                               dire socio-economic conditions and lack of health services contributed to poor reproductive health (RH) for women. The
                                                                                                                              national maternal mortality ratio is currently 2,000 per 100,000 live births. It is likely to be higher in Kono.
Sathyanarayanan Doraiswamy1, Bruce Campbell1, Gift Malunga1,
Anna-Reuben Mumba1, Annemarie Schuller1, Robert Gray Choto2                                                                   Purpose: Chibuzor Human Resource Development Organization’s (CHIDO) goal was to increase awareness of family
1 United Nations Population Fund                                                                                              planning and access to affordable contraceptives in target communities in Kono. Specifically, CHIDO aimed to build the
2 Zimbabwe Ministry of Health and Child Welfare                                                                               capacity of 100 community members to serve as family-planning focal points, providing information and services.
E-mail: sathya.doraiswamy@undp.org
                                                                                                                              Methods: CHIDO recruited community focal persons in three chiefdoms based on their good standing in the community
Background: The United Nations Population Fund (UNFPA) in Zimbabwe supports national partners to formulate,                   and willingness to serve. In preparation for this role, they participated in three capacity-building workshops on family
implement, monitor and evaluate programmes to combat gender-based violence (GBV). Training is one of the strategies           planning, based on a simplified family planning manual. Public awareness campaigns were held in each community.
used by the country office to strengthen national capacity.                                                                   Contraceptives (male and female condoms, pills, and injectables) were distributed through focal points and distribution
                                                                                                                              centres. A baseline survey was conducted to assess family planning knowledge and access to contraceptives in the target
Purpose: Capacity-building efforts were organised and conducted to enhance participants’ appreciation of the multi-           communities. If funds are available, an endline survey will be conducted at a later date to measure progress. The main
sectoral response in the management of rape; and to study the feasibility of supporting the UNFPA/United Nations High         programme outputs are monitored on a regular basis.
Commissioner for Refugees (UNHCR) training for a diverse group of stakeholders.




20          RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                         RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                21
Findings:
 • The baseline survey indicated that almost half of the respondents had not heard about family planning methods and,
                                                                                                                              Comprehensive HIV/AIDS Programming Among
   for a majority, contraceptives were not easily available. Eighty-four percent of respondents said they would be willing
   to pay for contraceptives.                                                                                                 Conflict-Affected Populations in Rwanda
 • Using volunteer community focal persons instead of project staff to provide family planning information and services
   fosters the development of a sustainable base of support for family planning. However, community focal points need         Leah Elliott, Jennifer Nantale
   the right level of training and support in order to take on this new responsibility and play their role effectively.
                                                                                                                              American Refugee Committee, Rwanda
 • It is effective to integrate the provision of family planning information and contraceptives into other development
                                                                                                                              E-mail: rh@arc.org.rw
   programming when possible. CHIDO has held highly successful family planning sessions within its literacy and
   livelihoods programmes.
                                                                                                                              Background: Since 2004, the American Refugee Committee (ARC) has successfully implemented comprehensive HIV
 • More needs to be done to reach out to youth (age 10 to 24) in Kono District with family planning information and
                                                                                                                              and AIDS prevention, care, and treatment programs in two Congolese refugee camps in Rwanda. At onset, there were no
   services. In the next implementation phase, CHIDO will design targeted outreach activities for youth.
                                                                                                                              on-site HIV and AIDS services available to the thousands of refugees living there.

Conclusion: A capacity-building approach to family planning service provision is particularly effective in a post-conflict    Purpose: In close partnership with the Rwandan government, ARC has worked to obtain official certification to operate
setting where local health infrastructure has been destroyed. With the right level of training and support, a capacity-       on-site voluntary counseling and testing (VCT) and prevention of mother-to-child transmission (PMTCT) services in both
building model provides a sound base for future expansion of RH programming at the community level.                           camps. With a refugee population of 18,000, Gihembe Camp received official certification for on-site VCT and PMTCT
                                                                                                                              services in February 2004. This was followed by certification for Nyabiheke Camp (population 8,000) in April 2007.

Community Perspectives and Programs on Gender-Based Violence and Human Rights                                                 Methods: Since beginning on-site VCT/PMTCT services in the camps, ARC has implemented many components of a
                                                                                                                              comprehensive HIV program. One of the main focuses of the HIV prevention programming in the camps has been to
Programming Among Conflict-Affected Populations in Rwanda
                                                                                                                              successfully tailor activities in such a way as to reach all populations, including women, children, and men. On the side
                                                                                                                              of care and treatment, ARC has focused most of its energy to make sure comprehensive care is provided to persons
Leah Elliott1, Anita Ho2, Sidiki Kanneh1, Carol Pavlish3                                                                      living with HIV and AIDS (PLWHAs). This includes not only routine counseling and physician care, but also extensive
1 American Refugee Committee                                                                                                  psychosocial, material, and nutritional support.
2 University of British Columbia
3 University of California, Los Angeles                                                                                       Findings: Developing a comprehensive HIV program focusing on prevention and response is possible within a refugee
E-mail: cpavlish@sonnet.ucla.edu                                                                                              camp setting via creative and participatory programming. On the care and treatment side of the programming, thanks
                                                                                                                              to diverse donor support, ARC was able to go beyond traditional programming and ensure that each PLWHA receives
Background: Gender-based violence (GBV) and human rights concerns persist in post-conflict settings and pose a                regular home visits, is assigned a trained home-based care provider, receives monthly and annual care kits and also
challenge to reproductive health specialists and human rights activists. As one of the most significant protection concerns   receives weekly supplemental food. Since the beginning, ARC has worked in close collaboration with the Rwandan Minister
in populations affected by armed conflict, sexual violence is well known as a strategy of war. Other forms of GBV such as     of Health, the Rwandan Treatment and Research on AIDS Center, the United Nations High Commissioner for Refugees
domestic violence, forced/early marriage, family abandonment, and wife-beating occur with regularity in many cultures,        (UNHCR), the United States Centers for Disease Control and Prevention (CDC), and donor organizations such as the United
and sexual exploitation is a serious and continuing problem in humanitarian settings. Women and children are the most         States Agency for International Development (USAID), the President’s Emergency Plan for AIDS Relief (PEPFAR), the Great
vulnerable to exploitation, violence, and abuse by virtue of their gender, age, and status in societies where community       Lakes Initiative on HIV/AIDS (GLIA), and the Organization of Petroleum Exporting Countries (OPEC). It was only through
protection and support systems have been disrupted and abuse of power frequently occurs with impunity. The American           building close partnerships with these organizations that ARC became one of the first non-governmental organizations
Refugee Committee (ARC) currently offers a multi-sectoral program to prevent and respond to GBV amongst the residents         (NGOs) in a refugee setting to receive official government approval to commence on-site antiretroviral (ARV) services.
of two refugee camps, Nyabiheke and Gihembe, in Rwanda. The ARC Rwanda program is committed to utilizing culturally           Indeed, establishing ARV services in a refugee setting is a first for Rwanda and ARC would not have been chosen to help
appropriate and sustainable approaches that empower communities to find ways to address GBV. The current GBV program          lead the way had they not established such strong ties with local, government, and international organizations.
emphasizes community education and behavior change strategies using appropriate outreach methods and channels.
                                                                                                                              Conclusion: ARC’s work in the camps has shown that it is possible to successfully implement comprehensive HIV/AIDS
Purpose: An ethnographic study was conducted to seek community perspectives on justice and human rights and how               programming among conflict-affected populations in a refugee camp setting.
these perspectives influence community structures and people’s attitudes towards gender relationships and GBV.

Methods: Two ARC Rwanda GBV program specialists will describe current GBV service components that are offered to              Health Facility Assessment Report, South Kordofan State, Sudan
camp residents. In particular, we will look at how community involvement enhances various sensitization programs. Two
university-based researchers from Canada and the United States will describe their collaboration with ARC Rwanda to
implement a community-based, ethnographic research study at one Rwandan refugee camp. Presenters will describe ways
                                                                                                                              Elsadig Elnour, Sarah Ashraf
to implement study findings on human rights into community structures and existing GBV programs and services. Benefits        Save the Children USA
and challenges of incorporating community perspectives into GBV programming will also be discussed.                           E-mail: sashraf@savechildren.org.sd

Findings: The team of presenters will describe selected research findings on human rights and gender relationships and        Background: The Nuba Mountains were among the most hotly contested parts of Sudan, with scenes of intense conflict
examine potential ways to apply the research findings to reproductive health programs and services that are culturally        from 1985 through 2002. Population displacement is estimated at between one-third and one-half of the population.
sensitive and sustainable.                                                                                                    Improvement of community and primary health services targeted at women and children is needed to reduce maternal
                                                                                                                              and child mortality.
Conclusion: The presentation offers reproductive health specialists deeper insights into GBV, gendered perspectives on
human rights as well as community facilitators, and barriers to advancing a human rights perspective.


22          RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                           RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                 23
Purpose: A facility-based assessment was undertaken by Save the Children (SC) and the Ministry of Health in South              Conclusion: IRC documented some successes in achieving set targets. Working closely with community-level structures
Kordofan State (SKS) in 2007. The objective of the study was to map health service availability, functionality, quality, and   and collaborating with the government and other NGOs can contribute to improvement in access to and quality of RH
health manpower of all health facilities in SKS. The findings of the facility-based assessment will be used to establish a     services. However, there remains much to be done and any further significant achievements may require use of innovative
baseline, design a health development plan to strengthen the health care system, and improve the quality of health services.   methods of service delivery.

Methods: The assessment was performed in partnership with State Ministry of Health (SMoH). A consultant was hired
to design the study protocol and implement the study. In the design stage, a workshop was held at state level with
                                                                                                                               Reproductive Health Logistics in the Democratic Republic of Congo
main stakeholders agreeing on the study objective and methodology. Subsequently, a workshop with all supervisors
and coordinators was organized to revise the objectives, survey methodologies, and questionnaire. Data collectors and
supervisors were trained on the survey methodology and questionnaire. The tools were pre-tested in nearby health
                                                                                                                               Motomoke Eomba, Youssouf Ouedraogo
facilities. Three study coordinators and a supervisor for each of the localities were assigned, along with six team members    John Snow, Inc.
for data collection. Completed data forms were cleaned and entered into a database by a data entry team. The consultant        Email: motomoke_eomba@jsi.com
did the final data cleaning and analysis. The final assessment report is being written by the consultant.
                                                                                                                               Background: The USAID | DELIVER Project received funding from USAID to provide technical support to CARE to
Findings: Out of all the facilities assessed in the area, 24% were either closed or non-functional. Only 54% of                strengthen CARE’s reproductive health logistics systems in Kasongo, a conflict-affected area of the Democratic Republic
functional facilities have at least one qualified midwife, with a breakdown of one midwife per health facility available in    of Congo (DRC). The USAID | DELIVER PROJECT is funded by the United States Agency for International Development
27% of all assessed units, two midwives in 13%, and three or more midwives in 14% of the health facilities. Availability of    (USAID), and implemented by John Snow, Inc., in collaboration with its many partners. For numerous reasons, the existing
transportation for obstetrics referrals is very low: 64% of facilities do not have any transport means for emergency cases,    logistics system was not functioning well, and stockouts were frequent.
4% of the facilities have access to an ambulance service, and 29% have access to a privately-owned car.
                                                                                                                               Purpose: To assist CARE in designing and implementing a reproductive health logistics system for CARE’s program
Conclusion: Based on the assessment, a detailed strategy will be developed with the SMoH to address the main gaps and          in Kasongo that ensured a consistent and reliable supply of reproductive health commodities by avoiding stockouts
develop feasible strategies to improve reproductive health and primary health care service.                                    and expiries.

                                                                                                                               Methods: The project had three components: 1) to conduct an assessment of CARE’s existing RH logistics system and
                                                                                                                               facilitate a logistics design workshop; 2) to facilitate a training of trainers for CARE staff and develop a roll-out plan of
Implementing Reproductive Health Services in the Northern Ugandan Context:
                                                                                                                               the system; and 3) to conduct an impact assessment, using logistics-indicator and system-assessment tools, in order to
Challenges and Opportunities                                                                                                   identify weaknesses and strengthen the logistics system. The USAID | DELIVER team worked closely with CARE’s Health
                                                                                                                               and Family Planning Coordinators as well as local consultants throughout the process. The initial assessment found that
Ejesu Felix Emotu, Raphael Ogutu, Lilian Kiapi-Iwa                                                                             there were no maximum and minimum stock levels or emergency order points, no stock cards in place, report forms and
                                                                                                                               content were unknown, and stockouts were observed but not reported. The USAID / DELIVER then conducted a design
International Rescue Committee
                                                                                                                               workshop for CARE staff. With feedback from the assessment and health staff, the group designed a forced ordering
E-mail: liliank@uganda.theirc.org
                                                                                                                               logistics system with bi-monthly reports and ordering. The next step was a training for 25 trainers in the South Maniema
                                                                                                                               logistics system and the subsequent scale-up trainings. USAID | DELIVER followed up with a monitoring visit and finally
Background: The International Rescue Committee (IRC) operates in Kitgum District, an area with a population of
                                                                                                                               conducted an evaluation of the logistics system’s performance. The assessment included data collector training, a pre-test
152,284 whose disrupted social structure caused by the 20-year civil war has grossly affected accessibility to and
                                                                                                                               at four sites, 61 health units sampled, interviews of key health facility staff, and physical inventory of the existing stock of
adequate provision of reproductive health services.
                                                                                                                               contraceptives. There was also a workshop with stakeholders to review the 11 logistics system components.

Purpose: To increase full antenatal care (ANC) uptake to 60%; increase skilled birth attendance to 25%; offer routine
counseling and testing (RCT) to 50% of the women attending ANC; and increase to 50% antiretroviral (ARV) coverage
                                                                                                                               Findings: The assessment determined that there were many strengths to the new system. There were no stockouts on
                                                                                                                               the day of the visit and fewer stockouts during the last six months. Essential logistics data were collected and recorded,
among HIV-positive pregnant women and their newborns. To improve a new contraceptive acceptor rate to 2% among
                                                                                                                               and all facilities were reporting regularly. The logistics data were being used for the annual forecast, and 100% of
women of reproductive age and institute sexually transmitted infection (STI) partner tracking and treatment.
                                                                                                                               facilities received their products within two weeks. The weaknesses identified included the poor conditions of bicycles,
                                                                                                                               a lack of a logistics unit at the Ministry of Health (MOH), and a low percentage of health units respecting 80% of good
Methods: In an effort to increase access to quality reproductive health services, support to the local Ministry of Health
                                                                                                                               storage conditions. There was still some confusion about the emergency ordering among health staff, and staff were not
included drug and medical supplies supplementation; supportive supervision, training, and development; distribution
                                                                                                                               respecting their own maximum stock level. The situation in the DRC creates an especially difficult logistics challenge, but
of information, education, and communication (IEC) and data-collection tools; and building capacity of and providing
                                                                                                                               designing a new logistics system, training staff, and monitoring the system resulted in significant improvements in the
material support to community-based health providers. An integrated reproductive health (RH) service delivery approach
                                                                                                                               availability of contraceptives in CARE-managed health sites.
was taken while quality assurance and monitoring were incorporated into project objectives. Close collaboration with the
government, United Nations bodies and non-governmental organizations (NGOs) at both local and national levels through
the cluster system ensured that efforts were not duplicated. Outreaches carried out regularly increased
                                                                                                                               Conclusion: There are enormous challenges in ensuring a reliable and consistent supply of reproductive health
                                                                                                                               commodities in conflict-affected areas. However, with commitment and buy-in from the highest levels of an organization
access to services.
                                                                                                                               and technical support in logistics management using local means, it is possible.

Findings: During 2007, 21% of pregnant women had full ANC attendance (four visits) while 84% received RCT, with
3% testing positive. Only 41% of these individuals received ARVs, due to poor follow-up mechanisms. Live births in the
health facilities represented 39% of all births, though these included births attended by unskilled people, including
traditional birth attendants (TBAs), sometimes under supervision. The new contraceptive acceptor rate at 1.7%, though an
improvement from the previous year (0.9%), is still low. Various factors involved included the rampant myths surrounding
contraception. Some 31% of STI cases seen at the health facilities had their contacts traced and treated.


24          RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                            RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                  25
Determining Donor Commitment Through Policy Analysis:                                                                          Purpose: The aim of our project is to better understand the political, institutional, and regulatory barriers to expanding
                                                                                                                               access to EC in Palestine. Further, our initiative aims to document the need for EC, identify mechanisms for increasing
Examining the Policy Environment for Reproductive Health in Crisis Settings                                                    awareness of EC, and create avenues and opportunities for collaborating with local partners to support educational and
                                                                                                                               health policy reform.
Lydia Ettema1, Mihoko Tanabe2, Meriwether Beatty3, Louise Lee-Jones1, Marlou den Hollander1
1 The RAISE Initiative/Marie Stopes International                                                                              Methods: From 2006 to 2008 we conducted a series of case-building studies dedicated to EC in Palestine. Our multi-
2 Women’s Commission for Refugee Women and Children                                                                            pronged initiative included a review of regulatory and policy documents, knowledge assessment research with university
3 JSI Training and Research Institute, Inc.                                                                                    students and pharmacists, and a study dedicated to the reproductive health content of nursing education. Our project
E-mail:mihokot@womenscommission.org                                                                                            was also informed by in-depth interviews with government, the United Nations Relief Works Agency (UNRWA), and non-
                                                                                                                               governmental organization (NGO) representatives, and by discussions with clinicians in East Jerusalem and the West Bank.
Background: A 2004 global evaluation of reproductive health (RH) services in refugee and internally displaced settings
showed that while significant progress has been made since 1995, substantial gaps remained. Limited funding and a lack         Findings: Our study reveals that while there is a widespread perception of need, EC is not incorporated into the UNRWA
of comprehensive policies are believed to have hindered service provision in these settings.                                   health system and is thus not available to Palestinian refugees. Although Postinor-2 is available in Israel and parts of East
                                                                                                                               Jerusalem, dedicated emergency contraceptive pills (ECPs) are not generally available in the West Bank or Gaza.
Purpose: The purpose of the study was to document donor commitment towards comprehensive reproductive health                   Further, few clinicians or pharmacists are aware of EC or the potential post-coital use of oral contraceptive pills
(CRH) in crises, as measured by the number and scope of relevant humanitarian and RH-related policy initiatives. The           for pregnancy prevention.
study was aimed to create a baseline against which policy developments conducive to the provision of CRH services for
refugees and internally displaced persons (IDPs) could be compared over the next five years.                                   Conclusion: Our project points to several avenues for expanding access to EC, including reform of UNWRA policies
                                                                                                                               and education campaigns targeting clinicians and pharmacists. We are now undertaking several efforts to expand
Methods: Marie Stopes International (MSI), JSI, and the Women’s Commission developed a tracking framework to                   awareness of and access to EC in Palestine, including the creation of a bilingual EC guidebook for health professionals, the
document CRH in crises-related policy initiatives for UN agencies, donor governments, and foundations. This cumulative         distribution of EC fact sheets, and the development of EC training modules for health professions students.
mapping exercise focused on official policies, technical/clinical standards and guidelines, and high-level meetings. It was
conducted through a systematic keyword search of existing policies and policy discussions, targeted questions to donors,
and interviews with relevant staff. Donor commitment was also assessed through attributing a policy score based on             The Sexual and Gender-Based Violence and HIV/AIDS
Population Action International’s “Donor Country Report Card.” The score takes into account the three indicators of the
mapping exercise, as well as the existence of policy restrictions. The timeframe examined was from the time the first
                                                                                                                               Situation and Response in Liberia
relevant policy was developed for the donor to July 2007. CRH components examined were: safe motherhood, family
planning, HIV/AIDS/STIs and gender-based violence (GBV). A perfect policy score yielded 32 points.                             Andrea Gibelli
                                                                                                                               United Nations High Commissioner for Refugees, Liberia
Findings: In total, both RH-specific and humanitarian policies for 16 government implementing agencies, two EU                 E-mail: gibelli@unhcr.org
bodies, 11 UN agencies, and 18 U.S.-based foundations were searched, listed and scored. Donor categories were analyzed
separately to account for organizational differences and capacity. Findings showed that in general, policies for HIV/AIDS      Background: Liberia is recovering after 14 years of war. Its HIV rates are the highest in the region. Sexual and gender-
and GBV were most available for UN agencies, although the latter was often captured under “gender” and addressed               based violence (SGBV) and female genital mutilation (FGM) still occur on a large scale. This creates a highly favourable
under the realm of protection. Family planning was underrepresented in official policies of many government and UN             environment for HIV transmission. Fifty-six percent of the population is under the age of 18. Ninety percent of women and
agencies. Agency politics and priorities were frequently reflected in the availability and content of policy initiatives.      15% men have been victims of SGBV. Stigma and discrimination of victims is common, and the impunity of perpetrators is
                                                                                                                               still a problem.
Conclusion: While monitoring systems exist for RH-related policies and funding in relation to the International
Conference on Population and Development (ICPD) objectives, the study has enabled the development of a system specific         Purpose: To develop a multi-sectoral approach to fight SGBV, including post-exposure profilaxis for survivors; syndromic
to humanitarian settings. The tracking framework, policy score and analyses are expected to facilitate the identification of   management of STIs; psychosocial services; and complementary activities in education, protection, capacity building of
gaps, and hence opportunities to advocate for policies on and funding for CRH in crises.                                       law-enforcement officials and human rights. Only by providing fully integrated services can the incidence and relief of
                                                                                                                               trauma be addressed appropriately and effectively.

                                                                                                                               Methods: The United Nations High Commissioner for Refugees (UNHCR) works with sister UN agencies (the United
Leveraging Case-Building Research to Increase Awareness of
                                                                                                                               Nations Joint Programme on HIV/AIDS, the World Health Organization, the United Nations Children’s Fund, and the United
Emergency Contraception in Palestine                                                                                           Nations Population Fund), local and international non-governmental organizations (NGOs), Ministries of Health, Education,
                                                                                                                               and Justice, local communities and internally displaced persons (IDPs). The target population consists of refugees,
Angel M. Foster1, Francoise Daoud2, Etaf Maqboul2, Sarah Ann Lewis1                                                            IDPs, host populations and returnees. Community leaders are sensitized on all forms of SGBV and the legal framework.
                                                                                                                               Survivors are offered an integrated response: medical care, counseling and care (legal and social). The project emphasizes
1 Ibis Reproductive Health
                                                                                                                               active participation of women in taking decisions in the community. They are involved in activities towards reducing
2 Faculty of Nursing & Health Sciences, Bethlehem University
                                                                                                                               poverty and conditions conducive to violence (alcohol and drugs, trauma, lack of employment, esteem loss). UNHCR has
E-mail: afoster@ibisreproductivehealth.org                                                                                     been instrumental in setting up an SGBV task force at the national level, and responsible for formulating a framework of
                                                                                                                               action, coordination, and monitoring and evaluation.
Background: The worsening political situation, frequent curfews, restrictions on movement, and sexual violence
contribute to high rates of unintended pregnancy among Palestinian women. Refugee and unmarried women are                      Findings: SGBV, especially against women and children, continues to threaten stability and a feeling of security in post-
particularly vulnerable, and emergency contraception (EC) has the potential to make a significant contribution to              conflict settings. Errant role models, loss of parental authority, and impunity greatly affect the delivery of appropriate
reproductive health in Palestine.                                                                                              health services to survivors. Eradication of SGBV treatment for victims should be recognized by government as key
                                                                                                                               elements of peaceful co-habitation and stability processes in post-conflict countries. This has been the case in Liberia.
                                                                                                                               Health, psychosocial and legal services should be merged into one consolidated approach for actions to be successful.

26          RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                            RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                27
Conclusion: We must increase knowledge of the problem and the causes of violence. We must work for prevention, such           Improving Access to Emergency Obstetric Care in Eastern Burma
as participatory involvement of refugees, especially women and youths, in communication strategies, planning exercises,
and empowerment; gender and age-sensitive health and social services as well as secure camp and site planning. Medical
                                                                                                                              Sophia Hla, Cynthia Maung, Lin Yone
care, such as the provision of the Minimum ISP service as of the start of a intervention in conflict and post-conflict
settings, ensuring same sex-health workers and quality post-SGBV care, including an appropriate response to rape is           Mae Tao Clinic
another necessity. Finaly, we must support the provision of legal support for survivors, the ensuring of confidentiality at   E-mail: sophiahla@gmail.com
all levels, increasing awareness and knowledge of the law for law enforcement officials (police, county attorneys, judges
etc.) thereby reversing the culture of impunity. In Liberia, UNHCR is building an integrated response to SGBV through its     Background: A half-century of civil war and military misrule in Burma have displaced hundreds of thousands of people of
legal mandate and its commitment to the fight against HIV and AIDS.                                                           various ethnic nationalities. High maternal mortality and HIV infection rates are concentrated in states bordering Thailand
                                                                                                                              and China.


Monitoring Reproductive Health Services Through a                                                                             Purpose: The project aims to improve availability and quality of reproductive health (RH) services for ethnic nationalities
                                                                                                                              in Burma. This project will build the capacity of Mae Tao Clinic (MTC) to deliver RH services for its growing client base
Standardised Health Information System                                                                                        in Mae Sot. MTC will upgrade its training capacities to disseminate Emergency Obstetric Care (EmOC) skills to those
                                                                                                                              providing services in Burma.
Christopher Haskew, Nadine Cornier
United Nations High Commissioner for Refugees                                                                                 Methods: Between October and December 2007, 20 RH medics received upgrade training at MTC, more than doubling
E-mail: cornier@unhcr.org                                                                                                     the number of medics qualified to provide EmOC (from 6 to 15). Thirteen medics were trained in facilitation skills and
                                                                                                                              teaching methods, and 24 attended training in family planning, treating reproductive tract infections and sexually
Background: Today, more than 200 different United Nations High Commissioner for Refugees (UNHCR) partners                     transmitted infections (RTIs and STIs), and preventing mother-to-child transmission of HIV. In 2008, MTC medics will be
deliver health services to some 14 million refugees. During emergencies, the rapidly-evolving operational environment         trained in clinical management of gender-based violence (GBV). In July 2008, 40 health workers from Burma will travel to
can contribute to disrupted gathering and flows of health information. In protracted situations, information systems face     MTC to attend maternal health worker (MHW) training covering comprehensive RH topics, with the exception of caesarean
difficult pressures to accommodate needs of different health care stakeholders.                                               section. One site will be developed as a training centre for EmOC in Burma.


Purpose: Health Information Systems (HIS) lay the foundation for public health decision-making. The purpose of the HIS        Findings: MTC currently supports the establishment of clinics inside Burma, provides supervision to newly trained
is to provide strong and reliable health information to inform evidence-based policymaking, to lead to better management      medics in the border areas, and works to meet the needs of the expanding clinic caseload. The number of medics needed
of public health programmes, and ultimately to drive the actions that improve refugee health in general and reproductive      at MTC to train and to travel for supervision is rapidly increasing. MTC proposes expanding the physical infrastructure for
health in particular.                                                                                                         training, upgrading MTC staff skills to include teaching skills, and increasing the number of MTC staff with RH experience
                                                                                                                              and training. Health workers from five ethnic areas in Burma will attend RH training at MTC, after which they will provide
Methods: UNHCR and the Centers for Disease Control and Prevention (CDC) have developed a standardised set of tools,           essential facilities-based RH services for an estimated 100,000 people. Newly trained MHWs will meet with community-
guidelines, and indicators to be used in the field to monitor refugee health programmes accurately and reliably. Observing    based health workers, including traditional birth attendants, to review basic RH knowledge, protocol, and referral
for inequities in coverage, use, and outcomes of reproductive health services are important functions of the HIS. Key         procedures. The project hopes to find success in building local capacity to provide EmOC services in areas where the
stratifiers such as age, sex, refugee or host/national status, and geographical location are used to describe trends, to      health care infrastructure has been destroyed by the governing military regime.
prioritise and grant visibility to vulnerable groups, and to track the degree of acceptance and accessibility of health
interventions by the refugees and by the local population. The under-18 age group is given particular attention within the    Conclusion: As a service provider and training centre, Mae Tao Clinic plays a vital role in health care for ethnic
reproductive health and HIV/AIDS sections of the information system.                                                          nationalities in Burma. This project will show how local capacity can be strengthened to disseminate essential RH skills in
                                                                                                                              areas inaccessible to national and international aid agencies.
Findings: The system is currently used in 10 countries and monitors reproductive health services delivered by over 20
non-governmental organisation (NGO) partners, to populations of concern living in over 70 refugee camps around the
world. The article presents case examples from the HIS, to illustrate how operational reproductive health data is analysed    Managing Reproductive Health Aid in Emergency Situations
and used by UNHCR at camp, regional, and headquarters level to improve health outcomes amongst populations of
concern. It also presents some of the challenges in deploying HIS in the field, and lessons learned to improve                Zahidul Huque
practices in the future.
                                                                                                                              United Nations Population Fund
Conclusion: The HIS can serve an important advocacy role with local health authorities to enhance refugee-host                E-mail: Huque@unfpa.org
community relations; to ensure balanced male and female representation across health services and to explore possible
barriers to service use where a gender imbalance is observed; and to document causal relationships between input and          Background: The management of emergency programmes remains a challenge for delivering timely, adequate, and
outcomes, such as increased rate of deliveries in health centres following increase of service quality.                       needs-based quality services. This paper highlights the complexities of managing emergency reproductive health
                                                                                                                              programmes in natural disaster situations in Indonesia and suggests appropriate measures based on the lessons learned.

                                                                                                                              Purpose: The programmes were developed to respond to the huge emergency reproductive health (RH) needs of the
                                                                                                                              people caused by the massive tsunami in Aceh and a huge earthquake in Yogyakarta in Indonesia: thousands of people
                                                                                                                              died, and many more became homeless and demanded RH services.

                                                                                                                              Methods: The emergency RH programmes were introduced in collaboration with other United Nations agencies,
                                                                                                                              bilateral donors, local and national governments, and civil society organisations. Communities affected by the disasters
                                                                                                                              participated actively through civil society organisations. Interventions included emergency needs assessment, immediate


28          RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                           RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                 29
psychosocial counselling, provision of health services, provision of reproductive health kits, hygiene kits, strengthening     Conclusion: Peace and security in Darfur and other conflict areas will improve the situation for all people, particularly
heath facilities through technical assistance, and provision of medical equipment. Women’s empowerment interventions           women who need reproductive health care. The author puts out a call to non-governmental organisations (NGOs) and
were undertaken through a network of non-governmental organisations (NGOs). The results of the programme were                  governments to support reproductive health and women’s education. Specifically, there is a great need for emergency
measured through focus group discussions with communities, leaders, service providers, and aid workers.                        transport and comprehensive care to prevent fistula and save the lives of women and children.

Findings: Organisational policy and procedures appropriate for an emergency situation are critical for providing timely
and necessary help to the affected people. An effective human resources management strategy is essential for reducing
                                                                                                                               Mental Distress and Intimate Partner Violence Outside of Bogotá, Colombia
the high turnover of staff that is a perennial problem in emergency operations. During a massive emergency situation, aid
organisations compete with each other to attract staff and often provide salary and incentives that are out of proportion
to the existing labour markets, causing “Dutch disease” in the local community. The enormous flow of funds to disburse
                                                                                                                               Michelle Hynes1, Stacy De Jesus2, Frances McCarty1, Marianne Zotti2, Kerry Thomson3
within a short time period often forces the aid organisations to focus more on spending money (implementation rate)            1 Emory University
without ensuring high-quality programme delivery. Another management challenge is minimising the duplication of                2 Centers for Disease Control and Prevention
interventions by many humanitarian actors working in the same programme areas and location. A cluster approach                 3 Oak Ridge Institute for Science and Education
mechanism has been tried in Indonesia and found to be an effective coordination mechanism to avoid overlap and                 E-mail: mhynes@sph.emory.edu
duplication of interventions.
                                                                                                                               Background: Complex humanitarian emergencies can have adverse effects on the health outcomes of individuals and
Conclusion: For an effective and efficient management strategy for RH programmes in emergency settings, each                   populations. Women are at particular risk for gender-based violence (GBV) in both the community and the home, and this
agency needs to develop an agency contingency plan for RH in emergency situations covering the human resources                 violence may be linked to mental distress.
component, budget, coordination mechanism, procurement procedures, and monitoring and evaluation. Quality control
and coordination are essential.                                                                                                Purpose: The current study examines the relationship between current mental distress and lifetime experience of
                                                                                                                               intimate partner violence (IPV) among a sample of 360 ever-partnered (ever had a live-in partner or husband) displaced
                                                                                                                               and non-displaced Colombian women of reproductive age, using data from a 2006 study. The study also explores whether
                                                                                                                               the experience of displacement modifies this relationship.
Fistula Survivor and Midwife
                                                                                                                               Methods: The Reproductive Health Assessment (RHA) Toolkit for Conflict-Affected Women was pilot tested in two
Awatif Altayib Mohammad Hussein                                                                                                neighborhoods outside of Bogotá, Colombia, in February 2006. Symptoms of mental distress in the past month were
Fistula Advocate and Midwife, West Darfur, Sudan                                                                               assessed using the Self-Report Questionnaire 20 (SRQ-20), a psychiatric screening instrument for assessing the
E-mail: mabrouk@unfpa.org                                                                                                      prevalence of depression and anxiety at the community level, where diagnoses of specific illness are not required.
                                                                                                                               The SRQ-20 consists of 20 ‘yes or no’ questions. A score of 8 or higher was defined as mental distress. Univariate
                                                                                                                               and multivariate analyses were performed using the complex survey features of SAS version 9.1. Age, education level,
Background: At the age of 14, Awatif Altayib Mohammad Hussein was married and pregnant with her first child. She
                                                                                                                               ethnicity, religion, neighborhood, and displaced status were assessed as potential confounders. The interaction term
laboured at home with a midwife for two days before her husband took her to the hospital, nearly two hours away from
                                                                                                                               between IPV and displaced status was tested in the logistic model. The data were weighted by the total number of eligible
their town of Furbaranga, West Darfur. Sadly, her baby did not survive this journey. “Six days later after we returned
                                                                                                                               women in each household surveyed.
back to Furbaranga, I felt that there was something wrong with my urine,” says Awatif. “At that time, I had no idea or
information about fistula.” Her father sold his cows to cover the cost of treatment, but the repair surgery failed. In spite
                                                                                                                               Findings: Fifty percent (n=180) of ever-partnered women reported mental distress in the past month. We found that
of her experience, Awatif was determined to ensure that other women not suffer from fistula. She decided to become
                                                                                                                               61% of women ever experienced IPV, and 26% experienced IPV in the previous 12 months. In our final model, controlling
a midwife, and in April 2007, Awatif graduated from a midwifery school in West Darfur. In May, at a fistula outreach
                                                                                                                               for education and neighborhood, women who reported IPV were almost four times as likely to report mental distress
campaign supported by the United Nations Population Fund (UNFPA) in Zalingei, West Darfur, Awatif and six other women
                                                                                                                               (OR=3.79, 95% CI=2.51, 5.71). Women with no education were more than three times more likely than women with
from Furbaranga (several of whom Awatif identified during an outreach effort) all underwent successful fistula repair
                                                                                                                               secondary education to report mental distress (OR=3.35, 95% CI=1.64, 6.83). Ever experiencing IPV and lower educational
surgeries. They have now returned home with new lives and new hope.
                                                                                                                               attainment were the main risk factors associated with mental distress. No differences in mental distress were found
                                                                                                                               between displaced and non-displaced women in these two communities.
Purpose: Ms. Hussein will discuss her experience living with fistula and becoming an advocate for other women who
suffer due to a lack of appropriate reproductive health care. The author will address how her role as advocate and health
                                                                                                                               Conclusion: Women who have ever experienced IPV are reporting high levels of mental distress. Urgent interventions
care provider has developed and what is needed to address fistula in Darfur.
                                                                                                                               and further research on the links between mental distress and intimate partner violence are needed. Furthermore, higher
                                                                                                                               levels of education seem to have a protective effect against mental distress in this population.
Methods: Awatif was among six fistula advocates who spoke at the Women Deliver Global Conference in October 2007.
Following a UNFPA-sponsored training in advocacy and public speaking skills, Ms. Hussein opened the Women Deliver
plenary session entitled “Working on Common Ground”, offering her testimonial as a survivor of obstetric fistula in a
conflict-torn region, and ultimately calling for peace in Darfur in order to ensure access to reproductive health care for     Increasing Demand for and Use of Modern Contraceptive Methods in
women. Upon her return to Sudan from the Women Deliver Global Conference, Ms. Hussein offered a presentation at the            Mornie and Kerenic Internally Displaced Person Camps, West Darfur, Sudan
November United Nations Darfur strategic planning meeting. It is envisioned that she will continue to advise UNFPA in
fistula programme design, implementation, and review.
                                                                                                                               Shihab Ibrahim, Sarah Ashraf
Findings: Ms. Hussein has advocated for improved reproductive health care in Darfur, to help other women avoid fistula         Save the Children
and other devastating maternal health injuries. By speaking publically about her own experience—both in her home region,       E-mail: fadulalmula@yahoo.com
Khartoum, and on the global stage—advocacy messages on fistula, the need for reproductive health care, and ultimately
the necessity for peace and security to ensure women’s access to maternal health services reach broader audiences.             Background: Save the Children (SC), over the last three years, has highlighted family planning (FP) interventions as part
                                                                                                                               of its comprehensive reproductive health program in West Darfur.


30          RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                           RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                  31
Purpose: The aim of the project is to enable and provide the means for FP to women of reproductive age affected by               Conclusion: It is important to include the issues of HIV/AIDS and RH in humanitarian assistance. HIV/AIDS and RH
crisis in Darfur. This study aims to depict the experience of SC in implementing a community-based FP program in a crisis        sessions seem to have potential as a strategy for peace-building efforts in conflict situations as well.
situation. It highlights key lessons learned: how to create an enabling environment for behavior change, and the dynamics
of addressing FP, a sensitive issue in West Darfur.
                                                                                                                                 Reaching Reproductive Health to the Unreachable:
Methods: Key activities included: a) FP awareness-raising sessions with community leaders and influential groups,
one-to-one counseling of women, couples counseling, and provision of service for women who presented to the clinic               UNDP-Initiated Mobile Medical Teams and Partnerships
for delivery, post-abortion care, or sexually transmitted infections (STI) services; and b) sustained availability of modern
contraceptive methods like oral contraceptive pills and injections, and re-supply of contraceptive methods at community          S. M. Shariful Islam
level for continued users. Data from population-based surveys done in 2005 and 2006 and review of clinic data were used          United Nations Development Programme
to measure progress and calculate the contraceptive prevalence rate (CPR).                                                       E-mail: sharif.undp@gmail.com

Findings: At the start of the project period, based on our assessment, we realized that the CPR was very low, that there         Background: The United Nations Development Programme (UNDP) initiated a pilot project in the Chittagong Hill Tracts
are various determinants that affect use of FP methods and even the acceptance of information about FP, and that these           of Bangladesh, a post-conflict, hard-to-reach area with 1.3 million people and almost non-existent health facilities and
differ from camp to camp. These determinates included: a) perception that using contraceptives will lead to infertility, which   services. Two-thirds of the population lack access to basic health care.
is a serious concern among communities that have lost their children due to the conflict; b) the belief among men that
condoms interfere with sexual pleasure and the perception of stigma in obtaining and carrying condoms among females;             Purpose: The overall objective of the initiative was to improve the health—including the reproductive health—of people
c) the lack of communication between the woman and her husband about FP; d) that the men are the decision makers; e)             in the region.
the perception that Islam is against the use of contraceptives; and f) a woman’s age, marital status, as well as the number,
sex, and age of her children affect her decision to use contraceptives. By targeting influential groups in awareness-raising     Methods: UNDP initiated mobile teams of community-based health workers, provided technical assistance, created
sessions and engaging men and women in program implementation, we were able to create an enabling environment and                partnerships, and engaged in capacity building of the government and other stakeholders. A group of female health
increase demand and use of modern contraceptive methods. The CPR increased from 7% to 13% over a two-year period.                workers was recruited from the community, trained for three months, and provided with essential kits and logistics.
                                                                                                                                 Outreach satellite clinics by mobile teams operated equipped with a mobile laboratory and pharmacy. Joint collaboration
Conclusion: FP promotion and awareness messages need to be based on assessment of the social and cultural                        programmes were organised with the government, non-governmental organisations (NGOs), the United Nations, and
determinant factors that influence use of FP methods.                                                                            private organisations to provide umbrella service at a one-stop service point. Hospitals were provided with modern
                                                                                                                                 equipment and logistics. Workshops for capacity building were organised and emergency referral services were provided.


Mainstreaming HIV/AIDS and Reproductive Health in a Food Aid Project                                                             Findings: After one year, the project helped to improve the health status of the people, compared with the baseline
                                                                                                                                 data collected before operationalising the initiative. Maternal deaths and child deaths recorded were lowest in a year
in a Conflict-Affected Area, Central Sulawesi
                                                                                                                                 compared to the averages of the last 10 years. As well, 43% of deliveries were attended by skilled attendants, compared
                                                                                                                                 to only 13% the previous year. Emergency referrals to district hospitals were provided in 95 cases. Some 5,350 cases
Rima Irmayani, Titin Rejeki, Julia Suryantan, Michael Koeniger, Maurice A. Bloem                                                 of acute respiratory infection (ARI) and diarrhoea were treated by the health team, and 98% of the children received
Church World Service, Indonesia                                                                                                  Vitamin A and antihelminthics in the mobile clinics. The contraceptive prevalence rate (CPR) increased to 85%, compared
E-mail: rimayani@cwsindonesia.or.id                                                                                              to 54% achieved the previous year. Some 3,780 cases of malaria were treated, significantly reducing malarial deaths.
                                                                                                                                 Also, 1,250 cases of undiagnosed and untreated sexually transmitted infections (STIs) received modern treatment, and
Background: The violent conflict in Poso, Central Sulawesi, between 1998 and 2003 has affected the lives of thousands            family planning (FP) logistics were available in all health centres and posts, which previously had always been short due to
of people. The conflict has also had a negative impact on the health sector and has increased health vulnerability,              difficulty with transportation.
including HIV and reproductive health (RH) problems.
                                                                                                                                 Conclusion: Capacity building of governments and NGOs is important to achieve desired results. Providing logistics
Purpose: Church World Service’s (CWS’s) food aid project in the conflict-affected area was intended to assist conflict-          support to government health staff helped to increase programme effectiveness. The infrastructure of a partnership
affected people in their efforts to rebuild their lives. The information sessions on RH, and HIV/AIDS were conducted to          was utilised by others, thus pooling resources and maximising utilisation. Teamwork allows maximum results and is
improve the knowledge of the internally displaced people (IDPs), resettled IDPs, and returnees as a first essential step to      cost-effective for all.
reduce their vulnerability.

Methods: The food aid program implementation started with a needs assessment that revealed a need for HIV/AIDS and               Improved Access to Obstetric Fistula Management in Conflict Zones
RH information. Although staff had been part of HIV/AIDS staff education programs, their main experience and expertise
had been in food aid project implementation. Therefore, CWS organized additional trainings in HIV/AIDS and RH, including
                                                                                                                                 Abdulcadir Mohamed Jama1, Rogaia Abuelgasim Abdelrahim2
facilitation skills for their food aid project staff. Further, CWS conducted information sessions covering the issues of HIV/
AIDS and RH for beneficiaries at the community level and training for the local partners to increase their knowledge as well.    1 Galkayo Medical Centre, Somalia
                                                                                                                                 2 United Nations Population Fund, Somalia
Findings: HIV/AIDS and RH sessions were well received amongst the conflict-affected people. They recognized their own            E-mail: abuelgasim@unfpa.org
(and their loved ones’) vulnerability, especially during times in which issues such as sexual harassment, sexual violence,
and military personnel mobilizations can cause unsafe sexual activity and put many people at r sk. After the initial             Background: The prolonged civil conflict in Somalia has resulted in the breakdown of social services and infrastructure,
session, even more information and support for them to strengthen their knowledge in HIV/AIDS and RH-related issues—             and deterioration of security and economic life. The weakened security situation has resulted in increased suffering for
such as contraception, safe delivery, and antenatal care—was requested.                                                          Somali women due to limited access to basic health services.


32          RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                             RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                 33
                                                                                                                               the year will serve to cover the loss of trained staff. So far our indicators have not shown any unfavorable results from the
Purpose: In 2007, a fistula management campaign was organized in Galkayo City in Somalia. The purpose of the                   loss of our experienced staff, and most RH indicators still meet the Sphere standards. The Thai government relaxed its
campaign was to assist the increasing number of affected women reporting to different health facilities in the city, and to    restrictions on movement of refugees for training and seems to accept the principle of promoting vocational training for
realize the high potential of Galkayo Medical Centre (GMC) to be a local Somalia centre.                                       refugees. This seems a significant factor for our strategy to maintain our staff level.

Methods: Although the magnitude of the fistula problem is not known, there is much evidence that Somali women                  Conclusion: ARC will continue producing midwives and medics to maintain quality RH services in camps and develop our
are greatly affected. For the last decade, there has been no training of professional midwives and almost no availability      training strategy with other concerned organizations to address this issue border-wide. This expanded training opportunity
of comprehensive emergency obstetric care (EmOC) services. The Ministry of Health (MOH) and the United Nations                 may also help refugees in the future: when they resettle or repatriate to Burma, they will have clinical skills and knowledge.
Population Fund (UNFPA) identified GMC, under the leadership of a Somali obstetrician/gynecologist, to be the site of repair
operations. The capacity of GMC was assessed and upgraded by UNFPA. GMC lead local advocacy work on fistula and the
call for free operations. The repair operations were conducted by the local staff. The project also supported other EmOC,
                                                                                                                               Emergency Contraception in Emergencies: Assessing Progress, Identifying Challenges
antenatal care (ANC), family planning (FP) and gender-based violence (GBV) medical and socio-psychological support.

                                                                                                                               Jill Keesbury1, Sandra Krause2, Elizabeth Westley3
Findings: A very important finding is that there are many affected women who await surgery for a long period of time,
but who do not know where to go for treatment. By January 2008, under this joint project of MOH/GMC/UNFPA, 30                  1 ECafrique
obstetric fistula cases had been operated on, with a success rate of 86.66 %. Of the 30 cases, 17 were recto- vaginal, 11      2 Women’s Commission for Refugee Women and Children
were vesico-vaginal and two were both recto- and vesico-vaginal. The age range for admission was 17 to 60 years, with          3 International Consortium for Emergency Contraception
only four cases under 20 years of age, indicating that many others were longstanding cases. The history provided in            E-mail: ewestley@fcimail.org
almost all the cases was typical: prolonged labour, no access to basic services and a lack of EmOC services. The repair
campaign is still ongoing and many cases are still reporting to the center.                                                    Background: To address the reproductive health needs and rights of refugee women, emergency contraception (EC),
                                                                                                                               oral contraceptive pills used post-exposure to prevent pregnancy, should be made available from the beginning of a
Conclusion: From the Galkayo experience it has been determined that, although fistula repair operations require                response to a humanitarian crisis.
specialization, local resources can still be upgraded to alleviate women’s suffering. Assistance to affected women can
be organized at conflict areas by upgrading the available resources when the security situation does not permit external       Purpose: This paper outlines why EC is essential in emergency responses and documents shortfalls in providing this
technical support.                                                                                                             contraceptive method in crises.

                                                                                                                               Methods: The Inter-Agency Working Group on Reproductive Health in Crisis (IAWG), which includes over 40 non-
                                                                                                                               governmental and United Nations agencies, including the World Health Organization (WHO), the United Nations High
A Strategy to Deal with the Great Impact on Reproductive Health Service
                                                                                                                               Commissioner for Refugees (UNHCR), and the United Nations Population Fund (UNFPA), developed the Minimum Initial
Delivery of Refugee Resettlement to Third Countries                                                                            Service Package (MISP) for reproductive health in 1997, as outlined in the Inter-Agency Field Manual (IAFM). The MISP
                                                                                                                               is a series of priority interventions to be implemented at the onset of a humanitarian emergency and includes EC as a
Yoriko Jinno                                                                                                                   component of the services to be provided to survivors of sexual violence. In addition, EC is included in the draft revision
                                                                                                                               of the IAFM family planning chapter planned for publication in early 2009. UNFPA also includes EC in the prepackaged
American Refugee Committee International
                                                                                                                               supply kits it ships to emergency situations.
E-mail: arcsang@loxinfo.co.th

                                                                                                                               Findings: Recent reproductive health assessments undertaken by the Women’s Commission for Refugee Women and
Background: The American Refugee Committee (ARC) has addressed primary health care in vulnerable refugee
                                                                                                                               Children with UNFPA in northern Uganda and in Jordan show that EC is still not a consistent component of health service
communities on the Thai-Burmese border since 1992, through the provision of health services for women and children
                                                                                                                               delivery to prevent an unwanted pregnancy, including for survivors of sexual violence. Moreover, the UNHCR Health
and through education, training, and community awareness activities. By training community members, ARC fosters
                                                                                                                               Information System, based on the collection of routine data from within refugee camps, shows that 54% of female rape
sustainability and independence within the health services.
                                                                                                                               survivors in refugee camps in seven countries did not receive the emergency contraceptive pill within 120 hours of an
                                                                                                                               incident in 2007. A rapid assessment of gender-based violence (GBV) during post-election violence in Kenya in 2008
Purpose: Since refugees in the camps began to resettle to third countries, it has been a major ongoing problem to
                                                                                                                               reported that none of the camps visited had EC on site, and camp staff had not been trained to respond to survivors of
maintain enough trained staff. Given resettlement of refugee medics and midwives, ongoing staff training continues to be
                                                                                                                               GBV. Efforts to increase access to EC will be presented, with a special focus on EC provision in Kenya.
essential to fully carry out our projects.

                                                                                                                               Conclusion: While there is certainly a growing awareness of the need for displaced populations’ access to EC, the
Methods: To maintain a pool of trained candidates to replace staff who resettle and depart, ARC produces midwives and
                                                                                                                               humanitarian community has a long way to go to ensure that EC is made available to all women who have been raped and
medics by conducting trainings throughout the year. Focusing on building the capacity of refugee staff, senior staff are
                                                                                                                               becomes a standard component of family planning services.
promoted and trained to be assistant trainers so that they are able to continue to educate and train students and new
staff, both on the job and in class. Additionally, ARC developed a midwifery training curriculum, reproductive and child
health clinical guidelines, and a package of training materials. These resources were shared with other health agencies
working along the border. Since many health agencies are facing the shortage of trained staff, students/trainees are
sometimes collected from other camps to share trainers border-wide. This has a significant effect in terms of maintaining
quality reproductive health (RH) services.

Findings: After the initial announcement of resettlement of refugees to the United States, we surveyed our current staff.
About 75% intended to apply for resettlement. We anticipated that a mass exodus of our experienced staff would occur
in 2008. However, ongoing recruitment of students/trainees and midwifery training in all ARC-served camps throughout


34          RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                            RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                   35
Adolescent Reproductive Health Service Package: A Guide for Field Practitioners                                                 total of 30 health providers. In October, a six-day family planning training took place in Ukraine. The goal of the trainings
                                                                                                                                was to not only improve RH but also to facilitate dialogue among communities, encourage collaborative problem-
                                                                                                                                solving, and develop inter-communal networks. Health is generally viewed as important to all sides of a conflict. Health
Brad Kerner, Ribka Amsalu
                                                                                                                                professionals have the unique role of taking part in healing communities that have been devastated by conflict— not only
Save the Children                                                                                                               in rehabilitating the physical wounds, but also in building bridges for reconciliation.
E-mail: bkerner@savechildren.org
                                                                                                                                Findings: During the trainings, in-depth interviews were conducted with training participants to discuss training outcomes
Background: Adolescence, from age 10 to 19 years old, is a complex life stage accompanied by specific reproductive              and assess immediate reconciliation outcomes. The immediate outcomes of reconciliation programs are difficult to evaluate
health milestones and threats, including puberty, sexual maturation, HIV/AIDS, and early marriage. Adolescents have             and gauge. However, the interviews showed that these trainings do form small bridges between different communities.
limited capacity to protect themselves, which is exacerbated during conflict, displacement, and crisis situations, due to the
disruption of family and social structures. In humanitarian settings, adolescents are at greater risk of sexual exploitation    Conclusion: The trainings provided health professionals from conflict zones with much-needed information, and
and early parenthood compared to stable situations. Humanitarian healthcare providers are confronted with the challenge         formed small linkages between these conflicting communities that will hopefully lead to the creation of healthy, peaceful
of addressing the reproductive health needs of adolescents transitioning through different developmental stages. Yet            environments. Due to their political nature, such programs need to be flexible and conscious of the political situation and
there is very limited documented evidence on the best practices in Adolescent Reproductive Health (ARH) in crisis               plan accordingly. These trainings are applicable in different conflict settings.
situations, and there are few user-friendly guides that specifically target health providers’ ability to address the needs of
adolescents in humanitarian settings.

Purpose: The ARH service package is a working document developed by Save the Children and provides user-friendly                Delivering Sexual and Reproductive Health Services Through
tools that are applicable to crisis situations.                                                                                 Community Partnerships in Northern Ethiopia
Methods: During the past decade, best practices and principles have been established for ARH in the development                 Joyce Kinaro
context. ARH program best practices in development settings, current experience in adolescent reproductive health
                                                                                                                                Planned Parenthood Federation of America
programming in crisis situations, and the revised ARH chapter in the Inter-Agency Field Manual were used as key
                                                                                                                                E-mail: joyce.kinaro@ppfa.or.ke
references for the development of the ARH service package. The package will be field tested for user-friendliness,
effectiveness in addressing adolescent reproductive health needs, and feasibility for implementation in crisis situations.
                                                                                                                                Background: Internally displaced persons (IDPs) have inhabited Adigrat, at the border of Eritrea and Ethiopia, for a long
                                                                                                                                time. Common problems for this community include high poverty levels, prostitution, scarce reproductive health (RH)
Findings: The ARH service package is intended for use by health service providers, RH program managers and youth
                                                                                                                                services, and high incidence of unwanted pregnancies.
center coordinators. The ARH service package includes: needs assessment tools, program strategies, key interventions,
user-friendly checklists, a monitoring matrix, health provider tools for improved youth-friendly health services, and
                                                                                                                                Purpose: Planned Parenthood Federation of America (PPFA) has been supporting the Nazareth Children’s Center
resources to help providers create intentional linkages to community-based adolescent interventions.
                                                                                                                                and Integrated Development (NACID) to implement a project with the aim to contribute towards improved sexual and
                                                                                                                                reproductive health and well being of women, men, and adolescents in Northern Ethiopia.
Conclusion: A paucity of data and best practice guidelines exists for ARH in crisis situations. The ARH service package
for conflict settings will be a milestone for promoting an ARH response in crisis situations. Save the Children will seek to
                                                                                                                                Methods: PPFA chose to partner with NACID because they fulfilled the organization’s partnership criteria, including
do a demonstration study to test the user-friendliness and feasibility of the package. By developing this package, Save
                                                                                                                                having the capacity to deliver outputs, maintaining good governance, focusing on marginalized communities, having the
the Children aims to promote dialogue and further research to build the evidence base for user-friendly ARH strategies
                                                                                                                                capacity to network and sustain activities, and maintaining a presence in the area. PPFA supported NACID by building the
in crisis situations.
                                                                                                                                capacity of the organization to integrate RH interventions in the community. This included providing financial support,
                                                                                                                                training staff, providing equipment, and lending technical support. Progress was measured by developing monitoring tools
                                                                                                                                and establishing a monitoring system through field visits, quarterly reports, and annual evaluations.
Promoting Community Reconciliation Through Health Activities
                                                                                                                                Findings: NACID used the community health principles to introduce the project and promoted community participation
Ghazal Keshavarzian                                                                                                             in the project by: a) creating awareness of the project activities; b) introducing the project to the community through use
                                                                                                                                of the existing activities; c) using locally established social structures; d) using the community to identify common needs
JSI Research and Training Institute, Inc.
                                                                                                                                and prioritizing; and e) using participatory methods to plan, implement and monitor activities. The project used traditional
E-mail: kghazal@gmail.com
                                                                                                                                channels to disseminate RH information. These channels included coffee ceremonies, dramas, schools clubs, and sports.
                                                                                                                                Awareness sessions at the community level were also organized. The purpose of the awareness sessions was to mobilize
Background: Georgia has been ravaged by internal conflicts since the collapse of the Soviet Union. Over a decade later,
                                                                                                                                the community to support and strengthen RH services in schools and the community. In seven years, the project served
the conflicts have not been resolved, and sections of Georgian territory have broken away, namely Abkhazia and South
                                                                                                                                4,416 contraceptive clients through the clinic and 36,853 through the community agents. Other RH services, including
Ossetia. The health care systems of the conflict areas are devastated and in need of rehabilitation and up-to-date training.
                                                                                                                                counseling and pregnancy tests, were provided to 5,911 clients, and over 160,666 people were reached with RH messages.
Purpose: To help bridge the conflicting communities, as well as to improve maternal-child health services in the conflict
areas of Georgia, JSI conducted two reproductive health (RH) trainings with health professionals from Georgia, Ukraine
                                                                                                                                Conclusion: Although family planning is a vertical program in the primary health care elements, this has been integrated
                                                                                                                                in the social development at the community level and strengthened by the existing health care system. Community
and the conflict zones of Abkhazia and South Ossetia in a neutral setting.
                                                                                                                                participation enha ces ownership and project sustainability.
Methods: By working with local health officials and facilities, health professionals were selected from each community
to participate in the trainings. In April 2007, a two-week effective perinatal care training took place in Ukraine with a




36           RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                            RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                 37
Knowledge and Use of Family Planning Among Women in Northern Uganda:                                                            15 youth. A series of complementary awareness-raising activities for youth were implemented alongside the classes,
                                                                                                                                including community radio discussions, video shows, dances, and drama. A baseline survey was conducted to establish RH
Findings from a Population-Based Survey                                                                                         trends among youth living in target communities and will be repeated at endline to measure programme outcomes. Notre
                                                                                                                                Dame has monitored progress using relevant indicators, including number of youth reached through literacy classes,
Frederick Mubiru E. Kintu1, Denis Okwar Rinyamoi1, Jimmy Odong1, Jennifer Schlecht2                                             number of peer educators trained and active, and number of awareness-raising activities conducted.
1 Marie Stopes Uganda
2 The RAISE Initiative                                                                                                          Findings:
E-mail: fred.mubiru@mariestopes.or.ug                                                                                            • Investment in peer educators can establish a cohort of community advocates with long-term commitment to improved
                                                                                                                                   RH. Peer educators grew with their new responsibilities and began to play an expanded role as ‘RH watchdogs,’ referring
Background: With support from the RAISE Initiative, Marie Stopes Uganda, in partnership with Canadian Physicians for               peers with STIs to seek treatment and encouraging pregnant women to access the district hospital for care.
Aid and Relief (CPAR), is expanding the quality and availability of reproductive health (RH) services in four of northern        • Teaching RH through a human-rights framework fosters self-respect and encourages youth to communicate effectively
Uganda’s conflict-affected districts. A survey was conducted in August of 2007 to provide baseline data for the project area.      with their partners. This is particularly critical for youth in a post-conflict setting, many of whom have had their
                                                                                                                                   rights severely abused in the past.
Purpose: The survey aimed to collect population data on the RH status of women of reproductive age living within the             • Youth are highly influenced by the views of adults living in their communities. It is therefore important to reach out to
catchment areas of two urban and four rural facilities. This assessment of RH knowledge, attitudes, and behaviors will be          parents, teachers, and community leaders at the same time as youth themselves.
used to inform program interventions and local advocacy efforts.                                                                 • While it is vital to build sustainable local capacity to provide RH education, regional, national, and global linkages are
                                                                                                                                   also valuable because they enable continuous learning and exchange.
Methods: A multi-stage cluster sample (10x25 in each rural area and 15x25 in each urban catchment area) was drawn
from the target population of RAISE-supported facilities. A pre-coded questionnaire covering basic socio-demographic            Conclusion: It is critical to tackle RH challenges in the immediate aftermath of conflict in order to prevent further
characteristics and knowledge, attitudes, and behaviors related to safe motherhood, family planning, reproductive               deterioration of RH status. Improving the RH literacy of youth before sexual debut and marriage is an effective strategy
tract infections (RTIs) including HIV, and gender-based violence was implemented. This questionnaire was adapted from           for improving the RH status of the next generation.
the US Centers for Disease Control (CDC) Reproductive Health Assessment Toolkit for Conflict-Affected Women. The
questionnaire was written in English and translated into local languages. Trained interviewers from communities of the
North implemented the tool. A total of 1,587 women were interviewed.                                                            We Want Birth Control: Reproductive Health Findings from Northern Uganda
Findings: Survey data continue to be analyzed and will be used at this conference to describe knowledge and use of
                                                                                                                                Sandra Krause
family planning among the women of reproductive age within the RAISE catchment areas of northern Uganda. Preliminary
data suggest that while many women report having heard of some modern methods of family planning, few have been                 Women’s Commission for Refugee Women and Children
given information on how to use them. Current use of family planning was low, with condoms, pills, and injectables being        E-mail: sandra@womenscommission.org
the most commonly reported methods. Reported current use of long-term and permanent methods was very low. Data
on barriers to use of modern methods of family planning will be presented along with discussion of socio-demographic            Background: The Women’s Commission for Refugee Women and Children (Women’s Commission) traveled to northern
characteristics of family planning users and non-users.                                                                         Uganda to explore the impact the civil war has had on the reproductive health (RH) of the approximately 1.5 million
                                                                                                                                displaced persons there. Although humanitarian organizations have been working in the area for years, basic services
Conclusion: Women in northern Uganda have been marginalized over the past three decades. Reproductive health                    were reportedly severely lacking, particularly RH care.
services have been adversely affected, resulting in limited access. The contraceptive prevalence rate is lower in this region
than elsewhere in Uganda. These women have the right to quality health services and access to a broad method mix of             Purpose: This field team aimed to assess the state of comprehensive RH services and identify gaps in two districts of
family planning.                                                                                                                northern Uganda. The topics studied were safe motherhood; family planning; sexually transmitted infections, including
                                                                                                                                HIV; gender-based violence; reproductive health services for young people; and male involvement in RH.

                                                                                                                                Methods: The assessment was undertaken by the Women’s Commission’s executive director, the organization’s RH
Adolescent Reproductive Health and Rights in Rural Post-Conflict Settings                                                       program director, and three board members, in addition to a United Nations Population Fund (UNFPA) technical advisor.
                                                                                                                                The team visited the districts of Kitgum and Pader and a youth center and clinic in Gulu. The team conducted structured
Isaac Yaw Kofitse, Agnes Wuya Alpha, Juliana Junisa, Baindu Buntu Konneh,                                                       interviews and meetings with representatives of local and international non-governmental organizations (NGOs), including
Jim Lappia, Miatta Hopa Jusu                                                                                                    RH coordinators and United Nations agency staff, in addition to officials of the Ministry of Health and district-level health
Notre Dame                                                                                                                      facilities. The assessment included 10 focus groups with 80 men and 140 women and youth displaced by the conflict. The
E-mail: notredamearhsil@yahoo.co.uk                                                                                             team also visited local and district-level health facilities.


Background: Youth living in rural communities in Kenema District of Sierra Leone were among the worst hit by                    Findings: While some components of RH have been addressed, coverage appears to be ad hoc. Regular RH working
the decade-long civil conflict. In post-conflict Kenema, youth remained highly vulnerable to early marriage, teenage            group meetings at the national or district levels were weak or nonexistent. The number of qualified staff remained grossly
pregnancy, unsafe abortion, HIV/AIDS, and other sexually transmitted infections (STIs).                                         insufficient and existing staff were overburdened and lacked adequate supervision and accountability. There was a
                                                                                                                                shortage of medicines and family planning commodities at health facilities. Gender-based violence—in particular domestic
Purpose: The overall goal of the programme was to cultivate reproductive health (RH) literacy in post-conflict                  violence, sexual exploitation, and rape—were noted as common occurrences. Prevention of gender-based violence and
communities in Kenema District. In particular, Notre Dame aimed to improve the RH literacy of youth, equipping them to          care for survivors were both very limited. Antenatal services were well established, although critical gaps existed in
make better health decisions in the context of severe RH challenges presented by the post-conflict environment.                 women’s access to emergency obstetric care. Universal precautions against the transmission of infection in health
                                                                                                                                facilities were poorly practiced by health workers. RH services for young people and male involvement were extremely
Methods: A team of 50 peer educators was trained to provide sessions on RH literacy to youth living in three rural              limited. There was widespread knowledge of HIV/AIDS, and although voluntary counseling and testing opportunities were
communities, particularly out-of-school youth. Each peer educator held two RH literacy classes a week with approximately        common, there was poor quality of care for some HIV-positive patients.


38          RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                            RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                 39
Conclusion: The results of the assessments are useful to guide humanitarian organizations providing health services            Methods: While there was no conventional epidemiologic design used in this case study, there was an algorithmic
in Kitgum and Pader Districts. Although they cannot be generalized for all of northern Uganda, they may be helpful to          process that was closely followed and led to achieving the intended objectives. These objectives included establishing
agencies implementing health programming in other districts and for advocacy purposes, both in Uganda                          a functional and dynamic coordination committee; establishing a multi-partner surveillance team; and designing,
and internationally.                                                                                                           developing, and generating comprehensive daily reports on the number of communities displaced, number of reported
                                                                                                                               deaths, number of people wounded, number of houses damaged, number of health facilities damaged and a corresponding
                                                                                                                               list of requirements, including materials for constructing temporary camps, food requirements, and reproductive health
                                                                                                                               (RH) emergency requirements. These were updated and made available to all stakeholders daily.
Good Practices in MISP Implementation from Darfur
                                                                                                                               Findings: Logistics management of RH emergency kits refers to making high-quality commodities available to the
Sandra Krause and Sarah Chynoweth                                                                                              appropriate vulnerable groups at the right times and in adequate quantities. In normal circumstances, these requirements
Women’s Commission for Refugee Women and Children                                                                              can be satisfied with limited efforts, especially if adequate and comprehensive planning has been done. During this
E-mail: sarahch@womenscommission.org                                                                                           intervention that was conducted in Sri Lanka during the tsunami, RH commodities were distributed to the affected
                                                                                                                               communities in a systematic, effective, and successful way. Despite the logistics challenges that were involved, the team
Background: Recent assessments have shown that humanitarian workers are not familiar with the priority, life-saving            was able to distribute over 1,000 kilograms of emergency kits. Lessons learned included limited availability of trained
activities of the Minimum Initial Service Package (MISP). The Women’s Commission for Refugee Women and Children                local staff, substantial difficulties communicating with international suppliers, overwhelming bottlenecks in processing
(Women’s Commission) identified good practices in coordinating the implementation of the MISP, which can be useful to          the paperwork through the bureaucracy, training the nationals on basic logistics-management concepts; minimizing
humanitarian workers globally.                                                                                                 conflicts among funding partners, and advocating with high-level national authorities to equitably assign the respective
                                                                                                                               destinations of the kits to all the vulnerable communities—especially in areas of civil conflicts.
Purpose: To identify the top 10 lessons learned about coordinating the implementation of the MISP in Darfur, Sudan, in
order to assist humanitarian workers to adequately, appropriately and efficiently implement the MISP in any emergency.         Conclusion: While there was no simple panacea for addressing emergency events, a minimum list of requirements
                                                                                                                               was instrumental in making this emergency exercise a success, including collaboration among stakeholders, equitable
Methods: From 2005 to 2007, the Women’s Commission sub-granted to three international organizations to coordinate              distribution of relevant tasks, and involvement of national counterparts. Input from volunteers was also useful.
the implementation of the MISP in each state of Darfur. The Women’s Commission conducted two field missions to Darfur
to assess the agencies’ coordination of the implementation of the MISP. Through the assessments and narrative reports,
the Women’s Commission assembled the top 10 good practices in coordinating the implementation of the MISP in order
to share this knowledge with other agencies delivering health services. This list was also reviewed by a United Nations        Delivering Youth-Friendly Services in Internally Displaced Persons
Population Fund (UNFPA) representative.                                                                                        Camps in Uganda Through Strategic Partnership
Findings: The level of success of the three agencies’ implementation of the MISP varied greatly. Despite the extremely
challenging circumstances in Darfur, one agency was able to fully implement the MISP through creativity, collaboration,
                                                                                                                               Christine Lalobo1, Denis Kibwola2, Samson Kironde1, Alexander Mugume1, Elizabeth Ekochu1
and persistence. The other agencies were not able to negotiate the challenges in their environment: the second agency          1 John Snow, Inc. (JSI)/Uganda Program for Human and Holistic Development
failed to implement almost all activities of the MISP; and the third set up superior emergency obstetric care services,        2 Straight Talk Foundation
but was inadequate in its implementation of the other MISP activities. Through the agencies’ successes and failures, we        E-mail: eekochu@upholduganda.org
identified good practices. For example, the Reproductive Health Coordinator should identify local counterparts from the
start and work with them to lead coordination to prevent gaps in MISP programming and sustain services. Another lesson         Background: Northern Uganda has had a civil war for two decades, and 17% of young people aged 15 to 24 years have
is that agencies working in the health sector should identify a health worker who is specifically responsible for ensuring     been living in internally displaced person (IDP) camps. According to the 2004–2005 Uganda HIV/AIDS Sero-Behavioural
universal precautions. Lessons were identified for each component of the MISP.                                                 Survey, HIV prevalence among this age group in the northern districts is among the highest in the country at 3.7%,
                                                                                                                               compared to the national figure of 2.9%. These young people are a special risk group because they live in an environment
Conclusion: Findings confirmed that the implementation of the MISP can be coordinated, even in challenging                     with disintegrated social structures. They are vulnerable to problems associated with early and unprotected sex, such
circumstances. The life-saving activities of the MISP should therefore be made more readily available in displaced settings,
                                                                                                                               as unwanted pregnancies and sexually transmitted infections (STI) including HIV/AIDS. They are also unlikely to get
preserving the health and saving the lives of women, men, and youth globally.
                                                                                                                               appropriate services for their health problems because of poverty or limited access to health services. John Snow,
                                                                                                                               Inc., with funding from USAID, implements the Uganda Program for Human and Holistic Development (UPHOLD), which
                                                                                                                               supports 28 districts in Uganda to improve access and utilisation of health and HIV/AIDS services. UPHOLD works
Logistics Management of Reproductive Health Emergency Kits in                                                                  through strategic partnerships with local governments and civil society organisations to provide and mobilise
Tsunami-Affected Sri Lankan Communities                                                                                        communities for services.

                                                                                                                               Purpose: In 2004, JSI/UPHOLD partnered with Straight Talk Foundation (STF) to establish a youth-friendly centre
Bongs Lainjo
                                                                                                                               targeting youth in IDP camps in northern Uganda.
United Nations Population Fund
E-mail: lainjo@unfpa.org                                                                                                       Methods: Gulu Youth Centre was the first of its kind in the region and is a one-stop service point for youth, providing health
                                                                                                                               information and education, reproductive health services, counselling and testing for HIV, and edutainment activities that
Background: The subject of this paper is logistics management of reproductive health emergency kits (RHEK) in the              promote life skills development and recreation through film, radio, and sports. One hundred twenty-six peer educators were
2004 Asian tsunami that affected Indonesia, Thailand, Sri Lanka, and Maldives, displacing entire communities and causing       trained to reach out to in-school and out-of-school youth in five IDP camps with reproductive health messages and services.
thousands of fatalities in many of these countries.

Purpose: This paper will present the experiences, lessons learned, and strengths and weaknesses identified in Sri Lanka
during this ominous event of 2004. Efforts will also be made to identify some of the key components that were essential
and contributed significantly to addressing some of these challenges.

40          RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                            RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                41
Findings: Since September 2004, 16,703 clients have been counselled and tested and have received their results                  Research with Women War Torture Survivors in Luwero District, Uganda:
at the centre. This has contributed to the increase in the proportion of individuals who received HIV counselling and
testing services in the district, from 18.2% in 2004 to 42.1% in 2006. To date, 11,546 youth sought services at the youth
                                                                                                                                Health Inequalities and Policy Implications
centre, including 3,579 who received various reproductive health services: STI treatment, family planning services, and
counselling for unwanted pregnancy.                                                                                             Helen Liebling-Kalifani1, Margaret Nassozi2
                                                                                                                                1 Coventry University
Conclusion: Partnership with non-governmental organisations (NGOs) that have a competitive advantage in adolescent              2 Luwero Women’s Development Association
health can assist the scale-up of reproductive health services to youth in conflict situations and should be sought if RH       E-mail: hsx497@coventry.ac.uk
indicators are to be improved among these hard-to-reach populations. This model of delivering youth-friendly services
should be replicated by partners working in areas with similar circumstances.                                                   Background: Although Luwero District suffered during the civil war years from 1981 to 1986, and much of the population
                                                                                                                                was traumatised, little has been done to address the trauma and reproductive health needs of women war-torture
                                                                                                                                survivors who have been affected.
The MOM Project: Delivering Maternal Health Services Among
                                                                                                                                Purpose: The paper will provide an overview of research and health interventions carried out with woman war torture
Internally Displaced Populations in Eastern Burma                                                                               survivors in Luwero District, Uganda from 1998 to 2008. These aimed to document women’s experiences of war as well as
                                                                                                                                to highlight the outcome of reproductive and mental health interventions provided.
Catherine Lee1, Palae Paw2, Lin Yone3, Kate Teela4, Cynthia Maung3, Luke Mullany4
1 Global Health Access Program                                                                                                  Methods: This paper outlines an Isis-Women’s International Cross Cultural Exchange (Isis-WICCE) intervention project
2 Karen Department of Health and Welfare                                                                                        that provided medical, psychological, and gynaecological services to 237 women war survivors in Luwero District. Analysis
3 Mae Tao Clinic                                                                                                                used a mixed method design. In further funded research, 99 in-depth interviews and focus group discussions were carried
4 Johns Hopkins Bloomberg School of Public Health                                                                               out with women war-torture survivors and key informants in Kikamulo Sub-County. Research questions focused in detail
E-mail: lmullany@jhsph.edu                                                                                                      on the effects of war on women’s reproductive and psychological health and the implications for health policy, services,
                                                                                                                                and funding. These themes together with the impact of an income-generating project, health interventions, and provision
Background: Access to maternal health care is severely limited among internally displaced persons of eastern Burma. In          of clean water were analysed using qualitative methodologies.
this and other conflict settings, a lack of functioning health systems renders an emphasis on facility-based delivery with
skilled attendants unfeasible. Alternative strategies to increase access to essential services including emergency obstetric    Findings: Women’s experiences of sexual violence and torture caused serious damage to their reproductive and
care among internally displaced populations are urgently needed.                                                                gynaecological health. It also caused traumatic effects that have not been addressed. Despite the stigma of sexual
                                                                                                                                violence, women were active agents during the war. They reconstructed their identities and engaged in collective and
Purpose: The Mobile Obstetric Maternal Health Workers (MOM) Project is a multi-ethnic collaboration to increase access          political activities. Emerging themes suggest local drama groups, links with international women’s groups, income-
to maternal health care services in 12 pilot areas of Karen, Mon, Shan, and Karenni states of Burma. The project aimed          generating schemes, and clean water have contributed to the increased empowerment of women, with increased
to evaluate the feasibility and impact of community-based provision of evidence-based interventions including basic             utilisation of essential health services. The study recommends: 1) Specific health provision in the Ministry of Health’s
emergency obstetric care, blood transfusion, antenatal and postnatal care, and family planning.                                 policy for women war survivors, including resources for free psychological and gynaecological treatment; 2) Holistic,
                                                                                                                                gender-sensitive services for women survivors and their families, providing physical and psychological treatment
Methods: Health workers (n=33) received seven months of practical training in five components of basic emergency                integrated into primary health care services; 3) Poverty reduction strategies and specialist health programmes to improve
obstetric care (antibiotics, magnesium sulfate, manual removal of placenta, manual vacuum aspiration [MVA], and                 women’s health outcomes; 4) Legal redress for human rights abuses; and 5) Training and sensitisation programmes on the
misoprostol) plus blood transfusion, antenatal care, and family planning at a central facility on the Thailand/Burma border.    gendered effects of war and policy changes required.
After returning to their target communities inside Burma, these first-tier maternal health workers trained a second tier
of local health workers (n=131) and a third tier of traditional birth attendants (TBAs, n=288) to provide a subset of these     Conclusion: Women in Luwero have suffered psychological and physical health traumas due to their experiences of
interventions, depending on training level. Annual cluster-sample surveys assess access to and coverage of individual           sexual violence during the war. There is a severe lack of services. The authors recommend the urgent need to establish a
interventions and include questions on vital events and human rights violations experienced at individual and household         coordinated, multi-disciplinary approach to address the trauma and reproductive health needs of these women.
levels. Pregnancy tracking logs and pictorial TBA forms provide further information regarding coverage levels and
facilitate tracking of live births and deaths during the first month of life.

Findings: Preliminary data indicate that malaria screening and treatment during pregnancy, receipt of insecticide-              Increasing Family Planning Uptake Through On–the-Job/Hands-On
treated nets and iron/folate supplementation, and administration of prophylactic misoprostol have increased from near-          Training at Two Refugee Settlements in Uganda
zero levels at baseline to approximately 70%. Further findings await final evaluation of this ongoing project.

                                                                                                                                Patricia A. Lohr1, Lilian Kiapi-Iwa2
Conclusion: This innovative program emphasizes mobility of services to the population, thus shifting the focus from
facility-based care, which is largely infeasible in this conflict setting, to mobile in-home maternal health (including basic   1 British Pregnancy Advisory Service
emergency obstetric care [BEmOC]) and family planning services. Furthermore, by promoting the roles of providers with           2 International Rescue Committee
variable capabilities and responsibilities, this multi-tiered model provides the flexibility necessary in a community-based     E-mail: liliank@uganda.theirc.org
model of health service delivery. Given the substantial burden of mortality and morbidity facing women in this setting, this
approach may have an important public health impact even without comprehensive care (including cesarean section) or
                                                                                                                                Background: The International Rescue Committee (IRC) provides humanitarian assistance to nearly 24,000 Sudanese
complete coverage of BEmOC and other proven interventions.
                                                                                                                                refugees and internally displaced persons (IDPs) at the Ikafe and Kiryandongo settlements in Uganda. Internal audits
                                                                                                                                demonstrated contraceptive prevalence rates at each settlement below the national target of 23%. One identified barrier
                                                                                                                                to service uptake was limited staff knowledge and experience in providing family planning.



42          RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                           RH in Emergencies Conference 2008 Proceedings — Book of Abstracts              43
Purpose: The purpose is to improve the knowledge and skills of service providers at two refugee settlements in Uganda               Rapid Assessment of Gender-Based Violence Among
and thereby increase the use of family planning services.
                                                                                                                                    Internally Displaced Persons in Baidoa, Somalia
Methods: Two three-week trainings on reversible contraception were undertaken in January and February 2007.
Teaching methods included lecture, group discussion, roleplay, brainstorming, and video demonstrations. Norplant and                Deman Mahamoud
intrauterine device insertion and removal were taught using demonstration models and practical sessions with clients. All           International Medical Corps Somalia
staff providing health services were invited to participate. However, only nurses, clinical officers, and midwives undertook        E-mail: dmahamoud@imcworldwide.org
practical training with clients, however. Informal meetings were held with community health workers and traditional birth
assistants regarding their roles in education and referral. Course participants’ knowledge and the number of new users of           Background: In light of increased reports of gender-based violence (GBV) against internally displaced persons (IDPs)
contraception were assessed pre- and post-training.                                                                                 throughout south central Somalia, International Medical Corps (IMC) conducted a rapid assessment of GBV in three IDP
                                                                                                                                    camps in Baidoa in October 2007.
Findings: Twenty-three staff at the Ikafe settlement and 25 staff at the Kiryandongo settlement participated. All
planned didactic and workshop sessions were successfully completed; however, practical experience was limited by time               Purpose: To obtain qualitative information on the existing GBV situation in Baidoa district to help guide the development
constraints and fewer clients than trainees. Of a total possible score of 18, the mean pre-training knowledge score at Ikafe        and implementation of prevention and response initiatives to address GBV in the region.
was 6.5 (SD 2.5) and 7.4 (SD 3.0) at Kiryandongo. After training, scores increased an average of 4.6 points and 5.7 points
respectively. The number of new users of family planning services in the six months before the training was 153 at Ikafe            Methods: Rapid Assessment: This comprised in-depth interviews with key informants and focus group discussions
and 186 at Kiryandongo. In the six months after training, uptake was 128 and 158 respectively.                                      with IDPs. Interviews and focus group discussions were chosen purposively. Thirteen interviews with key informants
                                                                                                                                    were undertaken and 10 focus group discussions were held. Secondary data were obtained from health facilities, non-
Conclusion: Focused training in contraception can improve provider knowledge; however, this may not translate                       governmental sources, and local authorities.
into increased uptake of family planning in the refugee setting. Possible reasons include an inconsistent supply of
contraceptives, inadequate practical training, scepticism about contraception by potential users and family members, and            Findings: This is the first GBV survey to be conducted in Baidoa district, south central Somalia. The survey revealed that
concern about available contraceptive services with impending repatriation. Future efforts should focus on community                rape, domestic violence, forced/early marriage, forced sex in marriage, and female genital mutilation (FGM) are occurring
education and providing sustained training and oversight of providers.                                                              in Baidoa’s conflict-affected environment. Sixteen of the 60 women interviewed (26%) and seven of the 60 girls (11%)
                                                                                                                                    who participated in the survey reported they had personally experienced at least one act of GBV in the past 12 months.
                                                                                                                                    Some women reported multiple acts of GBV. Domestic violence, forced sex in marriage, and early marriage were the most
Improving Access to Family Planning Services Through Community-Based Providers                                                      common forms reported, yet the majority of male IDPs did not perceive the same as acts of violence. The survey found
                                                                                                                                    health facilities and government institutions such as law enforcement lacking in human, financial, and material resources
                                                                                                                                    to provide adequate services to prevent and respond to GBV.
Primo Madra1, Mildred Latigo1,2
1 United Nations Population Fund                                                                                                    Conclusion: While the findings of IMC’s rapid GBV assessment are not representative of the entire displaced population,
2 Ministry of Health                                                                                                                they do indicate that multiple forms of GBV are experienced by many women and young girls living in Baidoa camps.
E-mail: madra@unfpa.org                                                                                                             Physical and legal protection and deterrent mechanisms to limit GBV are minimal, and legal, medical, and psychosocial
                                                                                                                                    responses are grossly insufficient in Baidoa. IMC’s findings and attendant recommendations outline practical measures
Background: Family planning (FP) is often not considered a priority in response to humanitarian emergencies. Studies                that relevant government ministries, UN agencies, international organizations, local leaders, and community members can
in Uganda, however, indicated a high unmet need for FP in conflict-affected regions of Uganda (58%). Most of the health             take in order to address this critical situation.
facilities in the region are nonfunctional/understaffed.

Purpose: To improve access to FP information and services at the community level.
                                                                                                                                    Reproductive Health Service During Conflict in Nepal:
Methods: Using funding from the United Kingdom Department for International Development (DFID), the United Nations                  Policy, Practice, and Achievement
Population Fund (UNFPA) Uganda Country Office collaborated with Pathfinder International to set up a community-based
FP service-provision system through village health teams (VHTs). More than 600 people selected from among trained                   Babu Ram Marasini
VHTs in 11 districts in northern Uganda were trained and equipped to provide FP services at the community level. Follow-
                                                                                                                                    Ministry of Health & Population, Kathmandu, Nepal
up support that comprised monthly meetings with health workers (midwives or nurses in charge of FP), during which
                                                                                                                                    E-mail: marasini2@yahoo.com
the VHTs presented data on utilization, reported on challenges, were re-supplied, and refreshed their knowledge, were
conducted monthly at health facilities.
                                                                                                                                    Background: Reproductive health (RH) and well being of women and adolescent girls becomes more vulnerable during
                                                                                                                                    armed conflict. According to the Ministry of Home Affairs, the decade-long (1996-2006) violence has killed 14,000, while
Findings: Effectively operational for only about three months, preliminary results reported by VHTs show increased
                                                                                                                                    thousands have sustained injuries or been displaced. Reported gang rape of women, displacement of adolescent girls to
uptake of family planning services by communities. This included long-term and permanent methods. Data from seven
                                                                                                                                    avoid recruitment by rebel groups, inaccessibility of RH services, food scarcity in villages due to strikes or embargos, risk
districts indicate that out of 9,715 people approached by the VHTs with information, education, and communication (IEC)
                                                                                                                                    of HIV infection, and additional burdens on families due to displacement of family members were the main sources of RH
on FP, 1,162 accepted various methods. The highest uptake is for the condom. About 364 opted for pills, while 328 were
                                                                                                                                    problems and concerns. Public-sector health services were less affected and continued to deliver services with positive RH
referred for Depo-Provera, 97 for tubal ligation, 74 for Norplant, and two for intrauterine devices. Some of the referred
                                                                                                                                    outcomes. These positive outcomes resulted from policy reforms initiated during the conflict.
clients were, however, frustrated at the health facilities that failed to provide expected services due to stockouts of supplies.

                                                                                                                                    Purpose: The purpose of the study was to analyze targeted policy reforms and strategies in view of the RH achievements
Conclusion: In situations where health facilities are not easily accessible, community-based approaches can be used to
                                                                                                                                    and outcomes in Nepal.
improve access to FP cost effectively. Follow-up support by the facility-based providers facilitates motivation and keeps
the VHTs active. Improved logistic management for FP supplies at the health facilities is, however, vital.


44           RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                               RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                45
Methods: Relevant health policies/strategies and study reports completed during the 1996–2006 period were reviewed.                Reproductive Health for War-Affected Youth
Findings: The targeted policy reforms initiated during conflict were: a new human resource management for health                   Philip Massago
act focusing on recruitment and deployment of local health workers; an increased role of local health volunteers in
community-based interventions; advocacy of health as a human right at the facility level; RH as priority component of              Brighter Future
essential health care service (EHCS) package; the legalization of abortion; the allocation of two-thirds of the national           E-mail: ptkmassago@yahoo.com
health budget to EHCS; health-sector reform to address health inequalities; a social inclusion approach adopted with
formation of local health management committees; an increased number of special outreach clinics; a maternity                      Background: At the close of the decade-long civil conflict in Sierra Leone in 2002, youth in war-affected Kenema District
incentive scheme; and pro-poor health schemes. Changes in health indicators between 1996 and 2006 reflect important                had low knowledge about reproductive health (RH) and limited access to health services, leaving them vulnerable to
achievements. These changes included a decrease in the total fertility rate from 4.6 to 3.1 and in the prevalence of               unwanted pregnancy, HIV/AIDS, and other sexually transmitted infections (STIs).
anemia during pregnancy from 74% to 36%, and an increase in the contraceptive prevalence rate from 25 to 44 and in
deliveries attended by trained health personnel from 9% to 29.7%. Further analysis of Nepal Demographic and Health
                                                                                                                                   Purpose: The Reproductive Health for War-Affected Youth programme was launched in 2005 to improve the health
                                                                                                                                   and well-being of youth (ages 15-30) in Kenema town through reduction of unwanted pregnancy. The programme’s main
Survey (NDHS-2006) has shown that for the socially excluded and the poorest of poor, access to RH services has begun to
                                                                                                                                   objectives were to improve family planning knowledge and access to contraceptives for war-affected youth.
increase, with 38% of the lowest caste, or ‘Dalits,’ utilizing antenatal care and the poorest quintile utilizing family planning
methods at 38%.
                                                                                                                                   Methods: Youth were primarily recruited from two Christian and two Islamic schools in Kenema town with large female
                                                                                                                                   student populations and high drop-out levels due to pregnancy. The programme took a multi-dimensional approach,
Conclusion: Achieving positive RH outcomes is possible if targeted reforms and community-based interventions
                                                                                                                                   combining RH literacy classes; group activities such as video sessions, discussions and games; one-on-one counselling;
are implemented even when there is a situation of conflict in the country. A social inclusion approach helps to
                                                                                                                                   and distribution of contraceptives. Services were provided by a trained nurse based at the organisation’s drop-in-centre,
reduce the conflict.
                                                                                                                                   working in partnership with eight mobile peer educators. Progress was measured by tracking relevant indicators over the
                                                                                                                                   course of the project, including contraceptive prevalence among sexually active youth clients, retention rate for youth in
                                                                                                                                   RH literacy classes, and percentage of stakeholders expressing satisfaction with the programme.
Identifying Survivors of Sexual Violence: Challenges in the Field
                                                                                                                                   Findings: 1) In post-conflict settings, adolescent RH programmes must compete with other pressing priorities for youth.
Sarah Martin, Meggy Verputten, Deborah Cunningham                                                                                  It is more effective for mobile peer educators to hold spontaneous gatherings than to organise group meetings at a
                                                                                                                                   fixed location. Ideally, RH youth outreach should be integrated with income-generating activities. 2) A multi-dimensional
Médecins Sans Frontieres
                                                                                                                                   approach to RH that combines traditional classes and one-on-one counselling with informal group activities increases
E-mail: sarah.martin@amsterdam.msf.org
                                                                                                                                   retention of youth clients. 3) Peer educators are generally more effective than adults as distributors of contraceptives
                                                                                                                                   to youth clients when given the right training and support. 4) Adolescent RH programmes that target young women
Background: Médecins Sans Frontieres (MSF) responds to medical and humanitarian needs in conflict situations and                   and men simultaneously are more effective at breaking the culture of silence around contraceptive use. 5) Creating and
strives to address the needs of survivors of sexual violence by providing medical and psychosocial care. Unlike health             maintaining a youth-friendly environment requires ongoing training for service providers. 6) Engaging key stakeholders
morbidities, MSF teams find sexual violence difficult to identify and address.                                                     such as schools, local government, health facilities, and community members, can help break down cultural barriers to
                                                                                                                                   adolescent RH services.
Purpose: MSF faces several challenges in implementing medical care for survivors of sexual violence, including: identifying
survivors, who are often reluctant to come forward for medical treatment; finding appropriate and trained staff; raising           Conclusion: Successful and sustainable adolescent RH programming at the community level requires a creative, flexible,
staff and community awareness of the issue; and creating clinics that promote a confidential and trusted atmosphere.               and youth-centred approach. Many of the best strategies for reaching youth clients run counter to traditional health
                                                                                                                                   provider-patient approaches. Community-based providers can promote youth-centred approaches by mobilising peer
Methods: In many conflicts, sexual violence is ongoing yet MSF teams struggle to recognize patients’ quiet symptoms.               educators, health providers, and other stakeholders around their programme vision.
Many survivors reluctantly present for healthcare – some long after the incident, and with vague, seemingly unrelated
symptoms. Most survivors are reluctant to be identified. “Invisible barriers”– including our own staff’s cultural values – can
also be a barrier to access. Sensitization of staff is challenging because of varying attitudes and backgrounds. Relying
solely on national staff is also problematic, as clinic staff often live in the same community, have shared experiences, and
                                                                                                                                   Committing to Quality and Coherence in Emergency Response
understand confidentiality differently. Recruiting trained female staff is challenging in almost all settings.
                                                                                                                                   Saramma Thomas Mathai, Wasim Zaman, Celia Pett
Findings: MSF has been piloting routine health screening for sexual violence in two countries: Colombia and Chad.                  United Nations Population Fund Country Technical Services Team South and West Asia, Kathmandu, Nepal
As the contexts are very different, it is hard to draw conclusions about the universal applicability of screening and its          E-mail: mathai@unfpa.org
added value. In Colombia, MSF found that with extensive supervision and support of clinical staff, teams were able to
identify survivors and improve medical services to a number of women. In Chad, it was more difficult to implement the              Background: United Nations Population Fund (UNFPA), along with its partners, is committed to and involved in
screening due to lack of female staff. While fewer survivors of violence were identified, some eventually self-identified in       protecting the reproductive health (RH) of communities in crisis. South and West Asia suffer from natural and manmade
resultant referrals to psycho-social programs. In both cases, MSF teams became more aware of the extent of violence in             disasters—tsunami, earthquakes, and protracted conflicts—and the experiences demonstrate “ad-hoc,” patchy response
the community and made programming adjustments to better meet the needs of survivors. These included: working with                 with negligible preparedness. A need for coherent organisational direction and support in emergencies has been identified
outreach workers and other community actors, spreading information about the importance of medical care for survivors              by UNFPA Country Technical Services Team (CST).
of rape, improving referral services, and implementing measures to improve confidentiality.
                                                                                                                                   Purpose: The objectives were to identify feasible roles for RH response in emergencies based on a review of current
Conclusion: Routine screening may not be appropriate for all settings where MSF works. Screening may be                            global guidelines and experiences globally and locally, to develop specific operational capacity and commitments in
inappropriate in some settings due to inability to safeguard confidentiality or to lack of referral services. Some of the          emergencies, to develop suitable partners for UNFPA South and West Asia (SAWA), and to develop standardised operating
challenges to identifying survivors may be better addressed by providing more support and supervision to staff.                    procedures for country offices in emergencies.



46           RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                              RH in Emergencies Conference 2008 Proceedings — Book of Abstracts              47
Methods: A literature search of existing policy and guidelines, programme experiences, and resources relating to                   Conclusion: Information and data recording has to be much more accurate and relevant. Methods of registration and
reproductive health in emergencies—including production of a selected bibliography of most relevant current resources—             data collection need to be reviewed to avoid duplication and to increase accuracy. All donors need to receive pre-test
was completed. Identification of regional institutions with emergency RH capacity and experience began. A regional                 counseling for the TTIs tested. Unreliable availability, risk of infection, and the disregard for protocols increase
internal brainstorming workshop, which identified feasible potential roles and commitments for UNFPA emergency                     morbidity and mortality.
preparedness and response through a discussion of literature/institutional search findings and country office emergency
preparedness/response experiences (including experience of UN ‘cluster’ approach to emergency response), was
conducted. The workshop resulted in an action plan for the development of UNFPA SAWA “core commitments” and
                                                                                                                                   Introducing Maternal Death Audit at a Provincial Hospital in Sierra Leone:
contingency planning/training for country offices.
                                                                                                                                   A Review of Twelve Months’ Experience
Findings: Both the findings of the literature search and conclusions based on country office experience indicate a
wide gap between principle and practice. Great difficulty was encountered at the country level in raising the profile of           Jeff K. Mathe
RH in emergency situations and, in particular, within the United Nations’ ‘cluster’ system. There was a realisation that
                                                                                                                                   International Rescue Committee
guidelines are only as good as the capacity to deliver allows. Success in the long term is more likely when the emphasis is
                                                                                                                                   E-mail: jeffm@theirc.org
on strengthening community and national government capacities in disaster mitigation and emergency response. There
is a need to invest in and support emergency preparedness and contingency planning activities as a core organisational
                                                                                                                                   Background: Maternal death audit has become a routine practice in obstetric care in most developed countries, but it
strategy. There was general agreement that one-off training exercises are not effective in improving emergency
                                                                                                                                   is not always common in developing countries. Under its emergency obstetric care (EmOC) programme, the International
preparedness/response. There was recognition regarding the importance of documenting emergency experience for
                                                                                                                                   Rescue Committee (IRC) introduced this practice in one provincial hospital in Sierra Leone.
effective organisational learning. Vital lessons are often forgotten when the emergency subsides if they are not recorded.
                                                                                                                                   Purpose: To present the results of the maternal mortality rate (MMR) process for the first year of its implementation.
Conclusion: The literature review and brainstorming process are essential elements in the development of realistic,
feasible roles/objectives for UNFPA SAWA in emergency preparedness/response. One important lesson learnt was the need
                                                                                                                                   Methods: This is a retrospective study of maternal deaths that occurred at Kenema Government Hospital, Sierra Leone, in
for interventions to be both feasible and of high quality, since several evaluations of recent emergency experiences—e.g.,
                                                                                                                                   2007. Data were extracted from the death notification forms as well as from minutes of the maternal death audit meetings.
the Asian tsunami—indicate that organisations often attempt interventions which far exceed their capacity or mandate.
                                                                                                                                   Findings: During the 12-month study period, there were 35 maternal deaths at the hospital, giving a maternal mortality
                                                                                                                                   ratio of 152 per 100,000 live births. The mean age of the deceased was 26 (16-45) years with mean parity of 3 (0-8).
Blood Transfusion Service: An Integral Component of Emergency Obstetric Care                                                       34.3% of the deaths occurred in the ante-partum period and 65.7 % during the postpartum period. 74.3% of the deaths
                                                                                                                                   occurred within 24 hours of admission and 26.7% after one or more days of admission. The most frequent obstetric
Jeff K. Mathe, Sue Clarke, Fredanna M’Cormack                                                                                      causes of death were: i) prolonged obstructed labour (25.7%); ii) eclampsia (22.8%); iii) hemorrhage (20%). The most
                                                                                                                                   frequent avoidable factors identified during the review meetings were: i) delayed referral; ii) management at inappropriate
International Rescue Committee
                                                                                                                                   level (traditional birth attendant [TBA] or home); iii) lack of transport; iv) lack of blood or drugs. Following the inception of
E-mail: jeff.mathe@theirc.org
                                                                                                                                   the audit, facility-based factors were promptly dealt with, leading to a reduced trend of maternal deaths at the hospital.
                                                                                                                                   Consequently, in the later phase of the year, community factors came to dominate maternal death trends.
Background: An objective of the emergency obstetric care (EmOC) program in Sierra Leone is to “build the capacity
of the blood bank to provide safe and adequate blood supplies for all cases of obstetric complications free of charge.” A
                                                                                                                                   Conclusion: The introduction of the monthly maternal death audit at this hospital has helped reduce unnecessary
more complete review of the activities and capacity of this intervention will follow.
                                                                                                                                   maternal deaths by identifying specific and general avoidable factors that are being addressed in terms of “best
                                                                                                                                   practices”, communication, accessibility and community awareness. It should be recommended to all hospitals.
Purpose: 1) To evaluate the activities in the blood bank and the methods of record-keeping used. 2) To review the
categories of blood donors and the outcomes of screening for transfusion transmissible injuries (TTIs). 3) To review the
criteria for transfusion requests for the maternity cases admitted. 4) To ensure the availability of safe blood in the facility.
                                                                                                                                   Evaluating the Needs for Reproductive Health Services: The Situation of
Methods: The blood bank activities were observed over a two-month period. Both qualitative and quantitative methods                Five General Reference Hospitals in the Democratic Republic of the Congo
were used to ascertain the information. Quantitative information was gleaned from the 2007 donor and transfusion
registers and from checklists developed by the International Rescue Committee (IRC) for supervision. Qualitative
                                                                                                                                   Martin Migombano, Amadou Sagnon
information was gained through observations made in the laboratory and on “voluntary blood drives”, and also through
group discussions with those volunteers donating blood.                                                                            International Rescue Committee
                                                                                                                                   Email: amadou.sagnon@theirc.org
Findings: 1) During the observation of the activities in the blood bank, the overall performance improved, but still never
exceeded a score of 50% on the checklist. The information recorded in the registers was limited, repeated, incomplete,             Background: The maternal and infant mortality rates in the Democratic Republic of the Congo (DRC) are among the
inconsistent, and therefore of little value. This also limited the findings of the study, which was unable to confirm whether      highest in the world. Deterioration of the health care system in general, combined with the various wars, are the principal
or not all women received their transfusions or if the transfusions were free. 2) Family replacement is still the highest          causes. Through the RAISE Initiative project, which is incorporated within the primary health care program, the International
contributor to the blood donation service. The majority of TTIs occurred amongst first-time donors in the voluntary donor          Rescue Committee (IRC) provided support for the Ministry of Health in five provinces within the DRC. In March, 2007, health
group. The most common TTIs detected were HBV (13.5%), HIV (7%), and VDRL (4%). This was compared to the family                    care training programs were evaluated on the basis of their capability to provide reproductive health services.
replacement donors who were found to carry HBV (4.6%), HIV (1.6%), and VDRL (0.5%). 3) The average hemoglobin
(Hb) of EmOC patients transfused was 5.9g/dl, well within the national reference for transfusions. 4) A total of 496 blood         Purpose: The objective of these efforts is to present the results obtained as a result of this evaluation concerning the
transfusions were given to EmOC cases out of 1,869 safe units of blood collected, representing a 26% transfusion rate of           level and capabilities of human resources being provided for reproductive health services.
safe blood for obstetric cases.
                                                                                                                                   Methods: Methods consisted of a six-part evaluation tool which examined general infrastructure, payment for services,


48           RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                                RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                  49
human resources, delivery of reproductive health services, statistics concerning services, and inventory of renewable            Conclusion: UNFPA’s rapid response to addressing GBV in the Kenya crisis provides lessons learned on establishing GBV
items, equipment, and drugs. Evaluation techniques included discussions, review of documentation, interviews at five             coordination, prevention, and response activities within the first month of a crisis in order to anticipate the needs of the
general reference hospitals being evaluated within three provinces (Eastern Province, Western Kasai, and Southern Kivu).         affected population and meet those needs efficiently and effectively.

Findings: None of the hospitals among the five which were being evaluated has the services of an obstetrician or a
pediatrician or a physician who is an anesthetist. All of the hospitals possess at least two general practitioners, one
                                                                                                                                 Discrepancy in Knowledge of and Attitudes on Condom Use by Burundian
A1 nurse, and one A2 nurse. Among the personnel at the five hospitals, none of the providers use vacuum extractors,
and none offer family planning services. Moreover, none of the providers within the five provinces performs neonatal             Refugees in Mtendeli Refugee Camp, Kibondo, Tanzania
resuscitation or provides active supervision of the third phase of childbirth. Only the personnel at Kabare, Kalehe, and
Ubundu provide prevention of mother-to-child transmission of HIV, and Kabare is the only facility where voluntary                Diane F. Morof1,2, Tabetha Harken2, Susan Purdin3,4
counseling and testing (VCT) services for HIV are provided. Among all of the services which are not offered, 68% can be          1 Planned Parenthood Golden Gate
attributed to absence of training of personnel, especially for VCT services, family planning, comprehensive emergency            2 University of California, San Francisco
obstetric care (EmOC), and comprehensive response services for sexual violence. Among all of the hospitals, 9% of the            3 International Rescue Committee
services not being offered can be attributed to a lack of adequate supplies and equipment, and 12.5% of the services not         4 Columbia University Mailman School of Public Health
being offered can also be attributed to a lack of training and equipment.                                                        E-mail: dmorof@gmail.com

Conclusion: Unavailability of training among personnel constitutes the first obstacle to the introduction of reproductive        Background: In 2006, estimated HIV prevalence rates at Mtendeli Refugee Camp varied between 1.6% and 3%, while the
health services. The second obstacle is a lack of equipment. On the basis of the RAISE Initiative project, the IRC is training   contraceptive prevalence rate (CPR) was 7.1% to 8.8%. Condom use was 1% of all family planning use at Mtendeli.
personnel for acquisition of practical skills in EmOC, family planning, and comprehensive response services for victims
of sexual violence, as well as supplying medical and surgical equipment and developing modern training rooms. RAISE              Purpose: Condom use was noted to be lower than rates of condom use for Tanzania as a whole (11% to 44%). With
and the Ministry of Health should cooperate - through validation of training and incorporation of certain equipment into         permanent and long-term contraceptive methods not easily accessible, researchers sought to understand barriers to
medical practice - in order that the high maternal mortality rate within the DRC may ultimately be reduced.                      condom use such that promotion of condoms for family planning and sexually transmitted infection (STI) prevention
                                                                                                                                 could be accomplished.


Rapid Gender-Based Violence Response to the Post-Election Violence in Kenya                                                      Methods: In-depth interviews of a random sample of 48 refugees, male and female, ages 17 to 63, were completed
                                                                                                                                 between March and August 2006. Data extraction for group health service use and individual use was coupled with the
                                                                                                                                 interviews. The semi-structured interviews were analyzed for theme using card files and spreadsheets. Quantitative
Jennifer Miquel
                                                                                                                                 analysis was completed with Stata.
United Nations Population Fund
E-mail: miquel@unfpa.org                                                                                                         Findings: When asked about condoms, the majority of respondents knew what condoms could be used for (avoiding
                                                                                                                                 pregnancy and preventing STIs). The participants were then further questioned using a standardized scenario, and the
Background: Violence erupted in Kenya as a result of the contested December 2007 election, displacing an estimated               perception was that people who used condoms do so in the context of “prostitution” or “promiscuity”. Additionally, with
250,000 people and affecting an additional 500,000. Within the first week of the crisis, the United Nations Population           in-depth probing about condoms, many misconceptions were identified, including condoms spreading disease, becoming
Fund (UNFPA) mobilized a gender-based violence (GBV) team to respond to the situation.                                           lost within a woman, and inhibiting the function or pleasure of the male partner.

Purpose: Through its mandate as the lead agency for the GBV subcluster, UNFPA’s aim was to establish coordinated,                Conclusion: Using open-ended questions coupled with scenarios allowed for improved understanding of the
efficient, and ethical mechanisms to prevent and respond to GBV (focusing on sexual violence) occurring as a result of           community’s true perception about condom use. Further in-depth probing was useful to identify barriers to use of
the crisis and displacement.                                                                                                     condoms for family planning and STI prevention. These areas may provide a focus for further education campaigns.


Methods: Within the first month of the crisis, UNFPA spearheaded an inter-agency rapid assessment to investigate
GBV issues related to the election violence in coordination with UNICEF, the United Nations Development Fund for                 Partnering with Grassroots Organizations to Deliver Reproductive
Women (UNIFEM), and the Christian Children’s Fund. UNFPA also established the GBV subcluster in partnership with the
Kenya Red Cross Society and with the support of the protection cluster. Over 30 governmental and non-governmental
                                                                                                                                 Health Services in Conflict-Affected Districts in Uganda
organizations (NGOs) represented in the subcluster share information, identify gaps, and develop action points to meet
emerging needs. In addition to mounting prompt coordination to address GBV through the subcluster, UNFPA ensured                 Tony Mugasa1, Moses Okello2, Maragret Kyenkya1, James Okello1, Elizabeth Ekochu1
availability of reproductive heath (RH) supplies in all affected regions, including post-rape treatment kits.                    1 John Snow, Inc./Uganda Program for Human and Holistic Development
                                                                                                                                 2 Rural Health Concern
Findings: Lessons learned from instituting rapid response to GBV in the Kenya emergency include: GBV experts should              E-mail: eekochu@upholduganda.org
be deployed immediately in an emergency to conduct specialized assessments that take ethical and safety issues
into account and ensure comprehensive understanding of key issues within affected populations; GBV coordination                  Background: Northern Uganda has had a civil war for two decades, which has displaced most of the population into
mechanisms must be established at the earliest stages of emergency to reduce duplication of efforts and promote                  internally displaced persons (IDP) camps. This has created a strain on health services delivery, a gap filled by many
targeted programming; technical, financial, and logistical resources should be mobilized in anticipation of needs                community-based organizations (CBOs). John Snow, Inc., with funding from USAID, implements the Uganda Program for
rather than after needs have been identified, in order to reduce delays in provision of critical services; working with          Human and Holistic Development (UPHOLD), which supports 28 districts in Uganda to improve access to and utilization
long-standing partners promotes rapid implementation of services and must include close partnerships with relevant               of health and HIV/AIDS services. UPHOLD works through strategic partnerships with local governments and civil society
government counterparts; mechanisms must be established at the outset to monitor and evaluate activities; and gender             organizations to provide and mobilize communities for services.
and GBV should be mainstreamed into the cluster approach through distribution of key resources, sensitization of cluster
partners, and training at the field level.


50          RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                             RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                51
Purpose: In 2004, UPHOLD partnered with a CBO, Rural Health and Environment Concern (RUHECO), to deliver                       able to use condoms when having sex compared to the other 25% of rural women who reported their inability to negotiate
integrated reproductive health (RH) services in six IDP camps in one conflict-affected district, Lira. The partnership aimed   for monogamy or safer sex practices. Psychological support and psycho-education amongst the infected population was
to address diverse factors exacerbated by conflict that lead to underutilization of RH services in the district.               associated with safe sex practices, disclosure, and compliance to the treatment.

Methods: The CBO trained 441 community RH workers (CRHWs) to promote couple communication on family planning                   Conclusion: These findings indicate that there is still a gap of psychological imperatives between rural and urban areas
and safe motherhood and to address gender-based violence in the communities through local leaders’ involvement                 with regard to HIV prevention. The urban population is more likely to be supported psychologically and socially, and tend
and advocacy. One hundred twenty-seven (127) adolescent peer educators (67 males and 60 females) were trained to               to have enough information to improve their health behaviours while the rural population remains neglected and often
reach out to adolescents with RH and HIV prevention messages, while 54 men peers were trained to reach out to men              immersed in unhealthy behaviours. These findings somehow substantiate for the higher spread of HIV amongst rural
in the community. Thirty-four (34) drama shows were also staged in six IDP camps and 16 radio talk shows were held             communities, survivors of genocide, and especially amongst marginalised women. Thus, it is important that HIV
on promoting parent-adolescent communication. The CBO also assisted in the distribution of 2,560 safe delivery kits            prevention focus on increasing psychological support among vulnerable populations after any conflict or war,
to mothers attending antenatal care at public health facilities with accompanying messages to promote safe deliveries          and increasing their healthy behaviours.
at health facilities.

Findings: The CRHWs reached out to 4,398 people through home-visiting activities, from which 3,057 new family                  Challenges to Availability and Utilization of Clinical Management of
planning users were mobilized. The adolescent peer educators reached 5,479 adolescents with RH and HIV prevention
messages, 579 people with prevention of gender-based violence messages and 24,593 people with safe motherhood                  Rape Services in Northern Uganda
messages. Counselling services were provided to 95 (25 female and 70 male) victims of gender-based violence and 825
expectant couples were reached with safe motherhood messages. These interventions contributed to an increase in the            Alex Muhereza1, Rachel Goldstein2, Simon Akena1, Grace Latigi2, Mike Odong1
proportion of women who delivered their babies at facilities in Lira district from 33% in 2004 to 39 % in 2006.                1 Gulu Health Workers Network
                                                                                                                               2 United Nations Population Fund
Conclusion: Partnership with grassroots organizations is an effective way of delivering reproductive health services           E-mail: goldstein@unfpa.org
areas with conflict. Programs intending to implement RH services in conflict areas should adopt a multi-pronged approach
for effective use of services.                                                                                                 Background: The Minimum Initial Service Package (MISP) highlights the prevention and management of sexual
                                                                                                                               violence as one of the priority, life-saving interventions for populations affected by crisis. While the humanitarian context
                                                                                                                               in northern Uganda has largely shifted from emergency to early recovery, the availability and utilization of clinical
Psychological Support and Health Behaviour in Women Survivors Living with HIV                                                  management of rape services remain limited despite a number of interventions to strengthen access to these services.

After the Genocide: The Case of Rwanda-Village Concept Project in Mpungwe Village
                                                                                                                               Purpose: This study sought to identify some of the constraining factors to ensuring the availability of appropriate and
                                                                                                                               timely health care services for survivors of sexual violence among internally displaced persons in Gulu District. This
Jean Claude Mugunga1,2, Celestin Hategekimana1,3                                                                               assessment was conducted as part of a project to improve access to health services through follow-up of health workers
1 Rwanda Village Concept Project                                                                                               that had received training and supplies for clinical management of rape.
2 National University of Rwanda
3 Faculty of Medicine, National University of Rwanda                                                                           Methods: Interviews were conducted with 24 health workers posted to 11 health units that had previously received
E-mail: jcmugunga@gmail.com                                                                                                    training and supplies for provision of clinical management of rape services. A focus group was also held with social
                                                                                                                               workers from three agencies that provide case management services to survivors of gender-based violence (GBV),
Background: Last year, in 2007, about 3% of Rwandans were estimated to be living with HIV. Young people and female             including referral to health services. Following the assessment interviews, on-the-job refresher training was provided to
genocide survivors continue to have the highest prevalence of HIV. After experiencing unimaginable rape during the 1994        health workers.
genocide, widows are disproportionately affected, and account for about 39.1% of the infected population in Mpungwe
Village, which reflects the general case in rural communities.                                                                 Findings: The findings of the study suggest that while general knowledge about GBV is high among health workers, most
                                                                                                                               lack the confidence and/or competence to provide appropriate care to survivors. Only 10 (42%) of health workers present
Purpose: This paper explores the relationship between psychological support and health behaviour for rural and urban           at these facilities had received training on clinical management of rape. Despite the provision of guidelines, tools, and
women who are living with HIV in Mpungwe Village, supported by the Rwanda Village Concept Project (Rwanda-VCP) and             supplies to all of these facilities, only 11 (46%) had Ministry of Health (MOH) guidelines, consent forms, or medical history
the neighborhood (Huye district, Rwanda).                                                                                      and exam forms available at the time of the interview. Both health workers and social workers indicated that fear of legal
                                                                                                                               implications of conducting medical exams and confusion around the Police Form 3 (PF3) were obstacles to availability
Methods: This study was a descriptive survey of a group of pregnant and non-pregnant women living with HIV. The                and utilization of services for survivors. Social workers and assessment teams also found that low staffing levels and staff
sample size was 262 women, 131 from urban areas and 131 from rural areas. Data were collected using three instruments,         absenteeism in government health units were serious barriers to service delivery. While a few private health units in Gulu
namely a demographic questionnaire, the health behaviour schedule, and the multidimensional scale of perceived                 District provide high quality services to survivors of sexual violence, interventions to build capacity of government health
psychological and social support.                                                                                              units to provide these same services have been inadequate.

Findings: Significant findings indicate that 71 % of urban women received counselling and/or psycho-education, while           Conclusion: This study suggests that a more strategic approach to provision of clinical management of rape services
in rural areas only 22% had done so. A total of 77% of women in urban areas reported that they had disclosed their HIV         in humanitarian settings may demand rigorous supervision and monitoring of health workers as well as targeted
status to someone, while in the rural areas 49% had done so. Support groups were found to be more effective in rural           advocacy efforts.
areas than in urban areas, with statistics indicating that only 12% of women attended support groups in urban areas
compared to 27% of rural women. However, only 2% of rural women within the support groups indicated that they were




52          RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                            RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                 53
Tracking and Improving Pregnancy Care in Rwanda                                                                                  Methods: The programme renovated and equipped a 30-bed fistula ward and operating theatre at JFK Medical Center
                                                                                                                                 in Monrovia. Collaborative efforts with county health teams resulted in the creation of six fistula outreach sites. To build
                                                                                                                                 capacity, a core team of two doctors, two nurses, and one anesthetist received fistula management training in Nigeria.
Therese Mujawamaria, Emmanuel d’Harcourt
                                                                                                                                 Additional training was conducted with doctors, nurses, and midwives at project sites. Advocacy efforts with government
International Rescue Committee                                                                                                   officials garnered support for the new fistula programme. Additional advocacy focused on community awareness-building
E-mail: mujarese@yahoo.fr                                                                                                        and mobilisation. Partnerships were developed with the Schools of Medicine and Nursing in Liberia. Consultations were
                                                                                                                                 held with non-governmental organisations (NGOs) to develop a functional referral system for patients.
Background: Rwanda has a maternal mortality rate of 1,100 deaths per 100,000 live births. As elsewhere, this mortality
is caused in part by lack of access to qualified birth attendance. There has been only limited discussion on strategies to       Findings: With the establishment of a fistula care unit at JFK Medical Center in Monrovia and six outreach sites,
improve this access in poor and post-conflict countries.
                                                                                                                                 154 patients received surgical treatment in 2007, with a success rate of 94.6%. In addition, efforts aimed at
                                                                                                                                 integration of fistula into national-level systems resulted in its inclusion in the Schools of Medicine and Nursing
Purpose: The Counting Every Woman program has three objectives: 1) to follow the pregnancy of every woman in a rural
                                                                                                                                 curriculum and the integration of fistula prevention and treatment into the Liberia National Reproductive Health Road
district in Rwanda, 2) to use this information to improve quality and coverage and 3) to support health facilities in a
                                                                                                                                 Map and Country Programme Action Plan (CPAP). Partnerships have been developed between the fistula programme,
targeted, cost-effective way to improve services.
                                                                                                                                 NGOs, and stakeholders, with the goal of improving coordination of efforts. Constraints and challenges that need to be
                                                                                                                                 addressed include the poor socio-economic status of patients, reduction of stigma experienced by women living with
Methods: Program staff, in collaboration with the Ministry of Health, created a pregnancy card similar to the vaccination
                                                                                                                                 fistula, accessibility of treatment sites, limited capacity at some of the outreach sites and the increased demand
card. This card was designed for use in both facilities and community. After the postnatal period, data from the card is
entered electronically at District level using a handheld device, then shared with clinic staff. The program also provides for   for fistula treatment.
targeted support to health facilities, including provision of obstetric drugs and equipment, renovation of maternity wards
to make them more welcoming, waiving of all fees to women, and seconding of a midwife.                                           Conclusion: Despite major challenges, this programme illustrates that it is possible to conduct a successful fistula
                                                                                                                                 effort in the post-conflict country setting. The programme is new and continues to require additional support from the
Findings: From January to September 2007, 414 women were registered, including 355 who delivered in health facilities            Government of Liberia and international actors to successfully bring pride and dignity back to women who have been
(60% of the 589 who actually delivered), and 59 who delivered at home (4% of the estimated 1,410 home deliveries).               stigmatised and rejected due to fistula. Resources must be mobilised to increase the provision of prevention, treatment
During the support period, skilled attendance increased from 16% to 38%. The average monthly cost of support was $600            and reintegration services in Liberia.
for health centers with a midwife and $100 for those without. However, centers with a midwife experience the greatest
increase in skilled attendance. The registration system showed important gaps: 45% of women received no iron at all
during pregnancy, and only 3% received iron for three or more months. 96% of women attended antenatal care, but
                                                                                                                                 Impact of the Reproductive Health Project on Care for Rape
more than half began that care in their third trimester. The most common complications were prolonged labor (7%) and
hemorrhage (6%). Coverage for post-natal care was better: 89% of new mothers got family planning counseling, and 98%             Victims in Southern Kivu Province
of newborns got proper eye care.
                                                                                                                                 Immaculée Mulamba, Elysée Kalemwa, Kimberly Connolly, Amadou Sagnon
Conclusion: Targeted support to health facilities, or “basic basic EmOC,” is a cost-effective way to increase skilled
                                                                                                                                 International Rescue Committee
attendance. Adding a midwife on staff adds significantly to the cost, but yields even greater improvement. The “Every
                                                                                                                                 Email: Amadou.Sagnon@theIRC.org
Woman Counts” pregnancy registration system yields valuable information about pregnancy care, and has served to
highlight gaps in services coverage. More work is needed, though, to improve pregnancy tracking of mothers who
deliver at home.                                                                                                                 Background: Since the month of August, 2007, clinical care has been provided for rape victims within the Kabare Rural
                                                                                                                                 Health Care Area in the eastern portion of the Democratic Republic of the Congo (DRC), where rapes have been occurring
                                                                                                                                 for more than seven years as a result of war (rape used as a weapon in warfare). The International Rescue Committee
                                                                                                                                 (IRC) is active in relation to primary health care and, more specifically, in terms of strengthening the capabilities of health
Establishment of a National Fistula Project in Liberia                                                                           care structures in the field of quality reproductive health care, according to the following areas: emergency obstetric care
                                                                                                                                 (EmOC), family planning, HIV and sexually transmitted infections and gender-based violence (GBV).
John Mulbah
National Fistula Project, Liberia                                                                                                Purpose: To demonstrate our reproductive health care program’s contribution to improving quality of care for victims of
E-mail: jmpolyclinic@yahoo.com                                                                                                   GBV within the Kabare Health Care Area in Southern Kivu Province.

Background: As Liberia emerges from 14 years of civil crisis, challenges, including an absence of adequate maternal              Methods: Training for providing clinical care for rape victims was furnished by training personnel from the Ministry
health services, must be addressed. As part of this effort, increased awareness and services for obstetric fistula are           of Health with financial support from the International Rescue Committee. Twenty-five providers received training for
needed. While data on fistula incidence and prevalence in Liberia are minimal, current maternal health indicators highlight      clinical care, along with 30 community assistants, in order to increase the population’s awareness of this type of care at
the risk for poor maternal health outcomes, including fistula. For example, 2007 Demographic and Health Surveys (DHS)            a hospital level. The IRC assumed responsibility for availability of rape kits, as well as other supplies for providing care
findings show an increase in maternal mortality from 558 per 100,000 live births in 2000 to 994 per 100,000 live                 according to the DRC’s national policies. Incoming cases were listed in consultation registers, with specific identification
births in 2007. A 2006 situational analysis, conducted in 48 institutions, found a high prevalence of fistula in 4 of the        of cases arriving less than or more than 72 hours after rapes.
15 surveyed political subdivisions. The analysis identified 351 women who received fistula surgery over two years, with
57% of the women reporting rejection by their husbands. In response to the maternal health situation and the challenges
                                                                                                                                 Findings: After strengthening of providers’ capabilities, use of the hospital by rape victims increased from zero to 127
facing women living with fistula, a comprehensive national project was created by the Ministry of Health, the
                                                                                                                                 cases in less than six months. Victims arriving within 72 hours after rapes numbered eight in comparison with use of a
United Nations Population Fund (UNFPA), and JFK Medical Center in order to provide fistula prevention, treatment,
                                                                                                                                 facility in a distant location which received 579 cases originating from the health care area during 2006-2007.
and social reintegration.

                                                                                                                                 Conclusion: An increase was observed in the number of cases referred to health centers in collaboration with local
Purpose: The presentation will address advocacy efforts to increase awareness about fistula, the creation of service
                                                                                                                                 organizations working on care for GBV survivors as well as in the quality of clinical care and subsequent follow-up.
delivery points for fistula care, and the training of medical professionals to increase human resource capacity. The
presentation will also address partnerships formed to increase commitment at various levels for fistula service provision.
54          RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                              RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                  55
Psychosocial Effects of Sexual Violence in Conflict Situations
                                                                                                                               Findings: The main baseline findings are highlighted, including:
Margaret Mungherera                                                                                                             • There is high demand for SRHR in IDP camps, far outstripping supply.
                                                                                                                                • There is much need in the camps for sexual and gender-based violence services and primary health care services
Hope After Rape                                                                                                                   for diverse age groups, including orphans and vulnerable children, former abducted persons, and child mothers.
E-mail: cngongo@engenderhealth.org                                                                                              • Stigma and discrimination against people living with HIV/AIDS (PLWHA) is very high.
                                                                                                                                • Sexual and gender-based violence (SGBV) is rampant and perpetuators are rarely brought to justice.
Background: The Ugandan population has experienced conflict for the past 20 years. A psychosocial needs assessment              • The project is not able to provide the comprehensive SRHR package.
was carried out in 1998. Hope After Rape is one of the programs established to respond to the needs identified.                 • The area’s population is mobile, changing from time to time.

Purpose: This presentation will describe the challenges faced in developing programs for psychosocial support in conflict      Conclusion:
areas of Uganda.                                                                                                                • Introduction of community-based structures/systems can help to improve the SRHR for the IDPs, and more
                                                                                                                                  interpersonal approaches in community mobilization should be adopted.
Methods: Local women organized themselves to address psychosocial issues around sexual violence and other forms                 • Project design needs to be flexible in order to remain relevant; the project could pay added attention to other
of gender-based violence (GBV). They developed a counseling training program and trained teachers, nurses, and others             vulnerable populations and change original sites to others where need is greater; if necessary, RHU could be granted
as community psychosocial workers. They have also trained parents to support children formerly abducted by rebels.                authority to make appropriate changes.
These programs have supported victims over the long term, and brought to light the range of psychosocial issues faced by        • To reduce stigma, there is need for increased advocacy and sensitization for PLWHA.
communities in conflict or post-conflict settings.                                                                              • The project should include a secondary service package addressing SGBV and primary health care conditions and focus
                                                                                                                                  on providing RHU’s minimum SRHR services package rather than the comprehensive SRHR package.
Findings: Psychological disorders resulting from sexual violence in conflict situations include personality disorders,          • There is need to work in closer partnerships with other organizations.
emotional disorders, suicidal behavior, and post-traumatic stress disorder. Several factors can make victims of sexual
violence in conflict settings particularly vulnerable, including poverty, insecurity, and a lack of access to shelter, food,
water, clothing, education, and information. Moreover, victims may have limited opportunities for life skills development,
vocational training, and access to income-generating activities. Survivors must be empowered with information and skills       The Role of Logistics in Programme Life Cycle and Effectiveness
in order to recover and be reintegrated into their families and communities. Counseling enables survivors to express and
deal with emotions associated with rape. It can also provide information about health, legal, social, and policy issues.       Pamela Ohonde
To be effective, counseling programs must equip counselors to address sexual abuse and adapt to the special needs of           United Nations Population Fund
some victims, such as young children or those whose abuser is within the family. Programs must maintain quality while          E-mail: Ohonde@unfpa.org
understanding the cultural and infrastructural context.
                                                                                                                               Background: Logistics and supply is fundamental to programme support. It serves as a bridge between disaster
Conclusion: Psychosocial rehabilitation strategies should be based on the community’s perceptions regarding the                preparedness and response, between procurement and distribution, and between headquarters and the field. Logistics
causes and effects of sexual violence. Programs that build on existing social and cultural support systems are therefore       and supply is crucial to the effectiveness and speed of response for programme delivery. Lastly, since logistics should
more likely to be acceptable to communities.                                                                                   track goods through the supply chain, logistics reports provide information that reflects all aspects of execution: from the
                                                                                                                               effectiveness of suppliers and transportation providers, to the cost and timeliness of response, to the appropriateness
                                                                                                                               of donated goods.
Between Two Fires: Ensuring Sexual and Reproductive Health and Rights
                                                                                                                               Purpose: To explore challenges that the United Nations Population Fund (UNFPA) and its partners have experienced that
Among Internally Displaced People in Gulu District, Northern Uganda                                                            impact on programme delivery; and to devise means of addressing these challenges.

Wilfred Ochan                                                                                                                  Methods: Observations during field visits to UNFPA programme sites, which were conducted to assess logistics,
Reproductive Health Uganda/Family Planning Association of Uganda                                                               supply, and support.
E-mail: e_mugumya@yahoo.com
                                                                                                                               Findings: Logistics, as a repository of data and lessons learned, is critical to the performance of both current and future
Background: Gulu District is an area of conflict where fundamental human and sexual and reproductive health and                operations and programmes. However, the lack of proper global supply/logistics systems and procedures, combined with
rights (SRHR) are being denied. These hostilities have displaced people, forcing many to flee their homes. As a result,        a lack of proper training of field staff, has led to less-than-optimal delivery of services and goods to beneficiaries. This
most people now live in internally displaced persons (IDP) camps.                                                              means that there is less impact on the alleviation of poverty and human suffering that can be achieved. Furthermore, poor
                                                                                                                               logistics and supply also mean that institutional donors, whose funds support this work, are not satisfied—either in terms
Purpose: The purpose of this study was to obtain baseline findings for an intervention conducted by Reproductive               of programme impact or value for money for the resources given.
Health Uganda (RHU), whose aim is improving the SRHR of IDPs in four IDP camps/villages by increasing access to SRHR
information and services, and increasing the number of people able to exercise their rights and choices.                       Conclusion: The issue of supplies/drugs and equipment—both in terms of quantity and quality, and variety—has been
                                                                                                                               identified (by RAISE partners) as among the main challenges. Stockouts, outdated drugs, and inconsistent and unreliable
Methods: A baseline survey study was carried out in four resettlement villages/camps that are the project target areas.        supplies are very commonly experienced. Some of these problems relate to the supplier, funding, national customs,
The survey included qualitative and quantitative analysis incorporating review of the literature, focus group discussions,     and/or related bureaucracies.
key informant interviews, and systematic random data sampling. Quantitative data for the baseline survey were
collected by interviewing men, women, and young people (10 to 45 years old) living within the camps using a pre-coded
questionnaire that asked questions related to knowledge, attitudes/beliefs, and practices regarding SRHR issues. This
data was subsequently coded, entered, cleaned, and processed.

56          RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                           RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                57
Importance of the Information System in Profamilia                                                                              Methods: The first stage of the study consisted of breaking down ENDS-05 data to identify the women who had been
                                                                                                                                raped by their husbands or partners, or by someone else. When the socioeconomic characteristics of these women were
                                                                                                                                analyzed, statistically significant differences in the proportions of raped women were established. Subsequently, a
Gabriel Ojeda
                                                                                                                                regression analysis was carried out, thereby identifying the factors that best explain sexual violence against
Profamilia                                                                                                                      women in the country.
E-mail: gojeda@profamilia.org.co
                                                                                                                                Findings: The main results show that 6% of all women of fertile age (between the ages of 13 and 49) have been raped
Background: Directors of health programs and projects have to make systematic decisions all the time. Some are about            by a person other than their husband or partner. Of these, 47% were raped before they were 15 years old. In 76% of
people: how to handle their bosses, their workmates, and their subordinates. Others are about how to allocate and spend         cases, the rapist was someone woman knew; friends are the most common rapists. The highest percentages of this type
funds. Many diverse decisions are made in the ordinary course of their work, and usually have to be made in a short period      of sexual abuse are found in women with a lower education level and lower socioeconomic status, women who have
of time. During the decision-making process, directors have to clearly identify the problem they want to solve, be very         been displaced as a result of the Colombian armed conflict, and women who work in the informal sector of the economy.
clear as to what they want to achieve, define all controllable or uncontrollable factors that could influence the decision      Additionally, 12% of women of fertile age who have been married or had a partner at some time have been raped by their
they make, identify the best alternatives by studying them in detail, and then apply the properly selected solutions.           husband or partner. Health problems, a history of abortion or miscarriage, a history of other types of family violence
                                                                                                                                (verbal, psychological, or physical), and variables related to poverty are closely linked to sexual violence.
Purpose: This whole process cannot be carried out without accurate, relevant, valid, reliable, and timely information
about the situation. This information will enable the executive to clearly and precisely identify the problem he or she         Conclusion: According to the results obtained in this study, sexual violence is a serious public health problem in
is trying to solve, the best solutions that can be applied, and the possible consequences of applying them. For all the         Colombia, affecting many women. It is driven by many factors operating in a range of social, cultural, economic, and
required information to be available, there is a need for an adequate, effective information system: a set of items and         health contexts. However, there is a great need for more research on all aspects of sexual violence. Of equal importance
elements that interact with each other in order to support the different activities of a program or organization. This          are appropriate interventions supporting and assisting the victims. It is vital to develop those interventions, including for
system should provide service statistics, measured against previously identified and defined indicators, about the              resource-poor settings, and to evaluate them rigorously. Health professionals have a large role to play in supporting the
activities that are carried out. These statistics should be gathered, processed, and analyzed systematically.                   victims of sexual violence, including by collaborating with the judicial system.

Methods: The purpose of this presentation is to introduce participants to the Profamilia information system, specifically:
definitions of information system data versus information, how data can be transformed into information, objectives of
information, information characteristics, information systems, a process definition of evaluation, evaluation stages, the
                                                                                                                                Sexual and Reproductive Health in Marginal Areas:
cost of evaluation, and the use of information within Profamilia.                                                               The Situation of Displaced Women in Colombia
Findings: The lack of valid and timely information leads to data that cannot be compared, differences that have no              Gabriel Ojeda
explanation, unmanageable files, and information that cannot be used.
                                                                                                                                Profamilia
                                                                                                                                E-mail: Gojeda@profamilia.org.co
Conclusion: Every sexual and reproductive health program or project requires an adequate information system to be
used in the decision-making process in order to reach its objectives and goals.
                                                                                                                                Background: The internal conflict in Colombia is a multi-party struggle involving drug barons, guerrilla movements,
                                                                                                                                and paramilitary groups. The power and military capacity of these groups have increased in recent years, resulting in the
                                                                                                                                intervention of armed forces. This has led to the most horrifying massacres, assassinations, and terrorist attacks, and the
Sexual Violence in Colombia                                                                                                     situation has forced entire populations to migrate to save their lives. They generally move to urban areas, leaving behind
                                                                                                                                their homes, and losing what little they had. It has been estimated that somewhere between 2,500,000 and 3,000,000
Gabriel Ojeda                                                                                                                   people are displaced under precarious conditions, living in poverty and misery.
Profamilia
E-mail: gojeda@profamilia.org.co
                                                                                                                                Purpose: Recognizing this situation, Profamilia carried out, with international support from USAID, the Sexual and
                                                                                                                                Reproductive Health Services National Program between October 2000 and May 2005, aimed at offering information and
                                                                                                                                services to people in marginal areas, especially displaced persons. At the same time, a development and impact study was
Background: It has been recognized that violence, especially against women and young girls, is one of the most
                                                                                                                                designed, as was a quasi-experimental pre- and post-study of a single group.
important aspects of sexual and reproductive health to be considered by health programs due the negative effects it
has on the victims, particularly on their physical and mental health. The 2005 National Demographic and Health Survey
(ENDS-05) is the fourth in a series of surveys that Profamilia has been carrying out every five years since 1990. Its
                                                                                                                                Methods: The conditions of women living in marginal areas were identified from the results of the first Sexual and
                                                                                                                                Reproductive Health Survey in Marginal Areas from January 2001. Using a representative sample of women between
general objective is to gather and analyze information about demographic and health matters related to the Sexual
                                                                                                                                the ages of 13 and 49, with both national and regional representation, this survey analyzed family composition, living
and Reproductive Health Policy of Colombia’s Ministry of Social Protection (Health). It is a national coverage survey,
                                                                                                                                conditions, General Social Security Health System affiliation, knowledge and use of contraceptive methods, knowledge of
representative of urban and rural areas, in six regions, sixteen sub-regions, and each Colombian state (department) on an
                                                                                                                                and attitudes about HIV/AIDS and sexually transmitted infections (STIs), knowledge of HIV and STI prevention, knowledge
independent basis. One of the specific goals is to estimate the levels of the different types of violence perpetrated against
                                                                                                                                and prevalence of pap smears and breast examinations, prenatal care, and family violence. Women displaced due to the
women and children.
                                                                                                                                armed conflict were asked how long they had been in the town where the interview took place, whether they had reported
                                                                                                                                their displacement condition, what their accreditation status was, what their knowledge of support entities was, and
Purpose: The main purpose of this study was to develop a deep analysis of the socioeconomic characteristics of women
                                                                                                                                what humanitarian assistance they had received. The second survey was conducted in December 2005, using exactly
who had been raped by their husbands or partners, or by someone else, and also to identify some of the endogenous and
                                                                                                                                the same methodology and indicators, but in different households. Information was obtained about the same variables
exogenous factors related to this phenomenon, using the ENDS-05 data.
                                                                                                                                that were measured in 2001, allowing comparison between the first and second surveys, and additionally, some aspects
                                                                                                                                of gender-based violence were studied in depth. In order to establish whether the changes detected were significant or
                                                                                                                                not, a null hypothesis was tested for each indicator. One-way analysis of variance was used to test the hypotheses, using a
                                                                                                                                significance level of 90%. The most important differences were identified.

58          RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                             RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                 59
Findings: The results show significant changes in certain variables, but due to the large increase in the number of           Perceptions and Experiences of Women with Abortion Complications
displaced persons in Colombia, this change did not occur across all indicators.
                                                                                                                              Within the Post-War Context of South Sudan: Preliminary Results
Conclusion: The Sexual and Reproductive Health Services National Program must be emphasized in the marginal areas
in order to have a real and significant impact.                                                                               Monica Adhiambo Onyango
                                                                                                                              Boston University
                                                                                                                              E-mail: monyango@bu.edu
Challenges of Maintaining Human Resources to Address
                                                                                                                              Background: Emerging from decades of war, abortion complications are some of the most significant reproductive
Reproductive Health in Emergency Situations                                                                                   health problems affecting women in South Sudan. On average, three to five women with abortion complications are
                                                                                                                              admitted daily at the region’s major health facilities.
Pius Okong
Association of Obstetricians and Gynaecologists of Uganda                                                                     Purpose: The purpose of this research is to explore and describe the perceptions and experiences of women who have
Uganda Christian University                                                                                                   experienced an abortion complication (spontaneous or induced) within a post-war context of South Sudan.
International Federation of Gynecology & Obstetrics
Email: pio_okong@yahoo.co.uk                                                                                                  Methods: A qualitative descriptive method of inquiry will be utilized to collect data via in-depth interviews. Women 18 to 49
                                                                                                                              who have experienced abortion complications and have received treatment will be eligible. Other eligibility criteria include
Background: Conflict is a common occurrence in Sub-Saharan Africa, in the very countries and settings where the               women 18 to 49 years of age who have verbally consented to the interview. A purposive sampling technique using maximum
burden of maternal morbidity and mortality is excessively high. Due to the social disruption caused by conflict, collection   variation will be employed to select participants for the study. Interviews will be conducted until data saturation is realized.
of comprehensive information on reproductive health (RH) needs and human resource needs, which must be addressed in           The study location is the gynecology ward, Yei County Hospital in South Sudan. To enhance rigor and trustworthiness,
order to implement urgent RH services in such settings, becomes a key challenge. Health workers experience the                qualitative frameworks utilized will include authenticity, credibility, criticality, integrity, transferability, and dependability.
same threat to their lives as the ordinary citizens. A common reaction among those who are in place is to flee
from areas of conflict.                                                                                                       Findings: Preliminary findings from this study will be reported at the conference.

Purpose: To explore the human resource challenges with regard to provision of RH services in conflict situations              Conclusion: Findings from this study will facilitate the design and implementation of appropriate nursing-led, integrated
including: retention of existing health workers with the necessary skills to meet emergency RH needs, recruitment of new      programs to manage and prevent abortions; contribute to shaping reproductive health policy during this reconstruction
staff, provision of ongoing, supportive supervision, arrangement of adequate coverage, and delivery of quality care.          phase; and form a basis for future scientific studies on reproductive health issues in South Sudan.


Methods: A case-study, using the example of northern Uganda.
                                                                                                                              Access to Sexual and Reproductive Health Services by Internally Displaced
Findings: Drawing from our knowledge of the conflict in Uganda, we have noted that those who remain in conflict areas
often lack the skills or commodities necessary to provide RH services. These include basic RH services such as provision
                                                                                                                              Persons in Kitgum and Pader Districts, Northern Uganda
of contraception, treatment of sexually transmitted infections, provision of skilled attendance at birth, and care of
newborns. Specialized relief service providers such as the Red Cross and Médecins Sans Frontières (MSF) are often more        Christopher Garimoi Orach
likely to be seen in these settings than health care professional associations or societies. In northern Uganda, a region     Makerere University School of Public Health
which has experienced conflict for more than 20 years, individual members of the Obstetrics and Gynecology Society            E-mail: cgorach@musph.ac.ug
have continued to actively contribute to work on the ground. They have received support not only from the government
but also from other members of the profession in the form of visits and training. However, these efforts by Ugandan           Background: Since the mid-1990s, Uganda has had an estimated 1.6 million internally displaced persons (IDPs) in camps,
health workers to provide care in emergency situations were hampered by lack of emergency preparedness among health           mostly from the Acholi sub-region, Kitgum and Pader district in northern Uganda.
care professionals. Other humanitarian settings have seen similar human resource contributions. Following the massive
earthquake in Pakistan, members of the Obstetrics and Gynecology Society organized provision of emergency RH services         Purpose: We explored the perceptions of, and evaluated access to, sexual and reproductive health services by IDPs.
among displaced communities.
                                                                                                                              Methods: We interviewed 1,383 respondents randomly selected from 35 of 67 camps in Kitgum and Pader districts
Conclusion: There is often little networking with other organizations working in conflict situations to integrate RH into     (northern Uganda) during March 2007. Nine hundred sixty-eight (70%) of the respondents were adults, and 415 (30%) were
their activities or to enhance the work of health care professionals. Health care professional associations or societies      adolescents; 60% were females and 40% males. We held 52 focus group discussions and interviewed 27 key informants.
should therefore have a small group of persons responsible for emergency preparedness. These members should be
trained in emergency RH care and work to develop systems to quickly respond to human resource needs within the                Findings: We found that most IDPs (78%) live within a five-kilometre distance of a health facility. The majority (70%)
country by creating a database of national health care professionals who are trained to work with conflict-affected           seek health care from public health facilities, while others (21.9%) go to either private not-for-profits (PNFP) or private
populations in emergency situations.                                                                                          health facilities. Main determinants of health care utilisation are proximity (29.6%), free treatment (22.7%), and
                                                                                                                              availability of drugs (17.7%). Most respondents (82.6%—86.1% men compared to 79.1% women) have received information
                                                                                                                              about HIV/AIDS. However, 44% did not know about the availability of condoms in their camps. The majority (72.7%—77.3%
                                                                                                                              women compared to 68.5% men) consider domestic violence common in the camps. Two-thirds of the respondents
                                                                                                                              (68.5%—71% males and 65.9% females) are satisfied with the care they receive at the health facility.




60          RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                            RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                    61
Conclusion: Most IDPs live in close proximity to and seek care from public health facilities. Most IDPs have been                Increasing Access to Reproductive Health Services in Emergencies
sensitised to HIV/AIDS and perceive gender-based violence as common in the camps. Our findings suggest the need to
strengthen community sensitisation and the capacities of existing first-line health facilities to deliver quality reproductive
                                                                                                                                 Through Partnerships in the Philippines
health services in these settings.
                                                                                                                                 Amado R. Parawan
                                                                                                                                 Save the Children USA
Impact of Training Community-Based Health Workers on the Use of the                                                              E-mail: docmads@pacific.net.ph

Partograph on Maternal and Perinatal Mortality and Morbidity in a Post-Conflict,
                                                                                                                                 Background: Save the Children (SC) has responded to various crisis situations in the Philippines, where its program
Resource-Constrained Setting                                                                                                     areas are located: in war-affected Mindanao (since 2002), Luzon flash floods (2004), Leyte landslides (2005), and
                                                                                                                                 typhoon-hit Luzon (2006). Since the National Disaster Coordination Council and Department of Health have limited
Ernest Orji1, Adesegun Fatusi2, Babalola Adeyemi1, Niyi Makinde1, Uche Onwudiegwu1                                               reproductive health (RH) coverage in the areas affected by crisis, SC has been working to increase access to RH
1 Department of Obstetrics and Gynaecology, Obafemi Awolowo University, Ile-Ife, Nigeria                                         services through partnerships.
2 Department of Community Health
E-mail: eoorji11@yahoo.com                                                                                                       Purpose: SC partnered with the community, government agencies, non-governmental agencies (NGOs), and donors
                                                                                                                                 to deliver RH services through integrated health, education, and emergency response programs during the immediate,
Background: Obstetric emergency from mismanaged labour is the major cause of maternal deaths in Nigeria. The                     transition, and rehabilitation phases of disasters in the Philippines. The aim of the partnerships was to increase access and
partograph may be an effective tool in preventing mismanaged labour, thereby reducing maternal deaths from obstetric             sustain RH services, mainly family planning (FP), for disaster-affected communities.
emergencies. Training health workers in partograph use may reduce obstetric emergencies.
                                                                                                                                 Methods: Since 2002, SC has partnered with national and international agencies to build capacity and establish
Purpose: To determine the effect of the introduction of the partograph on obstetric emergencies, such as prolonged               effective coordinative systems. These partnerships included partnership with regional and provincial officials that
obstructed labour, augmented labour, and operative delivery. This will determine if appropriate intervention based on            ensured provision of micronutrient supplements and family planning services and coordination with the Regional
the partograph will reduce fetal and maternal complications. It will also determine the effectiveness of training lower          Disaster Coordination Council and Departments of Health and Education. These partnerships, as well as the municipal
categories of health workers in its use.                                                                                         local government units (LGUs) and networks, were key to facilitating the training on Sphere standards and to integrating
                                                                                                                                 RH supplies in contingency plans. In 2007, SC advocated for the inclusion of RH services (maternal and child health, FP,
Methods: The study was set in delivery facilities in the war-torn Ife/Modakeke zone of southwest Nigeria. The zone               violence against women, reproductive tract infections) through the Health Cluster during disaster response. A schedule of
contributes the bulk of obstetric emergencies to the university teaching hospital. The study population consisted of             regular meetings with partners was a good approach to sustain RH support and coordination.
health workers undertaking the delivery of pregnant women in the zone. The entire population of nurse/midwives and
Community Health Extension Workers involved in the delivery facilities were trained. The intervention instrument is the          Findings: We achieved an increase in beneficiary numbers: coverage increased to 514,000 in 2007 from 97,000 in 2001.
partograph, produced according to the World Health Organization (WHO) guidelines. This experimental design compared              Surveys in rehabilitated communities revealed an increase in the availability of FP supplies. LGUs have preparedness plans
pre- and post-intervention measurements. Outcome measures included maternal and perinatal outcome, as well as                    and have increased the budget for micronutrient supplements, contraceptives, and capacity building. SC’s integration
obstetric emergencies arising from obstructed labour, prolonged labour, and augmented labour.                                    strategy has been recognized by the Philippine government and the Health Clusters.


Findings: Data on labour outcome for 242 labouring women who fulfilled the inclusion criteria were collected prior to            Conclusion: A partnership model is feasible for an emergency response in disaster-prone countries like the Philippines,
and after the training of 55 health care workers in the use of the partograph. After the introduction of the partograph,         as demonstrated by SC in the Philippines, and could result in increased program reach and coverage. Partnering at
there was an increase in detection and early transfer of obstetric emergencies (p=0.013), but a reduction in the duration        different levels unites key players (government agencies, United Nations [UN], donors) and local stakeholders (children,
of labour (p=0.0001), obstructed labour (p=0.0001), postpartum haemorrhage (p=0.0040), genital sepsis, and perinatal             parents, health providers, teachers, communities, NGOs, networks, LGU officials) around sustained delivery of RH services
mortality. There was also an improvement in neonatal Apgar scores at one and five minutes (p=0.0001). Though                     in emergencies, and during the transition and rehabilitation phases of disasters. Emergency response programs can use
augmentation of labour increased and caesarean section rates decreased following partograph use, there was no                    coordination, partnerships, and the recent UN Clusters approach to successfully provide RH services during emergencies,
significant difference. There were two maternal deaths and one uterine rupture before the introduction of the partograph,        thereby increasing the access to services and improving health outcomes and disaster preparedness.
but none after the partograph introduction. The introduction of the partograph reduced the incidence of obstetric
emergency arising from labour management and also improved the outcome of those developing emergencies.
                                                                                                                                 Tracking Official Development Assistance for Reproductive Health in
Conclusion: Introduction of the partograph in maternal units in Nigeria reduced the incidence of obstetric emergencies
arising from labour complications, with a resultant reduction in maternal and perinatal mortality and morbidity. The
                                                                                                                                 Conflict- and Crisis-Affected Countries
immediate strategic practical approach to reduce maternal deaths is the use of partograph in labour management. Training
community-based health workers in a post-conflict environment in the knowledge and use of the partograph as a tool in            Preeti Patel1, Sam Guy2, Bayard Roberts1, Louise Lee-Jones2, Lesong Conteh3
labour management is an immediate, practical approach in reducing obstetric emergency arising from mismanaged labour.            1 London School of Hygiene and Tropical Medicine
                                                                                                                                 2 The RAISE Initiative/Marie Stopes International
                                                                                                                                 3 Swiss Tropical Institute
                                                                                                                                 E-mail preeti.patel@lshtm.ac.uk

                                                                                                                                 Background: There is growing recognition that conflict- and crisis-affected countries receive less international aid
                                                                                                                                 than other low-income countries, despite their considerable disease burden. This particular group of countries is often
                                                                                                                                 characterised by deteriorating socio-economic conditions and weak governance, and progress towards achieving the UN
                                                                                                                                 Millennium Development Goals (MDGs) is slow. Although reproductive health (RH) is viewed as a “quick win” to achieving


62          RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                             RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                63
the MDGs, overseas development aid (ODA) for RH in these countries is thought to be inadequate. At the same time, little       pregnancies, abnormal lie of the baby, and short stature were not honoured because of the previous experiences of
evidence exists on funding patterns. The development of methodologies to analyse ODA distributed for RH is essential for       pregnancy outcome after referral. Previous abdominal delivery and bigger abdomen than normal in underage women
a more informed understanding of reproductive health funding patterns and to help advocate for improved resources in           are elective referrals, for which the community agrees to go to the hospital. The hospitals were seen as providing an
conflict and crisis countries.                                                                                                 acceptable quality of care, whereas the health centres had lower quality than expected.

Purpose: To research the methodological feasibility of calculating the amount of ODA allocated to RH in conflict and           Conclusion: There is a need to develop local, evidence-based guidelines to improve maternal referral compliance.
crisis countries, and to then analyse donor ODA disbursement for RH in conflict and crisis countries in 2005.                  Women’s empowerment and poverty reduction should be addressed within the society to enable women’s active
                                                                                                                               involvement in referral decision-making process. Prospective studies in maternal referrals and auditing of quality
Methods: A literature review and key-informant interviews were undertaken to review methodologies previously                   of care in health institutions are suggested.
used in other health-related financial tracking studies and to review relevant financial tracking databases: the Creditor
Reporting System (CRS); the Financial Tracking System; and the Resource Flows database maintained by the Netherlands
                                                                                                                               Gender-Based Violence and Health:
Interdisciplinary Institute. The CRS was selected for analyses as it was identified as the most reliable source of data. The
CRS was analysed for ODA distributions for RH to 19 conflict- and crisis-affected countries (using the Organisation for        Making Collaboration Work in Emergency Response
Economic Co-operation and Development definition of fragile states).
                                                                                                                               Catherine Leila Poulton
Findings: The literature review and interviews identified the CRS as the single best source of data, despite a number of       International Rescue Committee
limitations. The database provides development and humanitarian funding data from 22 high-income countries, the major          E-mail: catherine.poulton@theirc.org
development banks, and multilateral donors. Preliminary analysis suggests that a total of $34,519 million in ODA was
disbursed in 2005 to the 19 conflict and crisis countries. Of this, approximately 2% was allocated to RH. Of funds
                                                                                                                               Background: Recent violence in the Central African Republic (CAR) between rebel groups and the military has
allocated to RH, only 2% were explicitly for family planning activities, compared to over 40% for sexually
                                                                                                                               had disastrous effects on the population. Particularly, women and girls have been targeted, as demonstrated by the
transmitted diseases including HIV/AIDS.
                                                                                                                               International Rescue Committee’s (IRC) data showing a clear correlation between rape and conflict.

Conclusion: This study improves methodological understanding of ODA disbursal patterns for RH to support more                  Purpose: Given the context and following a needs assessment, the IRC’s gender-based violence (GBV) program was
effective use of ODA to meet the RH needs of people in countries affected by conflict and crisis.                              established, along with the IRC’s health program, to respond to the immediate, life-threatening consequences of rape.
                                                                                                                               IRC established essential, quality health services (implementing the WHO protocol for clinical management of rape) and
                                                                                                                               psychosocial services for rape survivors.
Qualitative Study on Maternal Referrals in Rural Tanzania:
                                                                                                                               Methods: Launched in April 2007, the IRC’s GBV and health programs successfully worked in symbiosis to establish,
Decision-Making and Acceptance of Referral Advice
                                                                                                                               within two weeks, confidential quality services for rape survivors. This includes the intake, the medical examination,
                                                                                                                               access to all necessary medication (post-exposure prophylaxis [PEP] including emergency contraception and treatment
Andrea B. Pembe1, David P Urassa2, Elisabeth Darj3, Anders Carlstedt3, Pia Olsson3                                             for sexually transmitted infections) and psychosocial support. By June 2007, over 30 survivors a day were receiving
1 Department of Obstetrics and Gynaecology, School of Medicine, Muhimbili University of Health and Allied Sciences             medical services. Eight months later, 1138 survivors had been treated, including PEP for 20 of them. Through careful
2 Department of Community Health, School of Public Health and Social Sciences, Muhimbili University of                         monitoring, the GBV and health coordinators maintained dialogue and collaboration between their teams and provided
Health and Allied Sciences                                                                                                     on-the-job training for their staff for whom such work was new.
3 International Maternal and Child Health, Department of Women’s and Children’s Health, Uppsala University, Sweden
E-mail: andreapembe@yahoo.co.uk                                                                                                Findings: Prior to IRC’s program, rape in CAR had not been addressed by the existing humanitarian response, and
                                                                                                                               was not considered a problem, even in the conflict-affected areas. Lack of awareness on rape in conflict, added to cases
Background: In Tanzania, the maternal mortality rate is still high, despite antenatal care attendance of more than 90%.        not identified in hospitals, meant that a great number of survivors’ needs remained unmet. A major finding from this
An action-oriented antenatal card is used in determining when to refer a woman for additional services. An efficient           intervention is that survivor-centered programming, which emphasizes confidentiality, female staffing, and informed
referral system is crucial to the reduction of maternal mortality.                                                             consent, is essential for survivors to feel confident to come forward. IRC’s outreach efforts, which involved disseminating
                                                                                                                               key messages about sexual violence, contributed to informing survivors on risks and how to access services. This
Purpose: The aim was to describe perceptions of maternal referrals within the community and among health staff in              intervention also illustrated how health and GBV programs must work closely together to establish efficient, confidential,
the rural district. The specific objectives were to describe the process of decision-making in seeking care for maternity      and comprehensive services to respond to sexual violence. Even in emergencies, quality services can be established.
problems and to identify factors that influenced acceptance of referral advice from health workers.                            The intervention illustrated that if the focus is on survivors’ well-being and the complementarity of the health and GBV
                                                                                                                               programs, comprehensive care can be provided.
Methods: Focus group discussions (FGDs) were used to collect data. Ten FGDs were held: two with health workers (N=11),
in two rural health centres (RHCs); and eight with community participants (N=85), from one village nearest to each RHC.        Conclusion: IRC’s experience in CAR illustrated that quality health and psychosocial services for survivors can be set
The community participants were stratified by age and gender. The FGD size ranged from 5 to 12 participants. Swahili           up extremely quickly in emergency settings. Implementing these requires an intimate collaboration between the health
language was used in all sessions. All FGDs were audiotaped. One tape was excluded from the analysis due to a                  and GBV teams, but this cannot be done without a GBV program focused on extremely targeted information sharing
 recording defect. Thus, nine FGDs were analysed using qualitative content analysis method as described by                     and trust-building.
Graneheim and Lundman, 2004.

Findings: The study revealed that women had limited influence in the process of decision-making, especially on
emergency referral arrangement. In emergency referrals, the husband, parents of both sides and other relatives decide
whether or not, and where, to seek care. They did their own risk calculation of referral advice according to their previous
pregnancy experiences. The unreliability and high cost of transport during emergency referrals and living expenses at
the referral hospital hindered referral acceptance. In most elective referrals, first pregnancy, young age, five or more

64          RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                           RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                65
Whose Choice? Results of a Survey of Knowledge, Attitudes, and Practices                                                         Methods: Active TBAs from the 2003–2004 study identified women from the same intervention and control villages
                                                                                                                                 who delivered between August 2004 and May 2007, irrespective of PPH status; 950 women completed questionnaires
About Abortion with Program Managers and Policymakers Working in Crisis                                                          retrospectively assessing their most recent birth outcomes, knowledge of PPH, acceptability of misoprostol for
Settings in Nine African Nations                                                                                                 prevention; among users, women assessed the safety, feasibility, and acceptability of misoprostol for home births. We also
                                                                                                                                 conducted five focus group discussions and 31 in-depth interviews with women, TBAs, community leaders, and nurses.
Bill Powell, Tamara Fetters
                                                                                                                                 Findings: Significantly more women were referred for excessive bleeding in the control area [n=21 (4.2%)] than in the
Ipas                                                                                                                             intervention area [n=6 (1.4%)] (p<0.05). TBAs made the majority of referrals in both areas. Among all misoprostol users
E-mail powellb@ipas.org                                                                                                          (n=161), two required additional interventions due to PPH (1.3%). Some 58% of users, compared to a third of non-users,
                                                                                                                                 experienced side effects, commonly fever and shivering. Side effects were transient and managed at the household
Background: Conflict-affected women and families often lose access to their own health systems, support mechanisms,              level. No woman was referred due to side effects of misoprostol. Acceptability of misoprostol was reportedly high: 86%
and local knowledge that helps them control their own fertility. Empowering women to make their own decisions includes           were willing to purchase misoprostol, with many (39%) willing to pay USD 1.20 for misoprostol. Qualitative interviews
providing contraceptive information and services, access to emergency contraception, and pregnancy termination                   revealed insights into the perceived barriers to facility births, and the need for community-based education and access
where it is legal.                                                                                                               to misoprostol. Nurses at the referral hospital perceived a reduction in PPH-related referrals since the introduction
                                                                                                                                 of misoprostol at the community level and cited positive externalities of minimizing already burdened staff time and
Purpose: The purpose of this survey is to examine the current knowledge, attitudes, and practices of implementing                minimizing the cost of care received at the facility for women. This was repeated in focus groups and in-depth interviews
partners providing reproductive health services in the African countries host to most of the continent’s conflict-               with TBAs and community leaders.
affected people.
                                                                                                                                 Conclusion: We strongly recommend use of misoprostol tablets at the community level in resource-poor areas for
Methods: A survey examining the knowledge, attitudes, and practices regarding the abortion law and abortion services             the control of PPH; expanded trainings of frontline healthcare workers on misoprostol for PPH treatment; and accurate
provided in conflict and post-conflict settings is currently under way. Respondents include policymakers and program             information, education, and communication campaigns. TBAs as educators and suppliers of misoprostol are an underused
managers working in or with conflict-affected populations residing in nine African countries. Each of the nine countries in      resource in communities.
the study was selected because the country’s penal code allows abortion for some legal indication(s).

Findings: Information on abortion or even unwanted pregnancy in refugee and internal displacement settings is virtually
                                                                                                                                 Unmet Need for Abortion Services:
absent in the searchable literature. Results of this survey will demonstrate the level of awareness of program managers
regarding the host country law relevant to abortion. Information on formal and informal access to safe abortion services is      The Case of Internally Displaced Women of Angola
being elicited to determine whether communities and/or healthcare providers have established means to provide abortion
services or inform women of their right to a safe termination. Finally, attitudes regarding demand for safe abortion, and        Ndola Prata, Malcolm Potts
individual perceptions to barriers in establishing safe abortion services to the full extent of the law, have been explored to
                                                                                                                                 University of California, Berkeley
provide insight into the necessity for and potential barriers to establishing safe abortion services.
                                                                                                                                 E-mail: ndola@berkeley.edu

Conclusion: Each of these countries permits terminations of pregnancy for some legal indications. In such cases,
                                                                                                                                 Background: Angola was ravaged by a civil war from 1975 to 2002. The country has a population of almost 14 million and
governments and implementing partners have an obligation to ensure that such services are safe and accessible. For
                                                                                                                                 has an estimated four million internally displaced persons (IDPs).
refugee women, it is almost impossible to exercise these rights, although they are accorded to them under national
and international laws and human rights documents. Barriers to safe abortion services exist at all levels and require a
                                                                                                                                 Purpose: This paper describes the journey of Angolan IDPs in need of safe abortion services and the challenges these
thorough exploration of knowledge and practice in order to make recommendations that ensure equitable access to care.
                                                                                                                                 women face. The roles of local service providers, relief organizations, and donors will be discussed.

                                                                                                                                 Methods: We use data from demographic and reproductive health surveys of IDP women in Angola.
Misoprostol at the Community Level:
A Feasible Postpartum Hemorrhage Treatment Option Over the Long Term?                                                            Findings: Demographic and reproductive health profiles of more than 2,000 IDP women of reproductive age show that
                                                                                                                                 69% have experienced some form of sexual violence. Of those, 21% reported being sexually assaulted more than once.
                                                                                                                                 IDP women are one of the most vulnerable groups in Angolan society, with a high unmet need for safe abortion services.
Ndola Prata
                                                                                                                                 In Angola, abortion is highly restricted, only permitted by law to save a women’s life. Pregnancy termination procedures
Venture Strategies for Health & Development                                                                                      frequently take place in homes, often using traditional medicine in the form of plant roots or mechanical instruments.
E-mail: NPrata@venturestrategies.org                                                                                             This puts women’s lives at risk, and is a major factor in the country’s maternal mortality rate, which, at 1,700 deaths per
                                                                                                                                 100,000 live births, is one of the highest in the world. Most public health facilities in Angola are ill-equipped to provide
Background: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide. Misoprostol tablets                life-saving care to the victims of these unsafe procedures.
are a stable, low-cost, and effective PPH treatment ideal for resource-poor settings. In 2007, Tanzania registered
misoprostol for PPH, portending expansion of its use countrywide.                                                                Conclusion: Results show the need for health care providers to screen women for possible rape, and to provide care,
                                                                                                                                 including safe abortion, according to the specific needs of patients. National and international organizations need to work
Purpose: In a 2003 intervention trial in Kigoma, Tanzania, we demonstrated that traditional birth attendants (TBAs)              together to increase access to the full range of reproductive health services to IDPs, especially women.
could safely and effectively diagnose and treat PPH with 1000µg of misoprostol rectally. These communities are unique
in that they have continued to use misoprostol outside a study-controlled environment. We present results from a study
evaluating the long-term, community-based use of misoprostol to treat PPH.




66          RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                              RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                67
Access to Comprehensive Health Services for Internally Displaced Persons                                                           Methods: LAM was integrated into a USAID-funded project as part of a range of family planning methods with a six-
                                                                                                                                   month cohort target of 4,723. The initiative promoted the mother/child pair by training peer educators and encouraging
                                                                                                                                   equal opportunities for men and women to be engaged in family planning decisions. Localized information campaigns
Andrés Quintero
                                                                                                                                   including radio and plays, as well as capacity-building with local leaders and community volunteers, have fostered the
Profamilia—Asociación Pro Bienestar de la Familia Colombiana                                                                       creation of space for community discussion and an opportunity to raise awareness of LAM as a first step in uptake of
E-mail: aquintero@profamilia.org.co                                                                                                family planning.

Background: For the past 40 years, the internal conflict in Colombia has involved the civil population in the crossfire
                                                                                                                                   Findings: Programmatic results included: 448 peer educators trained in seven months, 15 theatrical productions in six
between guerrillas, paramilitaries, and the army. Colombia has the world’s second-largest population of internally
                                                                                                                                   months, 19 trainers trained, 127 healthcare providers trained, and 4,460 (94.4% of cohort one) meeting LAM criteria.
displaced persons (IDPs), some 2,000,000 to 3,000,000.
                                                                                                                                   The initiative has contributed to gender equity through the inclusion of joint decision-making between husband and wife,
                                                                                                                                   which has also lead to greater community support of family planning. Additionally, mothers practicing LAM have noted a
Purpose: The program was originally designed to offer good access to sexual and reproductive health (SRH) services
                                                                                                                                   reduction in incidence of illness while exclusively breastfeeding. Exclusive breastfeeding has also resulted in savings that
to IDPs, who are generally marginalized from health services, as most are not affiliated with the national health security
                                                                                                                                   have been applicable towards the increased food consumption of the mother. High acceptance of LAM was reported in
system. Since 1998, Profamilia has offered a more comprehensive package of services, including basic health care.
                                                                                                                                   women after birth because it is an easily accessed method which does not require sourcing medications or use of surgical
Methods: Our community workers identify and visit the different IDP settlements. Then, in coordination with community              interventions. The LAM method is also not restricted by culture or religious beliefs. Availability and acceptance of LAM has
leaders, educational activities are scheduled. During those activities, people have the chance to hear about the project as well   contributed to increased uptake of modern family planning.
as to learn about their SRH and sexual and reproductive rights and to remove their doubts. The community worker offers an
individual assessment, if needed. This first contact with the community allows evaluation of existing health needs and also        Conclusion: LAM has resulted in fostering greater community engagement in family planning practices; providing
supports the programming of the Mobile Health Brigade (MHB). The Profamilia MHB mobilizes medical doctors, nurses, and             nutrition benefits to both infant and mother pairs by improving maternal food access; reducing illness in infants; and
equipment to remote locations and offers health services, including contraceptives and medicines, where needed.                    protecting the mother against unwanted pregnancies in a culturally feasible manner.


Findings: Because of the overcrowded settlements, IDPs’ living conditions are very precarious, with a lack of resources —
and in some cases, remote locations in the jungle — making their health situation critical. At the beginning of the program,       Is Family Planning a Sufficient Intervention for Meeting Reproductive Health Needs?
only SRH services were offered, but it was subsequently found that medical teams sent to remote areas should offer
complementary health services as well. Therefore, the MHB services were increased to provide more comprehensive
                                                                                                                                   Raoza Rafanoharana, Prince Kalenga, Jules Kabombo
service, with medical consultations and distribution of contraceptive methods (three months’ supply) and medicines
prescribed by our doctors. The re-supply after three months was established so that each community could be visited                CARE Democratic Republic of Congo
four times per year. This allows time to monitor the results and has helped to create a strong commitment from the                 E-mail: rrafanoharana@carerdc.org
community, who have become more responsible regarding their health. Sexual and reproductive surgeries derived from
services are offered as well, but due to the lack of proper installations on site, patients are offered a referral complete with   Background: In 2005, CARE launched a family planning project in three provinces within the Democratic Republic of
transportation back to the community, thereby granting real access to the services needed.                                         the Congo (DRC). The progress which has been achieved reflects actual needs in terms of reproductive health for the
                                                                                                                                   population living in a post-conflict situation. The RAISE Initiative project assumed responsibility within the Province of
Conclusion: It is important to offer access to comprehensive health services that cover the necessities of these                   Maniema in order to offer complete reproductive health services.
vulnerable populations, especially when SRH and sexual and reproductive rights are not covered by the national health
system. The package offered by Profamilia consists of educational talks, individual and group assessment, referral to              Purpose: A basic study of family planning needs was completed in Maniema. The objective was the collection and
reproductive health services including contraceptives and medicines, laboratory exams, and surgeries.                              dissemination of reliable data which would allow development of strategies for advocating on behalf of reproductive
                                                                                                                                   health, as well as identification of activities needed in order to provide better reproductive health services.

                                                                                                                                   Methods: The survey covered 10 health care areas within four territories in the southern portion of Maniema. Questions
Uptake of the Lactational Amenorrhea Method in West Kasai Province,                                                                were organized according to three topic areas: knowledge and practices in relation to family planning, sexual violence, and
Democratic Republic of Congo                                                                                                       intention to contribute financially to the health care system. We used a combination of research methods incorporating a
                                                                                                                                   survey of the population, as well as semi-structured focus group discussions through which to explore family planning issues
Raoza Rafanoharana1, Riziki Saleh Salama1, Usseni Mushabaa1, Ann Hudacek2,                                                         in greater depth. A sample of 599 households was selected, and 981 women and 588 men aged 15 to 49 were surveyed.
Mary Lung’aho3, Abigail Beeson3
                                                                                                                                   Findings: The average age of the women being surveyed was 28 years, and they had undergone an average of five
1 CARE Democratic Republic of Congo                                                                                                pregnancies. Women cited having between seven and eight children as an ideal family size, while men cited 10.5 children.
2 Independent Consultant                                                                                                           The average interval between births is 24 months. The contraceptive prevalence rate (all methods) is 5.7% for women and
3 CARE USA                                                                                                                         9.2% for men. Within this subset of women (n=56), 27.7% reported use of a modern method. Men are generally in favor of
E-mail: abeeson@care.org                                                                                                           use of family planning (75%), and even though there is a desire to have many children, women hope to space births and
                                                                                                                                   to avoid unwanted pregnancies. A midway evaluation revealed a considerable increase in respondents who know where to
Background: West Kasai Province, in the southwestern Democratic Republic of Congo boarding Angola, has suffered                    obtain family planning services (from 34% to 62% for women and from 44% to 77% for men). The number of women who
both food insecurity from continued conflict in the country’s east and challenges to its health care system, which have            expressed a desire to space births (two years) increased from 24% to 32%.
been complicated by recent outbreaks of Ebola.
                                                                                                                                   Conclusion: Family planning alone is not sufficient to meet reproductive health needs. It is necessary to place activities
Purpose: To use the lactational amenorrhea method (LAM) to provide an action-oriented, harmonized approach                         for emergency obstetric care and medical responses to sexual violence at the forefront, as well as improving information
through behavior-change communication strategies for the improvement of infant and young child feeding and                         and access for modern family planning methods (temporary and permanent). Hence CARE is working to link family
related maternal health.                                                                                                           planning services with a comprehensive reproductive health program.


68           RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                               RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                  69
Mifepristone and Misoprostol: The Promise of New Reproductive                                                                Findings and Conclusion: Misoprostol has the potential to reduce maternal mortality ratios, thereby contributing to
                                                                                                                             the successful achievement of one of the United Nations Millennium Development Goals (MDGs). During this presentation,
Health Technologies in Emergency Situations                                                                                  we will provide an overview of the research on misoprostol for these women’s health indications and discuss how it
                                                                                                                             may be adapted for use in refugee settings. We anticipate that after this presentation, the audience will have a better
Sheila Raghavan, Jennifer Blum, Beverly Winikoff                                                                             understanding of the potential role for misoprostol in transforming reproductive health care in emergencies.
Gynuity
E-mail: sraghavan@gynuity.org
                                                                                                                             Assessing the State Capacity for Operationalizing First Referral Units in Gujarat
Background: Mifepristone and misoprostol are two safe, easy-to-use, orally administered drugs that should be available
for use in emergency settings. Extensive clinical studies and operations research projects have demonstrated their safety
                                                                                                                             Parvathy Sankara Raman, Mudita Upadhyaya, Dileep V. Mavalankar, Bharati Sharma
and efficacy for early pregnancy termination.
                                                                                                                             Indian Institute of Management, Ahmedabad, India
Purpose: To provide a treatment option aimed at reducing unsafe abortion in emergency settings.                              E-mail: parvathy@iimahd.ernet.in


Methods: Gynuity has conducted dozens of studies testing combined mifepristone and misoprostol regimens for early            Background: India is a low-resource setting. There are various management issues and policy barriers for improving
pregnancy termination in a range of settings globally. In this presentation, we will present an overview of the published    maternal health, especially the operationalization of Emergency Obstetric Care (EmOC) services and access to skilled
data on use of these drugs for medical abortion, including dosing regimens, counseling/clinic needs, and the role of         attendants during delivery. Efficient use of resources helps in reducing the maternal mortality ratio.
technology (e.g., ultrasound and BhCG).
                                                                                                                             Purpose: India has made progress in public health over the last 50 years, but progress in the reduction of maternal
Findings: Used together, mifepristone and misoprostol provide a safe, highly efficacious and acceptable alternative          mortality has been very slow. Our study reviews managerial and technical challenges to smooth EmOC service delivery at
to surgery for early first-trimester pregnancy termination. Effective in terminating 92-97% of unwanted pregnancies,         district and state levels.
the method is adaptable to low-resource settings with limited access to ultrasound. Used alone, misoprostol effectively
induces abortion in anywhere from 60 to 90% of cases.                                                                        Methods: This study is part of a larger project for strengthening midwifery and EmOC in India, coordinated by the Indian
                                                                                                                             Institute of Management in Ahmedabad, along with a core group of five Indian and international partners, and supported
Conclusion: These two simple pills have the potential to reduce maternal mortality due to poor abortion care, thereby        by the Swedish International Development Agency (SIDA). We worked with stakeholders such as state government, non-
contributing to the successful achievement of one of the United Nations Millennium Development Goals (MDGs). During          governmental organisations (NGOs), nursing colleges, and various midwifery associations in India and Sweden. A mix of
this presentation, we will provide an overview of medical abortion technologies and discuss how they may be adapted for      primary and secondary data-collection methods was used. The study was conducted in six districts in Gujarat, covering 26
use in refugee settings. We anticipate that, after this presentation, the audience will have a better understanding of the   health facilities in total.
potential role for these technologies in transforming reproductive health care in emergencies.
                                                                                                                             Findings: It was observed that, in spite of having most of the available manpower and infrastructure as per First Referral
                                                                                                                             Unit (FRU) standards, the centers did not perform as expected. Though there is a system of monitoring available at the
                                                                                                                             state and district level, it was not followed appropriately. It was interesting to note, however, that some centers (even in
Misoprostol: A Promising Reproductive Health Technology in Emergency Situations                                              poor resource settings) were able to deliver services with a high patient load. The study also explored cross-cutting issues
                                                                                                                             such as leadership, motivation, and appropriate planning. The study also looked at other important issues like referral
Sheila Raghavan, Jennifer Blum, Beverly Winikoff                                                                             services and skilled birth attendants (SBAs) for delivery.
Gynuity
E-mail: sraghavan@gynuity.org                                                                                                Conclusion: Results of this study can be used to advocate at state and district level top management to develop
                                                                                                                             various mechanisms, which will be used for the monitoring of quality and services, and which, in turn, help in the smooth
Background: Misoprostol is a safe, easy-to-use, orally administered drug that should be available for use in emergency       operationalization of the FRUs for EmOC delivery at community level.
settings. Extensive clinical studies and operations research projects have demonstrated its safety and efficacy for a
range of reproductive health indications, including treatment of incomplete abortion and prevention and treatment of
postpartum hemorrhage (PPH). Unsafe abortion and complications from incomplete abortion are among the leading                “Midwives on Bikes” in Timor-Leste:
causes of maternal mortality. When safe abortion is difficult to access, women are often left to their own devices to
end unwanted pregnancies, leading to frequent incomplete abortions needing additional care. Misoprostol is a valuable
                                                                                                                             An Innovative Approach to Reproductive Health in Crisis
drug in the treatment of spontaneous abortion and in post-abortion care and, in recent studies, has proven to be a
pharmacological alternative to surgery (efficacy > 95%). PPH, a leading cause of maternal death in the developing world,     Jessica Redwood, Melinda Miles-Morela
can be both prevented by and treated with misoprostol.                                                                       Marie Stopes International Australia, in partnership with Marie Stopes International Timor-Leste
                                                                                                                             E-mail: jessica.redwood@mariestopes.org.au
Purpose: To perform a review of available data from studies we have conducted, together with those of other groups.
                                                                                                                             Background: Between 1975 and 1999, approximately one-third of the population in Timor-Leste died during the
Methods: In this presentation, an overview of available published and unpublished data on misoprostol for incomplete         independence struggle. Building a new nation has been challenging, exacerbated by enormous population growth,
abortion and postpartum hemorrhage care will be shared.                                                                      extreme poverty and, from 2006, internal conflict.

                                                                                                                             Purpose: Timor-Leste is experiencing high fertility (7.8) and unacceptable maternal (860/100,000) and infant (64/1,000)
                                                                                                                             mortality rates. Currently, approximately 10% of people are living in internally displaced persons (IDP) camps without
                                                                                                                             access to sexual and reproductive health (SRH) services. To improve the SRH status of remote, vulnerable, and internally
                                                                                                                             displaced people, Marie Stopes International Timor-Leste initiated the “Midwives on Bikes” project.

70          RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                         RH in Emergencies Conference 2008 Proceedings — Book of Abstracts               71
Methods: The “Midwives on Bikes” project has been specifically designed in acknowledgment of the rapidly changing                  The Basic Package of Health Services in Post-Conflict Countries:
economic, political, social, and risk environment of Timor-Leste. It brought SRH education and services door-to-door in the
crisis area, aiming to increase SRH awareness, access to affordable and quality services, and improved capacity to meet            Implications and Challenges for Reproductive Health Services
the target communities’ needs.
                                                                                                                                   Bayard Roberts1, Samantha Guy2, Egbert Sondorp1, Louise Lee-Jones2
Findings: Key findings are: going door-to-door dramatically increases the availability of and access to services,                  1 London School of Hygiene and Tropical Medicine
particularly in an environment of limited populace mobility; even in crisis, maximum outputs for communities can be                2 The RAISE Initiative/Marie Stopes International
achieved with extremely limited resources; by employing comprehensive risk-management strategies, services can be                  E-mail: bayard.roberts@lshtm.ac.uk
provided safely and effectively in conflict and post-conflict settings; in this case, effective client engagement did not hinge
upon indigenous service providers being from the specific district of implementation; and it is critically important to build
                                                                                                                                   Background: A major response to improve health service delivery in post-conflict countries is for the country
trust in communities that have been abused over generations.
                                                                                                                                   government and international donors to jointly contract non-governmental organisations (NGOs) to provide a basic
                                                                                                                                   package of health services (BPHS) to cover the country’s entire population. Current examples include Afghanistan,
Conclusion: This project provides a highly effective model for SRH information and service delivery that can be easily             Southern Sudan, and the Democratic Republic of Congo.
replicated in other emergency contexts with limited resources. With funding, this is a project that can be continued post-
emergency and can expand as rehabilitation and development progresses.
                                                                                                                                   Purpose: To analyse the potential implications and challenges the BPHS contracting approach may have for
                                                                                                                                   reproductive health services.

Comprehensive HIV Prevention as Part of Tsunami Response in Indonesia                                                              Methods: Relevant literature was reviewed on post-conflict health service delivery and the theoretical and empirical
                                                                                                                                   basis of the BPHS. The content of the BPHS in Afghanistan and Southern Sudan were also analysed. Key issues of
Titin Rejeki, Michael Koeniger, Irma Sopamena, Dino Satria,                                                                        availability and quality of reproductive health services, and advocacy activities for reproductive health, were explored.

Hindra Sulaksono, Maurice A. Bloem
                                                                                                                                   Findings: A significant number of key reproductive health services are included in the two BPHS in Afghanistan and
Church World Service, Indonesia                                                                                                    Southern Sudan. However, services addressing sexual and gender-based violence are not included, despite evidence of
E-mail: titin@cwsindonesia.or.id                                                                                                   high rates in both countries. This omission is compounded by the fact that mental health services are not included in the
                                                                                                                                   Southern Sudan BPHS. Specialist information and services for young people is also not mentioned in the BPHS for either
Background: The December 2004 Indian Ocean Tsunami increased the community’s HIV vulnerability, among both the                     country. General health NGOs contracted to provide the BPHS may not have the experience, knowledge, or commitment to
affected population and humanitarian workers who came, largely, from other parts of Indonesia. This was due to the lack            deliver high-quality reproductive health services. In countries following a BPHS approach there may also be very limited
of HIV and AIDS awareness and mobility, both co-factors for HIV transmission.                                                      space and funding available for specialist reproductive health NGOs. This could remove expertise for providing services,
                                                                                                                                   training, and technical assistance. The potential absence of dedicated reproductive health NGOs could also remove
Purpose: Church World Service (CWS) implemented an HIV prevention program as part of its emergency response, to                    an important resource to influence community attitudes, government, and donor policies to advocate for improved
reduce the HIV vulnerability of displaced and disaster-affected people. Staff participated in an AIDS education program.           reproductive health. Concerns also exist that the BPHS contracting approach may restrict NGOs’ ability to criticise
                                                                                                                                   governments or donors and play an effective advocacy role.
Methods: CWS carried out main emergency response activities in livelihood, water and sanitation, health and nutrition,
and psychosocial support in Banda Aceh, Meulaboh, and Nias. These programs were implemented together with local                    Conclusion: The BPHS contracting approach potentially offers an effective and efficient way of rapidly scaling up
community-based organizations, non-governmental organizations (NGOs) and other stakeholders. HIV-related activities                the provision of reproductive health services. However, there are a number of challenges relating to the availability
for disaster-affected people are implemented as an integral part of the main programs through information sessions,                of reproductive health services, quality of services, and advocacy activities. Recommendations are made to non-
campaigns, and other activities. For the humanitarian aid workers, HIV information sessions were delivered as a part               governmental, governmental, and donor actors to help address these challenges.
of the induction session. Provision of condoms and a policy opposing discrimination against HIV-positive people were
simultaneously put into place in each office of CWS.

Findings: Initially, program implementation was difficult, as neither internally displaced persons (IDPs) nor staff viewed         Differences in HIV-Related Behaviors at Lugufu Refugee Camp and
reproductive health and HIV and AIDS as important issues. There were initial difficulties in discussing sexuality as it is still   Surrounding Host Villages
considered a taboo subject by most Acehnese Moslems and Christians from Nias. Approximately 300 disaster-affected
people received information on HIV and AIDS and were enthusiastic about the sessions. At present, disaster-affected                Elizabeth Rowley1, Paul Spiegel1, Godfrey Mbaruku2, Zawadi Tunze3,
people approach CWS and its partners and request similar information sessions. Health cadres in integrated health posts
                                                                                                                                   Marian Schilperoord1, Patterson Njogu1
(posyandu), whose main concern is mother and child health, have also been trained to disseminate information to women
who visit posyandu. Two hundred staff from CWS and partners—from management to support staff levels—have received                  1 United Nations High Commission for Refugees
HIV information and actively disseminate this information to families and friends. Staff and community members have also           2 Ministry of Health, Tanzania
been trained to conduct events related to HIV and spread the message about HIV prevention to a wider public.                       3 Tanzanian Red Cross Society
                                                                                                                                   E-mail: schilpem@unhcr.org
Conclusion: HIV prevention in emergency context should be targeted, not only for the disaster-affected population, but
also for the humanitarian workers themselves. HIV sensitization training is the first step to build awareness because HIV          Background: Research in recent years demonstrates the complex dynamics of HIV infection in conflict-affected settings.
tends to be ignored in emergency situations. Other than information sessions, supporting activities need to be developed,          Various factors unique to refugee and internally displaced populations may lead to an increase or decrease in infection rates.
such as making condoms available and providing sterilized equipment. The Minimum Initial Service Package (MISP) should
be implemented for disaster-affected people—just like other primary aids. The program should be designed with attention            Purpose: This presentation reports key results from the Tanzania HIV Behavioral Surveillance Survey baseline data
to the local context to ensure information acceptance.                                                                             for HIV prevention programs at Lukole and Lugufu refugee camps and surrounding host villages. In addition to standard


72           RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                               RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                 73
questions in HIV behavioral surveillance research, specific questions on population displacement, mobility, networking and     Prevention of Mother-to-Child HIV Transmission Program in
forced sex were included.
                                                                                                                               Tham Hin Camp, Thailand
Methods: This presentation focuses on results from the Lugufu camp and surrounding host villages, where a total
of 1,743 interviews were completed. The research team used systematic sampling in the camp and cluster sampling in             Preeyalak Sataranon, Heri Ntoke
two surrounding villages. All members of selected households between 15 and 49 years old were eligible respondents.            International Rescue Committee - Thailand
Interviewers received a three-day training including practice exercises. Interviews in both the camp and villages were         E-mail: ntoke.heri@theirc.org
carried out in Kiswahili which is spoken by both the Congolese refugees and Tanzanians in the local communities.
                                                                                                                               Background: By the end of 2005, the estimated number of people living with HIV in Thailand was 580,000. HIV
Findings: Results show large differences between the camp and surrounding villages for several important indicators.           prevalence in pregnant women reached a peak of 2.35% in 1995, and had fallen to 1.18% by 2003. In 1999, Thailand’s
Within younger age groups (15-24 years), a larger proportion of never-married refugees had experienced sexual debut            Ministry of Public Health (MOPH) began implementing a national program for prevention of mother-to-child HIV
compared to the surrounding host villages. A greater proportion of camp respondents reported non-regular and/                  transmission (PMTCT). Tham Hin camp is a temporary shelter situated at the border of Thailand and Myanmar. Established
or transactional sex partners than respondents from the surrounding host villages. Although official restrictions on           for refugees from Myanmar in 1997, the camp has a current population of around 7,703. In 2005, the International Rescue
movements in and out of the camp exist, there was fairly regular interaction between communities for at least a third          Committee (IRC) took over from Médecins Sans Frontieres (MSF) the provision of primary health care in the camp.
of both populations, primarily for economic activities. Refugee males were more mobile than females. The majority of
both refugee and surrounding host village respondents who had experienced forced sex within the previous 12 months             Purpose: The purpose is to prevent mother-to-child transmission of HIV in Tham Hin camp.
identified their regular partner as the perpetrator. In both the camp and villages, there was generally high awareness of
where to go for HIV testing, although this was higher in the camp than villages, and more camp respondents than village        Methods: HIV/AIDS program: The HIV program in Tham Hin camp is registered in the National Access to Antiretroviral
respondents had ever had an HIV test.                                                                                          Program for People who have AIDS (NAPHA) Extension Program from the Thai MOPH. The components of the HIV/AIDS
                                                                                                                               program in Tham Hin camp include voluntary testing and counseling (VCT), PMTCT, and antiretroviral therapy (ART). HIV
Conclusion: Service points should be distributed for geographic accessibility to the greatest number of people. Programs       prevention: Health education and HIV awareness activities, including condom distribution, are done in the community by
should investigate the needs of women who experience forced sex within ongoing relationships and provide appropriate           the community health workers. We have a VCT campaign twice a year followed by a VCT service outreach. VCT is provided
support. It is important to further investigate why many do not regularly test for HIV and address any barriers to testing.    throughout the year at outpatient departments. ART: We have 18 HIV-infected patients in Tham Hin camp. Of these, 12
                                                                                                                               patients receive ART. All the patients attend the monthly HIV clinic, where they receive counseling, refill their medicine (ART
                                                                                                                               and opportunistic infections prophylaxis), and have their general health checked. Laboratory follow-ups (CD4, LFT, CBC, viral
Traumatic Fistula: A Consequence of Sexual Violence                                                                            load, etc.) and a supplementary feeding PMTCT program are also provided. At the antenatal care (ANC) clinic, all pregnant
                                                                                                                               women are informed about HIV infection and group counseling is offered. Individual pre-test counseling is given to all those
                                                                                                                               who are willing. A rapid HIV test is used and confirmation is done at a Thai hospital for positive and indeterminate cases.
Joseph Ruminjo
                                                                                                                               HIV-positive pregnant women receive AZT at the twenty-eighth week of gestation. According to the Thai MOPH protocol, all
EngenderHealth                                                                                                                 HIV-positive pregnant mothers are indicated for elective caesarian sections, and Nevirapine is given three hours before the
E-mail: cngongo@engenderhealth.org                                                                                             operation. After delivery, the mother and baby receive AZT. The baby is not breastfed; only formula is given.


Background: While global awareness about fistula caused by obstructed labor has grown, relatively little attention has         Findings: From January to December 2007, there were 423 pregnant women who received HIV counseling and tests at
been given to vaginal fistula caused by sexual violence. In many conflict settings, sexual violence is used as an instrument   ANC clinics. During this time, only one case of HIV was found. From January to March 2008, there were two cases of HIV
of war, potentially resulting in traumatic fistula.                                                                            detected among pregnant women. All of the positive cases are attending the PMTCT program.


Purpose: To learn more about traumatic fistula, the Access, Quality, and Use in Reproductive Health (ACQUIRE) Project/         Conclusion: PMTCT in Tham Hin camp is available and provided for all pregnant women under the supervision of an
EngenderHealth conducted a situation analysis and co-sponsored the first conference on traumatic gynecologic fistula           IRC doctor and a reproductive and child health (RCH) team. From November 2007 to March 2008, there were three HIV-
in September 2005.                                                                                                             positive pregnant women. The challenges of the program are lack of behavior change communications (BCC) materials
                                                                                                                               and of trained staff for HIV/AIDS prevention, care, and support. We have learned that community involvement, especially
Methods: Information was collected from individuals and organizations working on the issue. The meeting included               peer groups, is key for an effective HIV/AIDS program. In conflict-affected areas, collaboration with the local MOPH and
panels, group work, and expert testimony. The analysis uncovered information on the magnitude and distribution of the          other organizations can bring more success to programs.
program; existing programs around traumatic gynecologic fistula; programmatic successes, challenges, and gaps; and
related issues such as HIV and other sexually transmitted infections (STIs), child rape, domestic violence, and harmful
cultural practices.                                                                                                            Assessment of Sex Work in Refugee Camps
Findings: The magnitude of traumatic gynecologic fistula, rape, and violence has been difficult to assess. Collected           Marian Schilperoord, Elizabeth Ngugi
facility data represents a small percentage of actual cases. The situation analysis revealed information regarding the
magnitude of the condition, the needs for counseling, clinical training and supplies, and a multi-sectoral approach, all       United Nations High Commissioner for Refugees
of which resulted in the development of country strategies. Recommendations include: epidemiologic and operations              E-mail: schilpem@unhcr.org
research, developing networks of interested institutions and individuals, training and equipping facilities, and advocacy
campaigns among communities and decision-makers.                                                                               Background: Although studies and programmes have shown the feasibility and important benefits of halting HIV
                                                                                                                               transmission within sex work, programmes in refugee settings focus mainly on the general population and do not focus on
Conclusion: Findings suggest that women with traumatic gynecologic fistula have needs that cannot be met by clinical           groups at risk for HIV, such as sex workers.
services alone. Interventions must be holistic and multi-sectoral, including the health, social, legal, and other sectors.




74          RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                            RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                 75
Purpose: The purpose is to conduct an assessment to identify high-risk groups, to facilitate mapping and zoning of             Conclusion: UNHCR-defined “persons of concern” should be included in national HIV and AIDS programmes with data
hotspots where sexual networks are likely to exist, and to involve sex workers in the design of HIV prevention and             collected on their levels of knowledge of HIV and HIV risk behaviours within specific hot spots. Once data is available,
control services.                                                                                                              evidence-informed interventions should be targeted at those areas where HIV risk behaviour takes place. HIV and AIDS
                                                                                                                               data should be disaggregated by age, gender, and displacement, and access to prevention, treatment, care, and support
Methods: A qualitative HIV assessment was undertaken using interactive sessions with small groups of sex workers,              services for this population group should be monitored to improve universal access.
focus group discussions with sex workers, meetings with community and religious leaders, participatory observation at
sites with extensive sexual networks (e.g., bars and markets), and field visits to health facilities and refugee and local
communities. Limitations of the study are that women may occasionally engage in transactional sex and would never
                                                                                                                               Assessing Operational Barriers to Family Planning Services for
consider themselves to be sex workers.
                                                                                                                               Refugees and Internally Displaced Persons
Findings: Stigma and discrimination against sex workers and their children is very high. Children of sex workers are
highly stigmatised and in most cases denied access to schools. Most of the sex workers reported that they were afraid to       Theresa Shaver1, Emily Sonneveldt2, Anita Bhuyan2
go to public places such as the market. While sex workers were aware of HIV and sexually transmitted infection (STI) risk,
                                                                                                                               1 United States Agency for International Development Health Policy Initiative, Task Order 1 / White Ribbon Alliance
as well as prevention methods, they had very limited power to negotiate condom use and frequently reported rape and not
                                                                                                                               2 United States Agency for International Development Health Policy Initiative, Task Order 1 / Constella Futures
being paid for sex. Furthermore, the sex workers reported that the health services were not providing quality services for
                                                                                                                               E-mail: esonneveldt@constellagroup.com
HIV and STIs and their specific reproductive health needs.
                                                                                                                               Background: The international community has developed standards/protocols to help countries and organizations meet
Conclusion: It is important to establish comprehensive, multi-sectoral HIV programmes that will address protection,            family planning (FP) and reproductive health (RH) needs of refugees and internally displaced persons (IDPs). However,
health education, and social services. The high level of stigma and discrimination against sex workers and their children      there is a need to address the issue on a broader level. The absence of specific national policies and operational guidelines
needs to be urgently addressed. Peer education for sex workers needs to be established, and access to appropriate,             means that decisions about who gets FP and the conditions under which they receive services are determined by
non-stigmatising, confidential health services should be made available. In addition, urgent refresher training of health      individual organizations or even providers.
staff in syndromic management of STIs is required, and sexual and reproductive health services will need to address the
enormous sexual and reproductive health needs of sex workers through dedicated health care providers and improved              Purpose: To support policy advocacy and formulation, the United States Agency for International Development (USAID)
quality of services. Alternative life skills training and income-generating activities for women who would voluntarily stop    Health Policy Initiative conducted a study in Sierra Leone to identify operational policy barriers to the provision of FP
sex work need to be further explored in the context of the specific refugee camp settings.                                     services for refugees/IDPs before, during, and after conflict. Findings from the multi-faceted study are being used to
                                                                                                                               provide recommendations to in-country stakeholders and to prepare a guide on using the methodology in other
                                                                                                                               conflict-affected areas.

HIV Evidence-Based Programming for Displaced Persons in the Southern Caucasus                                                  Methods: The methodology involved four components: 1) focus group discussions with refugees, IDPs, and non-displaced
                                                                                                                               persons; 2) a participatory exercise entitled “Journey of a Woman”; 3) interviews with key informants/policymakers and
                                                                                                                               service providers; and 4) an assessment using the Policy Environment Score. These components provide qualitative and
Marian Schilperoord, Hilary Homans
                                                                                                                               quantitative information on the policy environment and operational barriers, and consider the viewpoints of various
United Nations High Commissioner for Refugees                                                                                  stakeholders. Key partners in the design and implementation of the study include the Reproductive Health Response in
E-mail: schilpem@unhcr.org                                                                                                     Conflict (RHRC) Consortium and local partners.

Background: Some 1.6 million people are living with HIV in Eastern Europe and Central Asia, an increase of 150% since          Findings: Refugee and IDP populations’ demand for and knowledge of FP increased during and after conflicts. Access
2001, with a heavy burden amongst young people. Of the new HIV cases reported in 2006, nearly two-thirds (62%) were            to FP increased to some degree, yet remained limited, especially for IDPs and host-country populations not served by
attributed to injecting drug use and more than one-third (37%) to unprotected heterosexual intercourse.                        refugee camps. FP was not viewed as a priority in emergency situations and quality and choice varied (e.g., condoms
                                                                                                                               for HIV prevention were most widely available, but there was limited access to emergency contraception for survivors
                                                                                                                               of sexual violence). Operational barriers included: lack of consistent and enforced service guidelines; costs transferred
Purpose: In 2006, the United Nations High Commissioner for Refugees (UNHCR) conducted HIV assessment missions
                                                                                                                               to clients; restrictions by providers based on client’s parity, age, marital status, and parental or spousal consent; lack of
in Armenia, Azerbaijan, and Georgia to review access of internally displaced persons (IDPs) and refugees to national
                                                                                                                               providers trained in FP counseling and service delivery; frequent stock-outs; and lack of youth-friendly services.
HIV policies and programmes. Armenia and Azerbaijan have concentrated epidemics, and Georgia has a
low-prevalence epidemic.                                                                                                       Conclusion: FP should be included in the initial package of services for refugees when they enter camps. It must also
                                                                                                                               be a part of repatriation plans. Moreover, the FP/RH needs of refugees and IDPs must be considered in human resource
Methods: A number of multi-sectoral HIV assessment missions were conducted.                                                    development and contraceptive security plans. Findings from the study will be used to advocate for improved policy
                                                                                                                               implementation guidelines in Sierra Leone, which adopted a national RH policy in 2007. We have also prepared a guide on
Findings: Poverty is widespread in the Southern Caucasus, with over half the population living at poverty level in             using the study methodology in other countries.
Armenia and Georgia. Studies have shown that poverty and migration are closely related to HIV, with up to 45% of
the people living with HIV (PLWH) having a history of migration to countries with higher HIV prevalence within the
region. Seventeen years after the regional conflict, some displaced persons live in communal centres or temporary
accommodation. Access to health care is poor amongst IDPs, and high levels of self-treatment, including for sexually
transmitted infections (STIs), are reported. Furthermore, IDPs, refugees, and asylum-seekers have difficulties accessing
condoms. Anecdotal evidence shows that refugees and IDPs are engaging in HIV risk behaviour. Despite this, their needs
are not adequately reflected in national HIV and AIDS programmes. Georgia is the only country that routinely collects
information on the number of IDPs living with HIV. The disintegration of health services in Abkhazia and South Ossetia
led to the absence of HIV test kits in South Ossetia and limited HIV tests and voluntary counselling and testing services in
Abkhazia. As a result of the assessment, UNHCR was able to address these shortcomings.



76          RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                            RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                     77
Partnering with Local Organizations to Expand Access to                                                                           Purpose: The overall purpose of the program was to support the Government of Indonesia’s (GoI) relief and
                                                                                                                                  rehabilitation efforts in Aceh through: 1) Reestablishing high-quality, sustainable reproductive health (RH) services for
Emergency Contraception in the Thai/Burma Border Zone                                                                             women and families; 2) Rehabilitating five community health centers and training service providers in three districts; 3)
                                                                                                                                  Reestablishing and strengthening quality RH service delivery by private sector midwives; 4) Ensuring continued and long-
Cari E. Sietstra                                                                                                                  term availability of trained providers by strengthening the preservice midwifery program at two schools.
Global Justice Center, Burma Border Projects
E-mail: sietstra@gmail.com                                                                                                        Methods: With quickly mobilized funding and in-kind support from a number of public and private sector partners,
                                                                                                                                  JHPIEGO designed a program with the GoI with both short- and long-term phases. Short-term: recruitment and
Background: Eastern Burma’s sixty year civil war has nearly halted development and the delivery of health care inside             mobilization of Indonesian midwives to fill service gaps; provision of equipment and supplies to hospital, health centers,
the country while driving hundreds of thousands of ethnic minorities into internally displaced persons (IDP) camps in             and private midwifery practices to enable them to resume MNH services; delivery of free MNH care and other RH services
Burma and into Thailand as both refugees and undocumented migrants. The Burmese army uses rape as a tool of warfare,              in internally displaced person (IDP) camps; and trauma counseling for service providers. Long-term: rebuilding/repairing
while Burmese women and girls in Thailand face sexual exploitation and lack access to reproductive health care.                   community health centers and village maternity homes; training facility health providers to implement national standards
                                                                                                                                  for MNH, family planning, and infection prevention; community mobilization and involvement to better prepare community
Purpose: The aim of the project is to partner with local organizations along the Thai/Burma border to expand availability         members to seek health services and respond to emergencies; and strengthening the practices of midwives in surrounding
and knowledge of emergency contraception (EC) for both sexual assault response and follow-up care for contraceptive               villages to minimize complications.
failure. The project focuses on Burmese communities inside the conflict zone of eastern Burma and in migrant areas
of western Thailand.                                                                                                              Findings: The program had the following key results:
                                                                                                                                   • Recruitment and deployment of 127 midwives to fill gaps in RH services in health centers and IDP camps in Banda Aceh
Methods: The project engages in four main activities: 1) “training trainers” of community-based organizations on the                 and Meulaboh. Services provided by these midwives covered an estimated 1,504 children under age 5 and 3,852 women
use and effectiveness of EC (both hormonal contraceptive pills and intrauterine devices [IUDs]); 2) funding and supporting           of reproductive age.
additional trainings on the use and effectiveness of EC in eastern Burma and migrant areas of Thailand by trained local            • Provision of counseling services to 141 midwives who lost their practices and/or family members.
health workers; 3) funding supplies of family planning for local organizations that include EC pills for both contraceptive        • Provision of supplies and equipment to Rumah Sakit Zainal Abidin Hospital (the provincial referral hospital) to enable it
failure and sexual assault response; and 4) facilitating the publication and distribution of Burmese-language materials that         to quickly and fully resume delivery of normal and emergency maternity and newborn services.
explain the use, effectiveness, and safety of EC.                                                                                  • Organization of clinical practice rotations for surviving Acehnese midwifery students to ensure their timely graduation
                                                                                                                                     and rapid entry into the health sector.
Findings: While the project is still in its early phases, several findings are already clear. 1) Local organizations and health    • Facility renovations, faculty development, and curricula strengthening at two midwifery schools.
workers’ attitudes towards EC vary across a wide spectrum, from a high level of interest and comfort with the drug to              • Strengthening of four community health centers in Aceh Besar and Banda Aceh city through provision of equipment
strong opposition to using EC resulting from a perception either that it is an abortafacient or that it is not useful in their       and supplies, training of providers, and development of community education/mobilization programs (Desa Siaga).
community (e.g., “Rape is not a problem in our area. We do not need this drug.”). 2) Offering funding for EC within a              • Renovation/reestablishment of 18 private midwifery clinics.
broader program of family planning is a successful strategy for facilitating small-scale distribution of EC. 3) While EC           • Establishment of free-care voucher system at selected private midwifery clinics.
is widely available in Thai pharmacies, lack of awareness among both Burmese women and health care workers of the                  • Development of RH inservice training center in Sigli. During the first year, JHPIEGO’s comprehensive rehabilitation
existence of a post-coital contraceptive is a key barrier to EC’s use along the Thai/Burma border. As a result, we are now           effort addressed reestablishment of service delivery at community level, empowerment of citizens to shape policies
undertaking efforts to expand Burmese-language resources for patients at clinics, mobile health workers, and for market              that affect their health, and increasing the economic and cognitive ability of individuals to make good decisions about
vendors in an effort to partner EC information with the dispersal of other family planning drugs and devices.                        their healthcare. Long-term rehabilitation support is an ongoing need, as demands for quality community health
                                                                                                                                     services will increase as Aceh continues its rebuilding efforts and more people return to their home areas.
Conclusion: Expanding access to and knowledge of post-coital contraceptives by partnering with local organizations
is possible. However, local organizations may face both internal disagreements about the appropriateness of EC and                Conclusion: Based on numerous discussions with stakeholders throughout the life of the program, the program received
different organizational focuses related to reproductive health. As a result, EC needs to be combined within a larger             very positive feedback in terms of its strategic approaches, partnerships, and planning and implementation of activities.
program of family planning education and supplies. Large-scale access to EC within Burmese communities will only come             The lessons learned from the successful Aceh experience with regard to rapid implementation of a short-term response,
with wider availability of all reproductive health care, increased literacy among women, economic growth, and an end to           while addressing longer term needs, could be useful in developing a model to be followed in the event of natural disasters.
the civil conflict in eastern Burma.


                                                                                                                                  Amid Conflict: Nepal’s Female Community Health Volunteer Program
Re-Establishing Reproductive Health Care in Emergency Situations:
The Aceh Tsunami Experience                                                                                                       Bal Krishna Suvedi
                                                                                                                                  Family Health Division, Department of Health, Nepal
Sushanty                                                                                                                          E-mail: bksuvedi@yahoo.com

Jhpiego Indonesia
                                                                                                                                  Background: In Nepal, widespread health disparities are evident along ethnic and socioeconomic lines, as well as
E-mail: sshanty@jhpiego.net
                                                                                                                                  between geographical areas. The main health problems are related to women’s and children’s health. The maternal
                                                                                                                                  mortality rate (MMR) is 281 per 100,000 live births, and the infant mortality rate (IMR) is 48 per 1,000 live births
Background: In the aftermath of the devastating December 2004 earthquake and tsunami in Aceh, Indonesia, access to
                                                                                                                                  (Nepalese Department of Health Services [NDHS] 2006). To address these issues, the Female Community Health
maternal and newborn health (MNH) care as well as to other reproductive health (RH) services was limited due to damage
                                                                                                                                  Volunteer (FCHV) program was launched in 1988, and continues successfully today. Starting in 1996, the Maoist
to health facilities and distressed health care providers. Urgent attention and support was required to address issues such
                                                                                                                                  insurgency affected all areas of rural Nepal. Until its resolution in 2006, the conflict led to the dissolution of local
as providing immediate care to women in need of MNH services, rebuilding community health centers, and ensuring the
                                                                                                                                  governments, the withdrawal of government services, and the disruption of development efforts. However, FCHVs were
capacity of the provincial referral hospital to manage complicated deliveries—all in the context of developing a plan for
                                                                                                                                  rarely targeted, so they have mostly been able to continue functioning throughout the conflict.
long-term sustainability of program efforts.

78           RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                             RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                 79
                                                                                                                              Conclusion: The study indicated that a high proportion of HIV-positive individuals who received medical care express
Purpose: The national FCHV program, focusing on family planning and maternal, neonatal, and child health, has the             a wish for parenthood and a desire to use family planning. The fertility desire and family planning needs of these people
objective of contributing to Nepal’s goal of reducing fertility and the under-5 and maternal mortality rates.                 have implications for vertical and heterosexual transmission of HIV, and appropriate counseling and delivery of services.

Methods: FCHVs are community women with little or no education. They receive basic health training and are provided
program materials and supplies. FCHV program activities are standardized and carried out nationwide. These include
                                                                                                                              Coordinating Relief and Development: Opportunities and Challenges
health promotion and community mobilization. Promising results have been found when additional activities are
implemented through FCHVs. These are being tested for nationwide scale-up.
                                                                                                                              Udaya Thomas1, Connie Kamara2
Findings: Through their voluntary services, FCHVs contribute extensively to the health and well-being of their                1 Jhpiego
communities, in particular to the women and children in rural Nepal. NDHS 2006 shows a 90% Vitamin A and 84%                  2 American Refugee Committee
deworming coverage. All doses are provided by FCHVs. This program saves an estimated 12,000 lives per year and                E-mail: uthomas@jhpiego.net
appears to be responsible for the reduction in childhood anemia (NDHS 2006).
                                                                                                                              Background: The optimal growth of a child is drastically affected by the number of diarrheal episodes that the child has
Conclusion: Nepal’s FCHV program represents an effective approach towards improving public health. FCHVs are                  to endure. Similar to this growth curve, countries devastated by disaster and conflict also experience dips that inhibit their
closely tied to the communities they serve. They are therefore able to offer more accessible care compared to the other       continued development.
government health workers. Childhood mortality rates have been decreasing, even during the conflict. If progress is
maintained, Nepal is expected to attain the fourth United Nations (UN) Millennium Development Goal (MDG) on childhood         Purpose: When countries are already struggling to meet the national health needs of their citizens, war and natural
mortality (UN 2005). Much of this progress can be attributed to the contribution of FCHVs. They have truly become the         disaster compound their existing struggles, requiring a wealth of support from relief agencies and international
backbone of the health sector.                                                                                                organizations. Local and international development agencies do not work in isolation from these occurrences
                                                                                                                              and are also affected.

                                                                                                                              Methods: American Refugee Committee (ARC) and JHPIEGO have come together to draw from their respective
                                                                                                                              strengths to begin to create a model for addressing this gap. Two sites, in Pakistan and Sudan, were used as pilots for
Fertility Desire and Family Planning Need Among HIV-Positive
                                                                                                                              this collaboration. The focus has been on building the capacity of existing local providers who are already serving the
Men and Women in Ethiopia                                                                                                     populations affected by disaster and conflict. ARC identified providers in the area, ARC staff, and local government
                                                                                                                              employees to participate in trainings to improve the delivery and quality of reproductive heath (RH) services.
Kifle Wossenyelesh Tamene1, Fantahun Mesganaw2                                                                                Assessments of the training and monitoring of the providers and the facilities are ongoing.

1 Family Health International
2 Addis Ababa University
                                                                                                                              Findings: Key interviews and preliminary data reveal that the collaboration of these two worlds has spilled over to
                                                                                                                              strengthen local health systems as well as other organizations. Tools that assist providers to track and monitor their
E-mail: Wossen_ta@yahoo.com
                                                                                                                              facilities, and their own standards of care for RH and other areas of health care, have been implemented and integrated
                                                                                                                              for the benefit of the facilities, the providers, and the clients.
Background: There is a paucity of information about the desire to have children and family planning use among HIV-
positive individuals, and how each varies by individual, social, health, and demographic characteristics in Ethiopia and in
most developing countries.
                                                                                                                              Conclusion: Collaboration between relief and development organizations is critical to cover the maximum number
                                                                                                                              of families in need of quality health services. The development of vulnerable environments depends on the capacity
                                                                                                                              of relief organizations to respond to crises, as well as the foresight and strategic vision of sustainability by
Purpose: To assess fertility desire and family planning demand among HIV-positive men and women in follow-up care in
                                                                                                                              development organizations.
antiretroviral (ARV) treatment centers in Addis Ababa.

Methods: A cross-sectional study, supplemented by qualitative, in-depth interviews, was conducted from January to
February 2006 on people living with HIV/AIDS under follow-up care in ARV treatment units in Addis Ababa. Study subjects       Reproductive Health Needs Among Female Sex Workers in Afghanistan
were selected using a stratified random sampling method. The data were collected using a pre-tested, structured
questionnaire and analyzed using SPSS version 11. Descriptive statistics were used to describe characteristics of study       Catherine S. Todd1, Mohammad Raza Stanekzai2, Abdul Nasir3, Paul T. Scott4,
subjects, and a logistic regression model was used to predict future desire for children and family planning according
                                                                                                                              Steffanie A. Strathdee, Boulos A. Botros
to different factors.
                                                                                                                              1 Division of International Health & Cross-Cultural Medicine, University of California, San Diego
Findings: Out of 460 people living with HIV/AIDS (PLWHA) involved in the study, 244 (53%) were females, while 216             2 International Rescue Committee, Kabul, Afghanistan
(47%) were males. One hundred nine (44.7%) women and 76 (35.2%) men, representing 40.2% of HIV-positive individuals           3 United States Military HIV Research Program, Walter Reed Army Institute of Research, Rockville, Mary
receiving care in Addis Ababa, desired to have children. Those who desired children were younger (ages 18 to 29, Adjusted     4 United States Naval Ambulatory Medical Research Unit 3, Cairo, Egypt
OR: 3.05, 95% CI: 1.5–6.4); married or in a relationship (Adjusted OR: 3.4, 95% CI: 2.1–5.6); had no child (Adjusted OR:      E-mail: cst2121@columbia.edu
11.5, 95% CI: 5.3–24.9); and had a partner who also desired to have children (Adjusted OR: 38.7, 95% CI: 16.7–89.1). Two
hundred thirty-one (50.2%) of the respondents had been sexually active within the past six months. Two hundred forty-         Background: Unplanned pregnancy is a relevant issue for female sex workers (FSWs), who may have less access to
six (53.5%) individuals were using contraceptives and 85 (39.7%) wanted to use contraceptives in the future. Eighty-          health services than other women.
nine (19.3%) of the respondents admitted to having been previously counseled on reproductive health issues such
as childbearing, contraception and sexuality; however, 35 (39.3%) of the respondents felt that the discussion did not         Purpose: The purpose of this study is to determine contraceptive utilization among female sex workers in Afghanistan.
sufficiently address reproductive health issues.


80          RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                           RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                81
Methods: Female sex workers in Jalalabad, Kabul, and Mazar-i-Sharif were recruited between June 2006 and                    Conclusion: This collaboration showed that data can be used for public health action. The Capacity-Building Program of
December 2007 through outreach programs. Following written informed consent, participants completed an interviewer-         JSI is in a unique position to enhance and support local health agencies to address reproductive health in a post-conflict
administered survey describing demographics, risk behaviors, and reproductive health history. Descriptive statistics were   setting. This model could be applicable in similar settings. Local health agencies should be given the support needed to
generated and correlates of unplanned pregnancy risk were assessed with logistic regression analysis.                       reach vulnerable populations.

Findings: Of 543 sex workers, 520 (95.8%) were female. Of the FSWs, mean age was 28.5 years (range: 18 to 45) and
mean duration of sex work was 4.6 years. Most (69.4%) were currently married, 94.2% were born in Afghanistan, and
                                                                                                                            Vulnerability of Adolescents to Sexual and Reproductive Health and
76.9% had no formal education. Most (79.5%) of FSWs had children, with a mean of 4.9 (SD=2.7, range: 1-17) pregnancies
and 3.9 (SD=2.4, range 0-12) living children. One-third (36.7%) had at least one prior unplanned pregnancy, and 33.2%       Rights Problems: Prevention Through Culturally Sensitive Education,
stated they had a prior pregnancy termination. Most FSWs (90.0%) stated that they did not desire a pregnancy at this        Services, and Empowerment
time and 85.2% were using a contraceptive method. The most popular methods were depot medroxyprogesterone
acetate (30.2%), oral contraceptives (20.6%), condoms (14.5%), and IUD (4.4%). FSWs not desiring pregnancy and not
                                                                                                                            Ahmed Ullah
using contraception (n=65, 12.0%) were at risk of unintended pregnancy; correlates of this risk were prior unplanned
pregnancy (OR=1.95, 95% CI: 1.07-3.55) and number of prior pregnancy terminations (OR=1.34, 95% CI: 1.04 – 1.72).           Balochistan Rural Support Programme
                                                                                                                            E-mail: achakzai_pk@yahoo.com
Conclusion: Though FSWs in Afghanistan appear to utilize contraception at high rates, some are at persistent risk
for unplanned pregnancy. Programming for FSW should include reproductive health services to reduce risk of                  Background: Lack of risk-awareness and poor understanding of sexual and reproductive health and rights (SRHR)
unplanned pregnancy.                                                                                                        problems—at all levels, but especially where adolescents are caught in the web of ignorance, discrimination, frustration,
                                                                                                                            and confusion—is one of the major problems in Pakistan, and consequently makes adolescents vulnerable to reproductive
                                                                                                                            health (RH) issues, particularly in emergency situations.

The Use of Epidemiological Data to Recommend Reproductive                                                                   Purpose: The project provides intensive SRHR education and services, addressing misunderstandings and social norms
Health Interventions in Post-Conflict Liberia                                                                               that put adolescents at risk of SRHR problems. The project also provides adolescents with confidence-building measures,
                                                                                                                            life skills-based education, adolescent sexual and reproductive health (ASRH) counseling, and referral linkages for
Basia Tomczk1, Fiona Galloway1, Meriwether Beatty2, Priya Marwah3, Geetor Saydee4                                           specialized services.

1 Centers for Disease Control and Prevention
                                                                                                                            Methods: Recognizing the dearth of attention to adolescents’ critical life issues, the European Commission (EC)/United
2 JSI Research and Training Institute, Inc.
                                                                                                                            Nations Population Fund (UNFPA)/Reproductive Health Initiatives for Youth in Asia (RHIYA) project has been implemented
3 United Nations Population Fund
                                                                                                                            in far-flung and conservative districts of Pakistan. Youth-Friendly Centres (YFCs) have been established in the districts.
4 University of Monrovia
                                                                                                                            The main activities in YFCs are mobilizing youth for SRHR awareness-raising and empowering them in developing life
E-mail: bet8@cdc.gov
                                                                                                                            skills. YFCs also focus on advocacy, community mobilization, and capacity building in order to create a supportive
                                                                                                                            environment. Youth in YFCs benefit from information, education, and communication (IEC) material; literacy classes;
Background: In post-conflict settings, it is important to develop new paradigms of public health care delivery. Local       recreational activities; sports activities; skill-development courses; counseling; and referral/advisory services.
health agencies should be recognized for their tenacity in staying throughout the emergency and caring for vulnerable
populations, despite limited resources.
                                                                                                                            Findings: Even in extremely challenging environments, progress can be made on adolescents’ SRHR issues and women’s
                                                                                                                            participation if a careful, culturally sensitive approach is taken. Involving the local community and religious leaders can
Purpose: The goal of the project was to conduct a reproductive health survey, use the data to plan health interventions,    have added benefits as members are stimulated to provide extra inputs and services to improve local conditions. In order
and identify local health agencies to implement the survey recommendations.
                                                                                                                            to achieve sustainability and to have a real impact on adolescents’ lives, support and active involvement at the community
                                                                                                                            level is fundamental. IEC materials played a major role as an important means of communication and awareness
Methods: The Centers for Disease Control and Prevention (CDC) collaborated with JSI Research and Training Institute,        promotion that could target different groups besides adolescents, such as parents, teachers, and community leaders.
Inc., the United Nations Population Fund (UNFPA), and the Ministry of Health and Social Welfare Liberia to support
                                                                                                                            The program has also encouraged adolescents to undertake actions in support of women’s rights and empowerment in
local non-governmental health agencies to deliver reproductive health care. For the survey, we used a three-stage
                                                                                                                            family and public settings, the socialization of female children, the improvement of women’s health, and the eradication of
cluster design and conducted face-to-face interviews of 907 women of reproductive age (15 to 49 years). We assessed
                                                                                                                            gender-based violence and exploitation.
maternal health care and contraception use, the prevalence of physical and sexual violence, and HIV/AIDS knowledge.
For implementation of the survey recommendations, we trained four local agencies in proposal writing and reproductive
                                                                                                                            Conclusion: The lessons learned/good practices would surely be of interest for other organizations working in poverty-
health, and developed monitoring and evaluation tools.
                                                                                                                            stricken communities with rigid religious practices and beliefs. Involvement of religious leaders and HIV/AIDS-affected
                                                                                                                            people is a unique feature. Culturally sensitive and religiously acceptable forms of communication and approaches have
Findings: The survey findings showed that about 35% of women sampled did not receive prenatal care, and almost              always resulted in success.
47% of all births occurred without a skilled attendant. The contraceptive prevalence rate was 6.8%. During the conflict,
women reported either sexual abuse (59%) or physical assault (90%). Comprehensive knowledge of HIV was low, 14.5%,
and women did not practice safe sex. UNFPA responded immediately to the survey recommendations by identifying a
local consultant to coordinate the implementation of the survey findings. JSI conducted a proposal-writing workshop
and identified four local health agencies that were awarded $10,000 each to implement their proposals. In addition, a
monitoring and evaluation tool became part of the agencies’ proposals, which strengthened their programs. The local
agencies successfully developed programs to address the unique survey findings, such as the training of peer educators
for HIV/AIDS and family planning and the training of traditional birth attendants to distribute safe delivery kits.




82          RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                        RH in Emergencies Conference 2008 Proceedings — Book of Abstracts              83
Mobile Service Units for Immediate Provision of Maternal and                                                                    Findings: The different findings or experiences of the WGNRR member organizations will be shared with the public
                                                                                                                                through an interactive panel discussion. The main findings are that in all conflicts, several actors are victimizing women
Child Health/Reproductive Health Services: UNFPA’s Experience                                                                   and girls by violating their bodily integrity and their human rights in one way or another. Rape, mutilations, sexual slavery,
from the Pakistan Earthquake of 2005                                                                                            forced pregnancies, and numerous other crimes are committed against women and girls. Violations are motivated
                                                                                                                                by many reasons linked to the war situation, but they have also been built upon the discrimination against women in
M. Hulki Uz                                                                                                                     society. In all shared experiences the women face enormous obstacles in protecting their human rights, regaining their
                                                                                                                                dignity, and finding redress. These obstacles that mostly reinforce each other, and therefore further impede victims from
United Nations Population Fund
                                                                                                                                obtaining justice, include social, medical, economic, security, political, and legal obstacles. The panelists do the work in
E-mail: hulki.uz@un.org.pk
                                                                                                                                their specific countries and will each indicate what is needed to improve their situation.

Background: In October 2005, a 7.6-magnitude earthquake hit northern Pakistan and left more than 73,000 people
                                                                                                                                Conclusion: We must strengthen and collectively organize continuous lobbying directed at national and international
dead and over 140,000 injured; rendered 3 million or more people homeless; and left 250,000 people sheltering in camps.
                                                                                                                                governments and institutions in order to amend and change national legislation regarding sexual violence and the position
                                                                                                                                of women. We must also improve access to social services for women victims of sexual violence; the WGNRR is advocating
Purpose: The United Nations Population Fund’s (UNFPA) humanitarian strategy focused on (1) restoring reproductive
                                                                                                                                these steps in its Call for Action 2008.
health (RH) services in order to prevent excess maternal and infant mortality and (2) addressing the psychosocial well-
being and hygiene needs of women and girls.

Methods: To provide emergency obstetric and neonatal health care, 10 Mobile Service Units (MSUs) were immediately               Integrative Asylum Policy Within South Africa: Investigating Access to
dispatched in the three most affected districts to provide 24/7 basic emergency obstetric and neonatal care, referral           Antiretroviral Treatment Services for Refugees and Asylum Seekers
for complicated cases, antenatal as well as postnatal care, and reproductive health services. An MSU consists of one
vehicle containing a delivery table, maternal and child health (MCH)/RH equipment and supplies, and a tented space for
                                                                                                                                Within a Complex Urban Environment
outpatient consultations. Each MSU is staffed with one female doctor, one midwife, at least one support staff, as well as
one driver. In order to monitor relevant health indicators, facility-based data were constantly collected from the beginning.   Joanna Vearey
                                                                                                                                Forced Migration Studies Programme, University of the Witwatersrand
Findings: Quickly setting up MSUs in the most affected and relatively inaccessible areas has been a key to ensuring             E-mail: jovearey@gmail.com
effective RH services, including emergency obstetric care (EmOC), in selected earthquake-affected districts. As of
March 2008, the 10 UNFPA-supported MSUs have seen 843,467 patients in total. This figure includes 174,424 antenatal             Background: South Africa has adopted an integrative asylum policy for emergency situations; no refugee camps exist
care consultations; 21,684 deliveries; treatment of 5,189 cases with post-abortion complications; and 2,911 referrals for       and many refugees and asylum seekers find themselves in complex urban environments such as the city of Johannesburg.
cesarean section. Interestingly, 41,674 cases with scabies were also treated.                                                   These individuals are required to integrate within existing welfare services such as health care, including access to free
                                                                                                                                antiretroviral therapy (ART).
Conclusion: Due to the pre-existing affiliation between UNFPA and the local authorities in the earthquake-affected
areas and the rapid availability of 10 MSUs, UNFPA was able to respond quickly to the most urgent needs of the affected         Purpose: The effective management of HIV within populations is a pressing public health issue. This paper presents
population, specifically women and their newborns.                                                                              findings from a study, conducted in 2007, that investigates access to ART within the public sector in urban South Africa
                                                                                                                                for different categories of migrants, including refugees and asylum seekers. This involved assessing access challenges
                                                                                                                                within existing integrative refugee policy.
Access to Social Justice for Victims of Sexual Violence in Conflict Situations
                                                                                                                                Methods: The study was based in the Johannesburg inner city at four sites providing ART—two governmental and
                                                                                                                                two non-governmental organisations (NGOs)—located within areas where there are known to be high concentrations of
Aika van der Kleij1, WGNRR members based in Philippines, Colombia,
                                                                                                                                refugees and asylum seekers. Qualitative and quantitative methods were used, and a cross-sectional, comparative study
Democratic Republic of Congo, Afghanistan or Pakistan, and Rwanda
                                                                                                                                of three categories of migrants (internal, refugees and asylum seekers, and undocumented migrants) and a control group
1 Women’s Global Network for Reproductive Rights                                                                                of South Africans was undertaken. Methods involved: (1) a desktop review of existing policy and literature; (2) 34 semi-
E-mail: coordinator@wgnrr.org                                                                                                   structured interviews with health care providers who work within ART provision; (3) a questionnaire conducted with 449
                                                                                                                                migrant ART clients; and (4) a focus group discussion with 8 refugee HIV counsellors.
Background: Although officially outlawed by international and/or national legislation, women and girls are far too often
victims of sexual violence in conflict regions. The Women’s Global Network for Reproductive Rights (WGNRR) has member           Findings: Findings indicate ART access challenges within the integrative refugee policy of South Africa. Government
organizations that work on the ground in trying to provide access to social justice.                                            clinics and public sector ART roll-out sites were found to refer refugees and asylum seekers out of the public sector and
                                                                                                                                directly into a resource limited NGO sector when they are in need of ART (which in many cases is at the time of testing).
Purpose: The purpose is to share experiences from women’s organizations working in different conflict areas in order            This has resulted in a dual-health care system, public and NGO, providing ART through separate routes to different groups
to learn from each others’ tactics, inform the conference audience, show similarities in the problems faced, and provide        of people: citizen and non-citizen. This raises concern around the sustainability of non-governmental services, and about
suggested solutions in the form of recommendations for which we will be advocating at all levels.                               these services currently taking on the role of public health services. South Africa has an integrative policy for emergency
                                                                                                                                situations and the rights of refugees and asylum seekers to access free ART within the public sector must be upheld.
Methods: The WGNRR put out a call amongst its membership to those working in a post-conflict zone on the theme of
Women and Conflict, which is the theme of our Call for Action of 2008. We sought members from different geographical            Conclusion: Protective policies and guidelines exist within South Africa to ensure “access to healthcare for all”, including
areas, different types of conflicts, and different types of service provision to women and girls that are victims of sexual     those fleeing emergency situations. Appropriate training within the public health care sector relating to the rights of
violence. Social justice is our focus, along with accountability of all perpetrators of these horrendous crimes. The work       refugees and asylum seekers to access ART is required.
different organizations do on the promotion of women’s sexual and reproductive health and rights in their respective
countries and conflicts will provide interesting experiences.


84          RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                             RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                85
Family Planning Saves Lives                                                                                                    Methods: The Female Condom Network integrates female condoms (FC) into reproductive health and HIV programs
                                                                                                                               among 17 organizations targeting migrants and refugees in Thailand and ethnic communities in Burma. An initial advocacy
                                                                                                                               workshop and Training of Trainers conducted by the Female Health Foundation allowed community leaders and other
Ayantu Wakira1, Melissa Sharer1, Katie Anfinson1, Jennifer Schlecht2
                                                                                                                               stakeholders to learn about the benefits of FC programming. FC Master Trainers returned to host organizations to train
1 American Refugee Committee International                                                                                     other staff members. FC Master Trainers piloted the product from February to June 2007, monitoring users with baseline
2 The RAISE Initiative                                                                                                         and endline questionnaires and weekly follow-ups. Biannual FC networking meetings reinforce FC needs and allow for
E-mail: katea@archq.org                                                                                                        troubleshooting and collaboration among organizations.

Background: Maternal mortality rates in South Sudan are among the highest in the world at 2,030 per 100,000 births             Findings: Quarterly data collection reveals demand for FC among migrant commercial sex workers in Thailand, family
(UNFPA 2007). In December 2006, the American Refugee Committee (ARC) embarked on implementing the RAISE Initiative             planning clients in refugee camps and internally displaced communities, and voluntary HIV counseling and testing
project to improve the availability and quality of comprehensive reproductive health (CRH) services in Malakal, South Sudan.   (VTC) clients at Mae Tao Clinic. A variety of users reflects strong integration in reproductive health and HIV programs.
                                                                                                                               Employing a network model that uses multiple non-governmental organization (NGO) and community channels minimizes
Purpose: This program aims to provide comprehensive emergency obstetric care (CEmOC) services in the Malakal                   stigma when introducing FC in the community. Health worker bias is similarly avoided with the network model, as FC
Teaching Hospital, which is currently the only referral hospital in Upper Nile State, and Bam primary health care clinic       Master Trainers reflect a balanced representation of providers and ethnicities. Outreach workers, midwives, nurses, peer
(PHCC), located in the most densely populated zone of Malakal county. Capacity building of the local health authorities will   educators, and counselors, including those of Muslim, Christian, and Buddhist faiths, participate in network trainings.
be a focus, with full handover by year five.                                                                                   Collaboration among diverse partners breaks down barriers and encourages support for FC integration. Sharing
                                                                                                                               experiences of integrating FC in refugee, migrant, and IDP populations strengthens FC Master Trainers’ confidence and
Methods: Project activities during the first year have included a baseline study, including a facility assessment and          increases capacity to offer to support to program staff in respective organizations.
population-based survey. The facility assessment was conducted at both supported facilities prior to initiating project
activities. The assessment detailed the existing capacity of each facility to meet the reproductive health (RH) needs of       Conclusion: Introducing female condoms in diverse ethnic and migrant populations is effective when a network model is
this population by determining the current availability, quality, and utilization of services. Key stakeholders, such as the   employed. Gathering NGO and community partners at the initial stage of FC integration has strengthened the supply
Ministry of Health (MOH), non-governmental organizations (NGOs), hospital staff, local leaders, and community members          side of programming, minimized health worker bias and stigma, encouraged collaboration, and facilitated border-
were involved from early planning through actual data collection and analysis.                                                 wide data collection.

Findings: Currently, family planning (FP) services are not provided in the Malakal Teaching Hospital or in the Bam PHCC.
Confirmed by the facility assessment, this finding is illustrative of the dearth in RH services throughout Upper Nile State.
The lack of access to FP at these facilities is particularly compelling when analyzed in tandem with the high use of post-
                                                                                                                               Adolescent Reproductive Health Network on the Thai-Burma Border
abortion care (PAC) services. Over a three-month period, nearly half (47%) of all obstetric admissions at Malakal Teaching
Hospital were for PAC. High numbers of complications are received at the hospital due to incomplete abortions. Additional      Meredith Walsh1, Lway Moe Kham2, Sai Myo Aung3
data emerging from the baseline assessment include high rates of dilation and curettage utilization (140 within five           1 Mae Tao Clinic
reported months), showing that providers having no access or utilization of manual vacuum aspiration. The assessment           2 Palaung Women’s Organization
also indicates a lack of demand/knowledge of FP services. These findings, when examined together, suggest immense              3 Shan Youth Power
gaps in family planning services, which appear to be elevating the demand for PAC services.                                    E-mail: meredithmwalsh@yahoo.com

Conclusion: FP is critical in any emergency CRH response. Unmet need leads to pregnancy complications and maternal             Background: An estimated two million people from Burma have crossed the border for migrant work in Thailand. Lack
morbidity and mortality. Programs should therefore prioritize the scale-up of family planning services, while increasing       of access to reproductive health services among undocumented migrants has led to increased complications from unsafe
demand via behavior change communication. ARC will use these findings to implement such an intervention in Malakal.            abortion and high HIV infection rates.

                                                                                                                               Purpose: The Adolescent Reproductive Health Networks aim to promote sexual and reproductive health services among
Female Condom Networking on the Thai-Burma Border                                                                              refugees and migrants in Thailand and internally displaced communities in Burma. The network trains peer educators to
                                                                                                                               provide sustainable access and availability of reproductive health services and education for young people aged 12 to 24.
Meredith Walsh1, Norda Phraisaengdet2, Myo Myo, Saw Than Lwin1
                                                                                                                               Methods: Eighteen community-based organizations, divided between Mae Sot and Chiang Mai, form two networks
1 Mae Tao Clinic                                                                                                               that coordinate to prepare standard curricula, train master adolescent reproductive health (ARH) trainers, and share
2 Médicins Sans Frontieres                                                                                                     experiences to solve common problems. A management committee composed of representatives from each organization
E-mail: meredithmwalsh@yahoo.com                                                                                               meets regularly to review budgets, plan interventions, and share activity reports. Family planning supplies are distributed
                                                                                                                               according to demand in respective target areas, and teaching materials are shared among all organizations. In 2007, a
Background: Thailand hosts two million people from Burma, most of whom have no legal documentation. High                       population-based survey was conducted among 1,000 migrants in Mae Sot and Chiang Mai, the results of which are being
HIV infection rates and high incidence of unsafe abortions among undocumented Burmese migrant workers warrant                  analyzed for future targeted programming. In 2008 a Youth Center will be established to provide access to reproductive
alternative interventions such as dual protection against sexually transmitted infections (STIs) and pregnancy.                health (RH) services and education for young urban migrants in Mae Sot.

Purpose: The project aims to provide dual protection for fertility regulation and prevention of STIs/HIV among                 Findings: The organizations involved in the ARH networks in Thailand reflect five ethnic communities from disparate
communities from Burma. The network model strengthens coordination and capacity among NGO and community                        settings along the Thai-Burma border. Coordination among such diversity builds organizational capacity to address broader
partners along the Thai-Burma border.                                                                                          border-wide humanitarian issues, while targeting respective community needs. Where community-based organizations
                                                                                                                               often lack technical and financial resources, collaboration allows peer monitoring and evaluation to create an organic
                                                                                                                               capacity-building mechanism. Organizations gain confidence when provided a forum to share experiences and troubleshoot
                                                                                                                               as a team. Credibility within local communities is gained by working with other organizations along the border.


86          RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                           RH in Emergencies Conference 2008 Proceedings — Book of Abstracts               87
Conclusion: The network model of coordination is an effective channel for sustainable, community-based interventions,            Purpose: ARC utilizes innovative approaches and lessons learned from neighboring countries, aiming to reverse the
especially for culturally sensitive issues such as adolescent reproductive health. This model provides an avenue for             spread and mitigate the impact of HIV/AIDS. ARC goes beyond vertical programming via developing sustainable, holistic
international aid agencies to support local initiatives.                                                                         interventions that provide quality and comprehensive community-based HIV prevention, care, and support services to
                                                                                                                                 targeted vulnerable groups.

                                                                                                                                 Methods: Due to the limited capacity of the labor force, ARC responded with a “task-shifting” approach, whereby
Building Capacity Through Partnership
                                                                                                                                 unskilled individuals were educated and supported to provide services. Using this approach, ARC opened the first
                                                                                                                                 counseling and testing (CT) sites in Yei. Carefully selected lay community members received extensive training on
Leora Ward, Beth Vann, Melissa Sharer                                                                                            voluntary CT, prevention of mother-to-child transmission (PMTCT), and psychosocial support; they currently provide
American Refugee Committee                                                                                                       counseling, parallel testing, and referral services at 14 CT sites. ARC has been able to implement a comprehensive
E-mail: leoraw@archq.org                                                                                                         program involving varied strata of society by modifying “traditional” HIV response models to integrate multiple sectors
                                                                                                                                 into the program methodology while also linking activities to varied social service providers.
Background: Historically, relief and development exist separately and are funded by different donor departments,
leading to uneven transition efforts that frequently leave gaps in programming. The American Refugee Committee (ARC)             Findings: In settings with limited HIV/AIDS data, programs are created to respond to a potential crisis of unknown
is developing an innovative programmatic response to work within the limitations imposed on the continuum.                       magnitude. Therefore, it is imperative to establish essential systems to prevent and minimize the devastating effects
                                                                                                                                 such a crisis could have on a country. In this environment, which is equally burdened by weak infrastructure, poverty, and
Purpose: ARC’s pilot project is an example of implementing a sustainable community-driven gender-based violence                  nascent national policies, it is crucial to expand the pool of already limited human resources by creating a new cadre of
(GBV) response. The aim of the partnership project is to work with national organizations in five crisis-affected countries      health workers who can respond quickly to health concerns at the grassroots level. Moreover, in addition to the apparent
to prevent and respond to GBV and decrease the gap in services that exists when the country transitions to development.          HIV risk factors typical in a post-conflict environment, other factors such as psychological trauma, gender-based violence
                                                                                                                                 (GBV), and limited income/poverty can exacerbate the potential HIV threat. ARC has realized that although addressing
Methods: Partnering with local organizations from the onset of an emergency is essential and extremely difficult.                the immediate HIV/AIDS concerns is of priority, these contributing factors also need to be included in the prevention and
This project provides support at both technical and organizational levels. Skilled ARC GBV staff in five countries are           response activities in order to provide a complete range of comprehensive services.
identifying and working with five national organizations to build organizational and technical capacity through training,
monitoring, evaluation, networking, and small amounts of funding. The project uses tools to measure baselines and chart          Conclusion: Modifying traditional models, incorporating a multi-sectoral approach, and utilizing innovative ideas can
organizational and technical growth among national non-governmental organizations (NGOs), thus allowing skills and               enable HIV programs to be implemented in even the most challenging environments. Applying such methodologies allows
funds to filter back to local efforts. Partnering with local organizations is imperative to ensure GBV programming can           mechanisms to rapidly be established, thus minimizing the harmful effects that a full-blown HIV/AIDS crisis could have on
support the relief-to-development transition.                                                                                    already fragile nations.

Findings: Those who do the majority of work to prevent and respond to GBV are local volunteers, staff, and leaders.
These local actors are knowledgeable, skilled, and committed to strengthening their organizational and technical capacity
                                                                                                                                 Contraceptive Use Among Women Refugees in Kyaka Refugee Settlement,
to provide improved services. ARC has found sustainable responses to GBV require a long-term answer that must
involve communities, local organizations, and networks in project planning, implementation, and evaluation. Capacity             Kyenjojo District, Uganda
building must be at the center of all programs—that is, more funding and technical assistance must be planned for local
organizations to increase their technical and organizational skills to provide good-quality GBV interventions in their           Lawrence Were, Roy Mayega, Christopher Orach
communities. The activities of this project—training, consulting, capacity building, and technical support to build local
                                                                                                                                 Makerere University School of Public Health, Kampala, Uganda
knowledge, skills, and confidence; local GBV networks; and developing/disseminating resources—are targeted toward
                                                                                                                                 E-mail: cgorach@musph.ac.ug
national organizations. These local groups are able to actively participate in and guide the design and implementation of
GBV protection strategies. Strong local capacity translates into sustainable programs.
                                                                                                                                 Background: Uganda hosts an estimated 230,000 refugees in 12 districts. There are 16,000 refugees in Kyaka
                                                                                                                                 settlement, in Kyenjojo district, western Uganda. Family planning services for refugees in Kyenjojo district are mainly
Conclusion: Following an integrated relief-to-development model ensures that the survivors of GBV are receiving                  provided by the Ministry of Health.
appropriate, culturally tailored, and sustainable support. Capacity building will ensure that local actors will be more active
in GBV interventions from the early stages and will be able to continue that work into the future.
                                                                                                                                 Purpose: To study factors influencing contraceptive use by refugee women in Kyaka settlement in Uganda.

                                                                                                                                 Methods: We carried out a cross-sectional study in Kyaka refugee settlement. We interviewed 484 women of
Comprehensive HIV Services in a Low-Resource Setting                                                                             reproductive age (15 to 49), randomly selected from all 24 zones in the settlements. We conducted three focus group
                                                                                                                                 discussions with health workers, married refugee men, and adolescents, and held four key informant interviews. We used
Stephanie Weber, Sanja Djurica                                                                                                   a health facility checklist to assess the quality of family planning services in the refugee settlement.

American Refugee Committee International
                                                                                                                                 Findings: We found that most refugee women (91.9%) were aware of at least one modern method of family planning. The
E-mail: ciaosteph@yahoo.com
                                                                                                                                 contraceptive prevalence rate (CPR) was 18.2%. The CPR was lowest (12.7%) in the 19- to 24-year age group and highest
                                                                                                                                 (26.0%) in the 25 to 34 age category. The most commonly used contraceptives were depo-provera (51.1%), condoms
Background: South Sudan is in jeopardy of a major HIV crisis due to various factors, which include being surrounded by
                                                                                                                                 (29.6%) and the pill (11.4%). Contraceptive use by refugee women was found to be affected by spousal consent, age,
high-prevalence countries, having recently opened borders, and currently receiving an influx of returnees. In response, the
                                                                                                                                 educational status, nature of income-generating activity, and the number and sex of surviving children. Barriers to the use
American Refugee Committee (ARC) initiated the first comprehensive, targeted HIV/AIDS intervention in Greater Yei County.
                                                                                                                                 of contraception included lack of knowledge, misinformation, fear of side effects, and lack of support from male partners.
                                                                                                                                 Current users perceived family planning services provided to be of good quality.




88          RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                             RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                89
Conclusion: Although our study showed a high level of awareness about family planning, and the quality of family                 INDEX
planning services was perceived to be high, contraceptive prevalence rates remain low in this setting. The findings suggest
the need to increase sensitization and to strengthen family planning services in the district.


                                                                                                                                 Adolescent Reproductive Health                            We Want Birth Control: Reproductive Health Findings
SPRINT: An Initiative to Address Sexual and Reproductive Health in Asia-Pacific                                                                                                            from Northern Uganda, 39
                                                                                                                                 Adolescent Reproductive Health and Rights in Rural
                                                                                                                                 Post-Conflict Settings, 38                                Whose Choice? Results of a Survey of Knowledge,
Anna Klinken Whelan , Tran Nguyen Toan , Wilma Doedens
                            1                          2                      3
                                                                                                                                                                                           Attitudes, and Practices about Abortion with Program
1 School of Population Health, University of New South Wales                                                                                                                               Managers and Policymakers Working in Crisis Settings
                                                                                                                                 Adolescent Reproductive Health Network on the
2 International Planned Parenthood Federation/East and South East Asia and Oceania Region                                                                                                  in Nine African Nations, 66
                                                                                                                                 Thai-Burma Border, 87
3 United Nations Population Fund
E-mail: a.whelan@unsw.edu.au                                                                                                                                                               Women’s Sexual and Reproductive Health Rights in the
                                                                                                                                 Adolescent Reproductive Health Service Package:
                                                                                                                                 A Guide for Field Practitioners, 36                       Occupied Palestinian Territory, 10
Background: Emergencies, natural and manmade, occur globally and often with little warning. Organisations that
respond to these crises focus on immediate shelter, food, water, and sanitation. The sexual and reproductive health (SRH)
needs of persons surviving crises are not immediately addressed during emergencies.
                                                                                                                                 Delivering Youth-Friendly Services in Internally          Afghanistan
                                                                                                                                 Displaced Persons Camps in Uganda Through
                                                                                                                                 Strategic Partnership, 41                                 Reproductive Health Needs Among Female Sex Workers
Purpose: Integrating SRH into emergency responses and the management of post-crisis situations is crucial for the
survival of the concerned populations, especially women and girls. Despite the importance of SRH in crises, it is still                                                                    in Afghanistan, 81
                                                                                                                                 Reproductive Health for War-Affected Youth, 47
not immediately and systematically addressed. The gap of SRH in crisis and post-crisis situations will be filled by the
implementation of the Minimum Initial Service Package (MISP) for SRH in crisis situations.                                                                                                 The Basic Package of Health Services in Post-Conflict
                                                                                                                                 Restoring the Right to Dignity as the Basis for           Countries: Implications and Challenges for Reproductive
                                                                                                                                 Promotion of Sexual and Reproductive Health of            Health Services, 73
Methods: SPRINT is an Australian Government, AusAID Initiative coordinated by the International Planned Parenthood
                                                                                                                                 Internally Displaced Adolescents in Colombia, 9
Federation/East and South East Asia and Oceania Region (IPPF ESEAOR). The overall goal of the SPRINT Initiative is to
integrate SRH into emergency responses and management of post-crisis situations, in the East, Southeast Asia, and the
                                                                                                                                 Vulnerability of Adolescents to Sexual and
                                                                                                                                                                                           Angola
Pacific Region. SPRINT is a joint initiative between IPPF and its partners: the United Nations Population Fund (UNFPA),
                                                                                                                                 Reproductive Health and Rights Problems:
the University of New South Wales, and the Australian Reproductive Health Alliance. It will also engage key grassroots                                                                     Unmet Need for Abortion Services: The Case of Internally
                                                                                                                                 Prevention Through Culturally Sensitive Education,
agencies working in emergency relief or SRH at the national level in each country. SPRINT aims to: increase the regional
                                                                                                                                 Services, and Empowerment, 83                             Displaced Women of Angola, 67
capacity of key stakeholders with regard to SRH response in crisis and post-crisis situations; strengthen the coordination
of SRH responses in crisis and post-crisis situations; raise awareness on the importance of addressing SRH in crisis and
                                                                                                                                 Youth and HIV-Positive People Support in a Conflict       Asia-Pacific
post-crisis situations at the national, regional, and international levels; respond in a timely fashion to SRH needs in crisis
                                                                                                                                 Setting: Experiences of Timor-Leste, 17
situations; and enhance access to SRH information and services for populations surviving crisis and living in protracted
                                                                                                                                                                                           Committing to Quality and Coherence in
post-crisis situations.
                                                                                                                                 Advocacy                                                  Emergency Response, 47

Findings: The first training of trainers will be conducted in April in Malaysia, followed by Australia and Fiji. Cascade
                                                                                                                                 Access to Social Justice for Victims of Sexual Violence   SPRINT: An Initiative to Address Sexual and Reproductive
trainings will be conducted later in 2008. Preliminary overview of the model and methods of evaluation will be presented
                                                                                                                                 in Conflict Situations, 84                                Health in Asia-Pacific, 90
at Reproductive Health in Emergencies Conference 2008.

Conclusion: Models of capacity building in SRH in the region require critical analysis. This intervention presents an ideal      Desperate and Alone: Reproductive Health Needs of Iraqi   Bangladesh
opportunity to document, evaluate, and analyse the effectiveness of a training model and consider innovative solutions.          Refugees in Jordan, 13
                                                                                                                                                                                           Acceptability and Utilization of Clean Delivery Kits in
                                                                                                                                 Emergency Contraception in Emergencies: Assessing         Cyclone-Affected Unions in Bangladesh, 5
                                                                                                                                 Progress, Identifying Challenges, 35
                                                                                                                                                                                           Reproductive Health Development Agency Provides
                                                                                                                                 Good Practices in MISP Implementation from Darfur, 40     Emergency Response to Cyclone-Affected Women and
                                                                                                                                                                                           Children in Bangladesh, 13
                                                                                                                                 Leveraging Case-Building Research to Increase Awareness
                                                                                                                                 of Emergency Contraception in Palestine, 26
                                                                                                                                                                                           Burma/Myanmar
                                                                                                                                 Promoting Access to Reproductive Health Products and
                                                                                                                                                                                           A Strategy to Deal with the Great Impact on
                                                                                                                                 Services in Conflict/Post-Conflict Countries, 5
                                                                                                                                                                                           Reproductive Health Service Delivery of Refugee
                                                                                                                                                                                           Resettlement to Third Countries, 34
                                                                                                                                 Research with Women War Torture Survivors in
                                                                                                                                 Luwero District, Uganda: Health Inequalities and
                                                                                                                                                                                           Adolescent Reproductive Health Network on the
                                                                                                                                 Policy Implications, 43
                                                                                                                                                                                           Thai-Burma Border, 87


90           RH in Emergencies Conference 2008 Proceedings — Book of Abstracts                                                                                                                                                                       91
Female Condom Networking on the                              Promoting Community Reconciliation Through                  Evaluating the Needs for Reproductive Health Services:       Fertility Desire and Family Planning Need Among
Thai-Burma Border, 86                                        Health Activities, 36                                       The Situation of Five General Reference Hospitals in the     HIV-Positive Men and Women in Ethiopia, 80
                                                                                                                         Democratic Republic of the Congo, 49
Improving Access to Emergency Obstetric                      SPRINT: An Initiative to Address Sexual and Reproductive                                                                 Improving Access to Family Planning Services Through
Care in Eastern Burma, 29                                    Health in Asia-Pacific, 90                                  Impact of the Reproductive Health Project on Care for        Community-Based Providers, 44
                                                                                                                         Rape Victims in Southern Kivu Province, 55
Partnering with Local Organizations to Expand                The MOM Project: Delivering Maternal Health                                                                              Increasing Demand for and Use of Modern Contraceptive
Access to Emergency Contraception in the                     Services Among Internally Displaced Populations             Is Family Planning a Sufficient Intervention for Meeting     Methods in Mornie and Kerenic Internally Displaced Person
Thai/Burma Border Zone, 78                                   in Eastern Burma, 42                                        Reproductive Health Needs?, 69                               Camps, West Darfur, Sudan, 31

Reproductive Health Status of the Rohingya                                                                               Reproductive Health Logistics in the Democratic              Increasing Family Planning Uptake Through
                                                             Caucasus
in Myanmar: Challenges in the                                                                                            Republic of Congo, 25                                        On–the-Job/Hands-On Training at Two Refugee
Returnee/Reintegration Phase, 11                                                                                                                                                      Settlements in Uganda, 43
                                                             HIV Evidence-Based Programming for Displaced Persons in
                                                                                                                         The Basic Package of Health Services in
                                                             the Southern Caucasus, 76
The MOM Project: Delivering Maternal Health                                                                              Post-Conflict Countries: Implications and Challenges         Is Family Planning a Sufficient Intervention for Meeting
Services Among Internally Displaced Populations                                                                          for Reproductive Health Services, 73                         Reproductive Health Needs?, 69
                                                             Promoting Community Reconciliation Through
in Eastern Burma, 42
                                                             Health Activities, 36
                                                                                                                         Uptake of the Lactational Amenorrhea Method in West          Knowledge and Use of Family Planning Among
                                                                                                                         Kasai Province, Democratic Republic of Congo, 68             Women in Northern Uganda: Findings from a
Capacity Building                                            Central African Republic                                                                                                 Population-Based Survey, 38

A Strategy to Deal with the Great Impact on                                                                              Ethiopia
                                                             Emergency Obstetric Care in a Chronic Conflict Setting                                                                   Leveraging Case-Building Research to Increase Awareness
Reproductive Health Service Delivery of Refugee
                                                             in Kaga Bandoro, Central African Republic, 20                                                                            of Emergency Contraception in Palestine, 26
Resettlement to Third Countries, 34                                                                                      Delivering Sexual and Reproductive Health
                                                                                                                         Services through Community Partnerships in
                                                             Gender-Based Violence and Health: Making Collaboration                                                                   Partnering with Local Organizations to Expand
Capacity-Building and Multi-Sectoral Collaboration of                                                                    Northern Ethiopia, 37
                                                             Work in Emergency Response, 65                                                                                           Access to Emergency Contraception in the Thai/Burma
Safe Motherhood Advocates: A Strategy for Reducing
                                                                                                                                                                                      Border Zone, 78
Maternal Mortality in Nigeria, 16                                                                                        Fertility Desire and Family Planning Need Among
                                                             Chad                                                        HIV-Positive Men and Women in Ethiopia, 80
                                                                                                                                                                                      Promotion of Family Planning and Reproductive Health
Challenges in Emergency Obstetric Care Training for Health
                                                             The Use of a Standard Questionnaire as a Tool to                                                                         Knowledge in Post-Conflict Lofa County, Liberia, 8
Workers in Conflict Areas in Africa, 16                                                                                  Maternal and Newborn Health in Refugee Camps in
                                                             Investigate the Cause of Spontaneous Abortions              Ethiopia: What a Difference Political and Financial
                                                             and Stillbirths, 14                                                                                                      Reproductive Health for War-Affected Youth, 47
Challenges of Maintaining Human Resources to Address                                                                     Commitment Can Make, 15
Reproductive Health in Emergency Situations, 60
                                                                                                                                                                                      Reproductive Health Needs Among Female Sex Workers
                                                             Colombia                                                    Family Planning                                              in Afghanistan, 81
Comprehensive HIV Services in a
Low-Resource Setting, 88                                     Access to Comprehensive Health Services for Internally      Amid Conflict: Nepal’s Female Community Health               Uptake of the Lactational Amenorrhea Method in West
                                                             Displaced Persons, 68                                       Volunteer Program, 79                                        Kasai Province, Democratic Republic of Congo, 68
Impact of Training Community-Based Health
Workers on the Use of the Partograph on Maternal and         Importance of the Information System in Profamilia, 58      Assessing Operational Barriers to Family Planning Services
Perinatal Mortality and Morbidity in a Post-Conflict,
                                                                                                                         for Refugees and Internally Displaced Persons, 77
                                                                                                                                                                                      Gaza/West Bank
Resource-Constrained Setting, 62                             Mental Distress and Intimate Partner Violence Outside of
                                                             Bogotá, Colombia, 31                                                                                                     Leveraging Case-Building Research to Increase Awareness
                                                                                                                         Contraceptive Use Among Women Refugees in Kyaka
Implementing a Training Centre in the South for People                                                                                                                                of Emergency Contraception in Palestine, 26
                                                                                                                         Refugee Settlement, Kyenjojo District, Uganda, 89
Living in Fragile States: Successes and Challenges of the    Restoring the Right to Dignity as the Basis for Promotion
RAISE Training Centre at Marie Stopes Kenya, 3               of Sexual and Reproductive Health of Internally Displaced                                                                Women’s Sexual and Reproductive Health Rights in the
                                                                                                                         Discrepancy in Knowledge of and Attitudes on Condom
                                                             Adolescents in Colombia, 9                                                                                               Occupied Palestinian Territory, 10
                                                                                                                         Use by Burundian Refugees in Mtendeli Refugee Camp,
Improving Access to Emergency Obstetric Care
                                                                                                                         Kibondo, Tanzania, 51
in Eastern Burma, 29                                         Sexual and Reproductive Health in Marginal Areas:                                                                        Gender-Based Violence
                                                             The Situation of Displaced Women in Colombia, 59            Ensuring Access to Family Planning Information
Increasing Family Planning Uptake Through
                                                                                                                         and Services Through Capacity Building in                    Access to Social Justice for Victims of Sexual Violence
On–the-Job/Hands-On Training at Two Refugee                  Sexual Violence in Colombia, 58                             War-Affected Regions, 21                                     in Conflict Situations, 84
Settlements in Uganda, 43

                                                             Democratic Republic of the Congo                            Female Condom Networking on the                              Building Capacity Through Partnership, 88
Issues in Training Post-Abortion Care Service Providers in
                                                                                                                         Thai-Burma Border, 86
Uganda: Personal Experience, 2
                                                             Clinical Management of Traumatic Fistulas in the                                                                         Challenges to Availability and Utilization of Clinical
                                                             Eastern Democratic Republic of Congo, 3                                                                                  Management of Rape Services in Northern Uganda, 53


92                                                                                                                                                                                                                                               93
Clinical Management of Rape Survivors in Emergencies:      Voices from the Field: Community Research on the              The Role of Logistics in Programme Life Cycle               The Sexual and Gender-Based Violence and HIV/AIDS
Looking Beyond Health Care Providers—UNFPA Zimbabwe        Experiences of Survivors and Perpetrators of                  and Effectiveness, 57                                       Situation and Response in Liberia, 27
Experience, 20                                             Sexual Violence, 4
                                                                                                                         Women’s Sexual and Reproductive Health Rights in the        Youth and HIV-Positive People Support in a Conflict
Clinical Management of Traumatic Fistulas in the Eastern                                                                 Occupied Palestinian Territory, 10                          Setting: Experiences of Timor-Leste, 17
                                                           General RH Response
Democratic Republic of Congo, 3

                                                           Access to Comprehensive Health Services for Internally        HIV & AIDS                                                  India
Community Perspectives and Programs on Gender-Based
                                                           Displaced Persons, 68
Violence and Human Rights Programming Among
                                                                                                                         Assessment of Sex Work in Refugee Camps, 75                 Assessing the State Capacity for Operationalizing First
Conflict-Affected Populations in Rwanda, 22
                                                           Access to Sexual and Reproductive Health Services by                                                                      Referral Units in Gujarat, 71
                                                           Internally Displaced Persons in Kitgum and Pader Districts,   Blood Transfusion Service: An Integral Component of
Discrepancy in Knowledge of and Attitudes on Condom
                                                           Northern Uganda, 61                                           Emergency Obstetric Care, 48
Use by Burundian Refugees in Mtendeli Refugee Camp,                                                                                                                                  Indonesia
Kibondo, Tanzania, 51
                                                           Between Two Fires: Ensuring Sexual and Reproductive           Comprehensive HIV/AIDS Programming Among
                                                                                                                                                                                     Comprehensive HIV Prevention as Part of Tsunami
                                                           Health and Rights Among Internally Displaced People in        Conflict-Affected Populations in Rwanda, 23
Enhancing Women’s Utilization of Reproductive Health                                                                                                                                 Response in Indonesia, 72
                                                           Gulu District, Northern Uganda, 56
Services Through Integration of Sexual and Gender-Based
                                                                                                                         Comprehensive HIV Prevention as Part of Tsunami
Violence Prevention and Response Activities, 1                                                                                                                                       Mainstreaming HIV/AIDS and Reproductive Health in a Food
                                                           Committing to Quality and Coherence in                        Response in Indonesia, 72
                                                                                                                                                                                     Aid Project in a Conflict-Affected Area, Central Sulawesi, 32
                                                           Emergency Response, 47
Gender-Based Violence and Health: Making Collaboration
                                                                                                                         Comprehensive HIV Services in a
Work in Emergency Response, 65                                                                                                                                                       Managing Reproductive Health Aid in
                                                           Delivering Sexual and Reproductive Health Services            Low-Resource Setting, 88
                                                                                                                                                                                     Emergency Situations, 29
                                                           Through Community Partnerships in Northern Ethiopia, 37
Identifying Survivors of Sexual Violence: Challenges
                                                                                                                         Differences in HIV-Related Behaviors at Lugufu Refugee
in the Field, 46                                                                                                                                                                     Re-Establishing Reproductive Health Care in Emergency
                                                           Implementation and Results of a Reproductive Health           Camp and Surrounding Host Villages, 73
                                                                                                                                                                                     Situations: The Aceh Tsunami Experience, 78
                                                           Survey Conducted in Darfur, 19
Impact of the Reproductive Health Project on Care for
                                                                                                                         Discrepancy in Knowledge of and Attitudes on Condom
Rape Victims in Southern Kivu Province, 55                                                                                                                                           Jordan
                                                           Implementing Reproductive Health Services in                  Use by Burundian Refugees in Mtendeli Refugee Camp,
                                                           the Northern Ugandan Context: Challenges and                  Kibondo, Tanzania, 51
Mental Distress and Intimate Partner Violence Outside                                                                                                                                Desperate and Alone: Reproductive Health Needs of Iraqi
                                                           Opportunities, 24
of Bogotá, Colombia, 31                                                                                                                                                              Refugees in Jordan, 13
                                                                                                                         Female Condom Networking on the Thai-Burma Border, 86
                                                           Increasing Access to Reproductive Health Services in
Partnering with Local Organizations to Expand
                                                           Emergencies Through Partnerships in the Philippines, 63       Fertility Desire and Family Planning Need Among             Kenya
Access to Emergency Contraception in the
                                                                                                                         HIV-Positive Men and Women in Ethiopia, 80
Thai/Burma Border Zone, 78
                                                           Managing Reproductive Health Aid in                                                                                       Preventing HIV and Ensuring Antiretroviral Continuity:
                                                           Emergency Situations, 29                                      HIV Evidence-Based Programming for Displaced Persons in     AMPATH’s Response to Internally Displaced HIV-Positive
Psychosocial Effects of Sexual Violence in
                                                                                                                         the Southern Caucasus, 76                                   Persons in Kenya, 12
Conflict Situations, 56
                                                           Mobile Service Units for Immediate Provision of Maternal
                                                           and Child Health/Reproductive Health Services: UNFPA’s        Integrative Asylum Policy Within South Africa:              Rapid Gender-Based Violence Response to the
Rapid Assessment of Gender-Based Violence among
                                                           Experience from the Pakistan Earthquake of 2005, 84           Investigating Access to Antiretroviral Treatment            Post-Election Violence in Kenya, 50
Internally Displaced Persons in Baidoa, Somalia, 45
                                                                                                                         Services for Refugees and Asylum Seekers Within a
                                                           Reaching Reproductive Health to the Unreachable:              Complex Urban Environment, 85
Rapid Gender-Based Violence Response to the
                                                           UNDP-Initiated Mobile Medical Teams                                                                                       Liberia
Post-Election Violence in Kenya, 50
                                                           and Partnerships, 33                                          Mainstreaming HIV/AIDS and Reproductive Health in
                                                                                                                         a Food Aid Project in a Conflict-Affected Area,             Establishment of a National Fistula Project in
Research with Women War Torture Survivors in
                                                           Re-Establishing Reproductive Health Care in Emergency         Central Sulawesi, 32                                        Liberia, 54
Luwero District, Uganda: Health Inequalities and
                                                           Situations: The Aceh Tsunami Experience, 78
Policy Implications, 43                                                                                                                                                              Promotion of Family Planning and Reproductive Health
                                                                                                                         Preventing HIV and Ensuring Antiretroviral Continuity:
                                                           Reproductive Health Development Agency Provides               AMPATH’s Response to Internally Displaced HIV-Positive      Knowledge in Post-Conflict Lofa County, Liberia, 8
Sexual Violence in Colombia, 58
                                                           Emergency Response to Cyclone-Affected Women and              Persons in Kenya, 12
                                                           Children in Bangladesh, 13                                                                                                The Sexual and Gender-Based Violence and HIV/AIDS
The Sexual and Gender-Based Violence and HIV/AIDS
                                                                                                                         Prevention of Mother-to-Child HIV Transmission Program in   Situation and Response in Liberia, 27
Situation and Response in Liberia, 27
                                                           Reproductive Health Status of the Rohingya in Myanmar:        Tham Hin Camp, Thailand, 75
                                                           Challenges in the Returnee/Reintegration Phase, 11                                                                        The Use of Epidemiological Data to Recommend
Traumatic Fistula: A Consequence of Sexual Violence, 74                                                                                                                              Reproductive Health Interventions in
                                                                                                                         Psychological Support and Health Behaviour in Women
                                                           The Basic Package of Health Services in Post-Conflict         Survivors Living with HIV After the Genocide: The Case of   Post-Conflict Liberia, 82
Unmet Need for Abortion Services: The Case of Internally
                                                           Countries: Implications and Challenges for Reproductive       Rwanda-Village Concept Project in Mpungwe Village, 52
Displaced Women of Angola, 67
                                                           Health Services, 73

94                                                                                                                                                                                                                                             95
Monitoring & Evaluation                                       Integrative Asylum Policy Within South Africa:                 The Use of Epidemiological Data to Recommend                 Increasing Access to Reproductive Health Services in
                                                              Investigating Access to Antiretroviral Treatment               Reproductive Health Interventions in                         Emergencies Through Partnerships in the Philippines, 63
Access to Sexual and Reproductive Health Services by          Services for Refugees and Asylum Seekers Within a              Post-Conflict Liberia, 82
Internally Displaced Persons in Kitgum and Pader Districts,   Complex Urban Environment, 85                                                                                               Partnering with Grassroots Organizations to Deliver
Northern Uganda, 61                                                                                                          Tracking and Improving Pregnancy Care in Rwanda, 54          Reproductive Health Services in Conflict-Affected
                                                              Introducing Maternal Death Audit at a Provincial Hospital in                                                                Districts in Uganda, 51
Assessing Operational Barriers to Family Planning Services    Sierra Leone: A Review of Twelve Months’ Experience, 49        Whose Choice? Results of a Survey of Knowledge,
for Refugees and Internally Displaced Persons, 77                                                                            Attitudes, and Practices about Abortion with Program
                                                                                                                                                                                          Philippines
                                                              Knowledge and Use of Family Planning Among                     Managers and Policymakers Working in Crisis Settings
Assessing Reproductive Health Needs in Crisis Settings by     Women in Northern Uganda: Findings from a                      in Nine African Nations, 66
                                                                                                                                                                                          Increasing Access to Reproductive Health Services in
Using the Reproductive Health Assessment Toolkit, 18          Population-Based Survey, 38
                                                                                                                                                                                          Emergencies Through Partnerships in the Philippines, 63
                                                                                                                             Nepal
Assessment of Sex Work in Refugee Camps, 75                   Mental Distress and Intimate Partner Violence Outside
                                                              of Bogotá, Colombia, 31                                                                                                     Policy & Funding
                                                                                                                             Amid Conflict: Nepal’s Female Community Health
Between Two Fires: Ensuring Sexual and Reproductive                                                                          Volunteer Program, 79
Health and Rights Among Internally Displaced People in        Misoprostol at the Community Level: A Feasible                                                                              Assessing Operational Barriers to Family Planning Services
Gulu District, Northern Uganda, 56                            Postpartum Hemorrhage Treatment Option Over the                                                                             for Refugees and Internally Displaced Persons, 77
                                                                                                                             Reproductive Health Service During Conflict in Nepal:
                                                              Long Term?, 66
                                                                                                                             Policy, Practice, and Achievement, 45
Blood Transfusion Service: An Integral Component of                                                                                                                                       Determining Donor Commitment Through Policy Analysis:
Emergency Obstetric Care, 48                                  Monitoring Reproductive Health Services Through a                                                                           Examining the Policy Environment for Reproductive Health
                                                              Standardised Health Information System, 28                     Nigeria                                                      in Crisis Settings, 26
Contraceptive Use Among Women Refugees in Kyaka
Refugee Settlement, Kyenjojo District, Uganda, 89             Monitoring the Availability and Utilization of Emergency       Capacity-Building and Multi-sectoral Collaboration of Safe   Integrative Asylum Policy Within South Africa:
                                                              Obstetric Care Services in West Darfur, Sudan: Using the       Motherhood Advocates: A Strategy for Reducing Maternal       Investigating Access to Antiretroviral Treatment
Differences in HIV-Related Behaviors at Lugufu Refugee        United Nations Process Indicators, 7                           Mortality in Nigeria, 16                                     Services for Refugees and Asylum Seekers Within a
Camp and Surrounding Host Villages, 73                                                                                                                                                    Complex Urban Environment, 85
                                                              New Methodologies to Measure Maternal Morbidity,               Impact of Training Community-Based Health
Evaluating the Needs for Reproductive Health Services:        Mortality, and Health Service Delivery in Emergencies, 8       Workers on the Use of the Partograph on Maternal and         Leveraging Case-Building Research to Increase Awareness
The Situation of Five General Reference Hospitals in the                                                                     Perinatal Mortality and Morbidity in a Post-Conflict,        of Emergency Contraception in Palestine, 26
Democratic Republic of the Congo, 49                          Perceptions and Experiences of Women with Abortion             Resource-Constrained Setting, 62
                                                              Complications Within the Post-War Context of South Sudan:                                                                   Maternal and Newborn Health in Refugee Camps in
                                                              Preliminary Results, 61                                                                                                     Ethiopia: What a Difference Political and Financial
Family Planning Saves Lives, 86                                                                                              Pakistan
                                                                                                                                                                                          Commitment Can Make, 15
Gaps in Systematic Approaches to Data Collection for          Qualitative Study on Maternal Referrals in Rural Tanzania:     Mobile Service Units for Immediate Provision of Maternal
Evidence-Based Reproductive Health Programming                Decision-Making and Acceptance of Referral Advice, 64                                                                       Promoting Access to Reproductive Health Products and
                                                                                                                             and Child Health/Reproductive Health Services: UNFPA’s
in Emergencies, 11                                                                                                                                                                        Services in Conflict/Post-Conflict Countries, 5
                                                                                                                             Experience from the Pakistan Earthquake of 2005, 84
                                                              Rapid Assessment of Gender-Based Violence Among
Health Facility Assessment Report, South Kordofan             Internally Displaced Persons in Baidoa, Somalia, 45                                                                         Reproductive Health Service During Conflict in Nepal:
                                                                                                                             Vulnerability of Adolescents to Sexual and
State, Sudan, 23                                                                                                                                                                          Policy, Practice, and Achievement, 45
                                                                                                                             Reproductive Health and Rights Problems:
                                                              Reproductive Health Needs Among Female Sex Workers             Prevention Through Culturally Sensitive Education,
                                                              in Afghanistan, 81                                                                                                          The Basic Package of Health Services in Post-Conflict
Impact of Training Community-Based Health                                                                                    Services, and Empowerment, 83
Workers on the Use of the Partograph on Maternal and                                                                                                                                      Countries: Implications and Challenges for Reproductive
Perinatal Mortality and Morbidity in a Post-Conflict,         Reproductive Health Status of the Rohingya in Myanmar:                                                                      Health Services, 73
                                                              Challenges in the Returnee/Reintegration Phase, 11             Partnership
Resource-Constrained Setting, 62
                                                                                                                                                                                          Tracking Official Development Assistance for Reproductive
                                                              Restoring the Right to Dignity as the Basis for Promotion      Building Capacity Through Partnership, 88                    Health in Conflict- and Crisis-Affected Countries, 63
Implementation and Results of a Reproductive Health
Survey Conducted in Darfur, 19                                of Sexual and Reproductive Health of Internally Displaced
                                                              Adolescents in Colombia, 9                                     Coordinating Relief and Development: Opportunities           Whose Choice? Results of a Survey of Knowledge,
                                                                                                                             and Challenges, 81                                           Attitudes, and Practices about Abortion with Program
Importance of the Information System in Profamilia, 58
                                                              Sexual and Reproductive Health in Marginal Areas:                                                                           Managers and Policymakers Working in Crisis Settings
                                                              The Situation of Displaced Women in Colombia, 59               Delivering Sexual and Reproductive Health Services           in Nine African Nations, 66
Increasing Demand for and Use of Modern Contraceptive
                                                                                                                             Through Community Partnerships in Northern Ethiopia, 37
Methods in Mornie and Kerenic Internally Displaced Person
Camps, West Darfur, Sudan, 31                                 Sexual Violence in Colombia, 58                                                                                             Women’s Sexual and Reproductive Health Rights in the
                                                                                                                             Delivering Youth-Friendly Services in Internally             Occupied Palestinian Territory, 10
                                                              The Use of a Standard Questionnaire as a Tool to               Displaced Persons Camps in Uganda Through
                                                              Investigate the Cause of Spontaneous Abortions                 Strategic Partnership, 41
                                                              and Stillbirths, 14

96                                                                                                                                                                                                                                                  97
Reproductive Health Commodities                              Establishment of a National Fistula Project in                 The MOM Project: Delivering Maternal Health                    Sri Lanka
                                                             Liberia, 54                                                    Services Among Internally Displaced Populations in
Logistics Management of Reproductive Health Emergency                                                                       Eastern Burma, 42                                              Logistics Management of Reproductive Health Emergency
Kits in Tsunami-Affected Sri Lankan Communities, 40          Impact of Training Community-Based Health Workers on                                                                          Kits in Tsunami-Affected Sri Lankan Communities, 40
                                                             the Use of the Partograph on Maternal and Perinatal            The Use of a Standard Questionnaire as a Tool to
Promoting Access to Reproductive Health Products and         Mortality and Morbidity in a Post-Conflict,                    Investigate the Cause of Spontaneous Abortions
                                                             Resource-Constrained Setting, 62                               and Stillbirths, 14
                                                                                                                                                                                           Sudan
Services in Conflict/Post-Conflict Countries, 5

                                                                                                                                                                                           Comprehensive HIV Services in a Low-Resource Setting, 88
Reproductive Health Logistics in the Democratic              Improved Access to Obstetric Fistula Management in             Tracking and Improving Pregnancy Care in Rwanda, 54
Republic of Congo, 25                                        Conflict Zones, 33
                                                                                                                                                                                           Family Planning Saves Lives, 86
                                                                                                                            Unmet Need for Abortion Services: The Case of Internally
                                                             Improving Access to Emergency Obstetric Care in                Displaced Women of Angola, 67
Rwanda                                                       Eastern Burma, 29
                                                                                                                                                                                           Fistula Survivor and Midwife, 30

                                                                                                                            Whose Choice? Results of a Survey of Knowledge,
Community Perspectives and Programs on Gender-Based                                                                                                                                        Good Practices in MISP Implementation from Darfur, 40
                                                             Improving Coverage and Quality of Antenatal Care in            Attitudes, and Practices about Abortion with Program
Violence and Human Rights Programming Among
                                                             Kerenik Internally Displaced Persons’ Camp in West             Managers and Policymakers Working in Crisis Settings
Conflict-Affected Populations in Rwanda, 22                                                                                                                                                Health Facility Assessment Report, South Kordofan
                                                             Darfur, Sudan, 6                                               in Nine African Nations, 66
                                                                                                                                                                                           State, Sudan, 23
Psychological Support and Health Behaviour in Women
                                                             Introducing Maternal Death Audit at a Provincial Hospital in
Survivors Living with HIV After the Genocide: The Case of
                                                             Sierra Leone: A Review of Twelve Months’ Experience, 49        Sierra Leone                                                   Implementation and Results of a Reproductive Health
Rwanda-Village Concept Project in Mpungwe Village, 52                                                                                                                                      Survey Conducted in Darfur, 19

                                                             Issues in Training Post-Abortion Care Service Providers in     Adolescent Reproductive Health and Rights in Rural
Tracking and Improving Pregnancy Care in Rwanda, 54                                                                         Post-Conflict Settings, 38                                     Improving Coverage and Quality of Antenatal Care in
                                                             Uganda: Personal Experience, 2
                                                                                                                                                                                           Kerenik Internally Displaced Persons’ Camp in West
                                                                                                                                                                                           Darfur, Sudan, 6
Safe Motherhood                                              Maternal and Newborn Health in Refugee Camps in                Assessing Operational Barriers to Family Planning Services
                                                             Ethiopia: What a Difference Political and Financial            for Refugees and Internally Displaced Persons, 77
                                                                                                                                                                                           Increasing Demand for and Use of Modern Contraceptive
“Midwives on Bikes” in Timor-Leste: An Innovative            Commitment Can Make, 15
                                                                                                                            Blood Transfusion Service: An Integral Component of            Methods in Mornie and Kerenic Internally Displaced Person
Approach to Reproductive Health in Crisis, 71
                                                                                                                            Emergency Obstetric Care, 48                                   Camps, West Darfur, Sudan, 31
                                                             Mifepristone and Misoprostol: The Promise of
Acceptability and Utilization of Clean Delivery Kits in      New Reproductive Health Technologies in Emergency
                                                                                                                            Ensuring Access to Family Planning Information                 Monitoring the Availability and Utilization of Emergency
Cyclone-Affected Unions in Bangladesh, 5                     Situations, 70
                                                                                                                            and Services Through Capacity Building in                      Obstetric Care Services in West Darfur, Sudan: Using the
                                                                                                                            War-Affected Regions, 21                                       United Nations Process Indicators, 7
Addressing Fistula: Process and Partnerships with Ministry   Misoprostol at the Community Level: A Feasible
of Health and Non-Governmental Organisations, 1              Postpartum Hemorrhage Treatment Option Over the
                                                                                                                            Introducing Maternal Death Audit at a Provincial Hospital in   Perceptions and Experiences of Women with Abortion
                                                             Long Term?, 66
                                                                                                                            Sierra Leone: A Review of Twelve Months’ Experience, 49        Complications Within the Post-War Context of South Sudan:
Amid Conflict: Nepal’s Female Community Health
                                                                                                                                                                                           Preliminary Results, 61
Volunteer Program, 79                                        Misoprostol: A Promising Reproductive Health Technology
                                                             in Emergency Situations, 70                                    Reproductive Health for War-Affected Youth, 47
                                                                                                                                                                                           The Basic Package of Health Services in Post-Conflict
Assessing the State Capacity for Operationalizing First
                                                                                                                                                                                           Countries: Implications and Challenges for Reproductive
Referral Units in Gujarat, 71                                Mobile Service Units for Immediate Provision of Maternal       Somalia                                                        Health Services, 73
                                                             and Child Health/Reproductive Health Services: UNFPA’s
Blood Transfusion Service: An Integral Component of          Experience from the Pakistan Earthquake of 2005, 84            Improved Access to Obstetric Fistula Management in
Emergency Obstetric Care, 48                                                                                                Conflict Zones, 33                                             Tanzania
                                                             Monitoring the Availability and Utilization of Emergency
Capacity-Building and Multi-sectoral Collaboration of Safe   Obstetric Care Services in West Darfur, Sudan: Using the       Rapid Assessment of Gender-Based Violence among                Differences in HIV-Related Behaviors at Lugufu Refugee
Motherhood Advocates: A Strategy for Reducing Maternal       United Nations Process Indicators, 7                           Internally Displaced Persons in Baidoa, Somalia, 45            Camp and Surrounding Host Villages, 73
Mortality in Nigeria, 16
                                                             New Methodologies to Measure Maternal Morbidity,                                                                              Discrepancy in Knowledge of and Attitudes on Condom
Challenges in Emergency Obstetric Care Training for Health   Mortality, and Health Service Delivery in Emergencies, 8
                                                                                                                            South Africa                                                   Use by Burundian Refugees in Mtendeli Refugee Camp,
Workers in Conflict Areas in Africa, 16                                                                                                                                                    Kibondo, Tanzania, 51
                                                                                                                            Integrative Asylum Policy Within South Africa:
                                                             Perceptions and Experiences of Women with Abortion
                                                                                                                            Investigating Access to Antiretroviral Treatment
Emergency Obstetric Care in a Chronic Conflict Setting       Complications Within the Post-War Context of South                                                                            Misoprostol at the Community Level: A Feasible
                                                                                                                            Services for Refugees and Asylum Seekers Within a
in Kaga Bandoro, Central African Republic, 20                Sudan: Preliminary Results, 61                                                                                                Postpartum Hemorrhage Treatment Option Over the
                                                                                                                            Complex Urban Environment, 85
                                                                                                                                                                                           Long Term?, 66
Family Planning Saves Lives, 86                              Qualitative Study on Maternal Referrals in Rural Tanzania:
                                                             Decision-Making and Acceptance of Referral Advice, 64                                                                         Qualitative Study on Maternal Referrals in Rural Tanzania:
Fistula Survivor and Midwife, 30                                                                                                                                                           Decision-Making and Acceptance of Referral Advice, 64

98                                                                                                                                                                                                                                                    99
Thailand                                                      Improving Access to Family Planning Services Through
                                                              Community-Based Providers, 44
A Strategy to Deal with the Great Impact on
Reproductive Health Service Delivery of Refugee               Increasing Family Planning Uptake Through
Resettlement to Third Countries, 34                           On–the-Job/Hands-On Training at Two Refugee
                                                              Settlements in Uganda, 43
Adolescent Reproductive Health Network on the
Thai-Burma Border, 87                                         Issues in Training Post-Abortion Care Service Providers in
                                                              Uganda: Personal Experience, 2
Female Condom Networking on the Thai-Burma Border, 86
                                                              Knowledge and Use of Family Planning Among
Partnering with Local Organizations to Expand Access          Women in Northern Uganda: Findings from a
to Emergency Contraception in the Thai/Burma                  Population-Based Survey, 38
Border Zone, 78
                                                              Partnering with Grassroots Organizations to Deliver
Prevention of Mother-to-Child HIV Transmission Program in     Reproductive Health Services in Conflict-Affected
Tham Hin Camp, Thailand, 75                                   Districts in Uganda, 51

                                                              Psychosocial Effects of Sexual Violence in
Timor-Leste                                                   Conflict Situations, 56

“Midwives on Bikes” in Timor-Leste: An Innovative
                                                              Research with Women War Torture Survivors in
Approach to Reproductive Health in Crisis, 71
                                                              Luwero District, Uganda: Health Inequalities and
                                                              Policy Implications, 43
Youth and HIV-Positive People Support in a Conflict
Setting: Experiences of Timor-Leste, 17
                                                              Voices from the Field: Community Research on the
                                                              Experiences of Survivors and Perpetrators of
Uganda                                                        Sexual Violence, 4

Access to Sexual and Reproductive Health Services by          We Want Birth Control: Reproductive Health Findings from
Internally Displaced Persons in Kitgum and Pader Districts,   Northern Uganda, 39
Northern Uganda, 61
                                                              Zimbabwe
Between Two Fires: Ensuring Sexual and Reproductive
Health and Rights Among Internally Displaced People in
                                                              Clinical Management of Rape Survivors in Emergencies:
Gulu District, Northern Uganda, 56
                                                              Looking Beyond Health Care Providers—UNFPA Zimbabwe
                                                              Experience, 20
Challenges to Availability and Utilization of Clinical
Management of Rape Services in Northern Uganda, 53

Contraceptive Use Among Women Refugees in Kyaka
Refugee Settlement, Kyenjojo District, Uganda, 89

Delivering Youth-Friendly Services in Internally
Displaced Persons Camps in Uganda Through
Strategic Partnership, 41

Enhancing Women’s Utilization of Reproductive Health
Services Through Integration of Sexual and Gender-Based
Violence Prevention and Response Activities, 1

Implementing Reproductive Health Services in the
Northern Ugandan Context: Challenges and
Opportunities, 24




100
          Reproductive Health in
                                     Organised by the RAISE Initiative in
          Emergencies in
Reproductive HealthConference 2008   collaboration with the RHRC Consortium

Emergencies Conference 2008

								
To top