Getting it right? Women’s reproductive health and health services in Darfur, Sudan.

Abstract

Abstract Title: Getting it right? Women's sexual-and reproductive health and health services in Darfur, Sudan. A qualitative study Researcher: Sara Rivenes Supervisor: Prof. Johanne Sundby Background: There are 25 million internally displaced in the world due to armed conflict. 70- 80% of these are women and children. The conflict in Darfur have received massive international attention due to the forced displacement of over 2 million people, mass killings and widespread use of sexual- and gender based violence. A number of NGO's are providing humanitarian assistance to the people of Darfur, including women, who have specific needs and concerns related to their reproductive- and sexual health. When these are not addressed adequately this part of women's health is a major cause of morbidity and mortality. Few studies conducted during conflict have focused on the health services directed at women's sexual- and reproductive health. Objectives: The overall objective of the study was to acquire new knowledge about how women's sexual- and reproductive health concerns are catered for by the health services available during conflict. The specific objectives where the following; to explore women's experiences of safety and/ or danger in their lives, to explore quality issues in the availability of family planning methods, to explore quality issues in the antenatal and postnatal care, to explore women’s perception of the health care available and to identify recommendations for improvements and/ or changes of these services. Method: Qualitative research methods were used, including interviews with 14 women, 9 IDP's and 5 women of the host community, interviews with 6 health care workers and 60 hours of non- participant observation of the health services. Results: All the informants said they felt safe in the current lives. The IDP's had before the displacement experienced threats of violence and witnessed severe forms of violence, including killings. The women in the study had limited access to family planning methods. A limited selection of oral and injectible contraceptives were available at cost, which meant that this was unattainable for most, especially the women living in the IDP camp who had limited resources and income. The antenatal services were less than optimal. Antenatal examinations were unfocused and random and essential components such as identifying risk cases or interventions to ensure adequate nutrition during pregnancy where not adequately addressed. The women interviewed were in general pleased with the health services, but expressed a need for more equipment in the primary health clinics and more attention on nutrition during the antenatal and postpartum period. Recommendations are to include pregnant and lactating women into the nutrition programme, strengthen income generating activities for women, improve reproductive-and sexual health education and information, reinforce procedures and guidelines of health care workers, especially with regards to antenatal-and postpartum examination and emergency obstetric care, provide oral and injectible contraceptives free of charge to all women and improve procedures related to monitoring and evaluation of the health services. Conclusion: the health services directed at women's sexual- and reproductive health should be strengthened and improved to more adequately address the concerns and needs of the women included in the study.