By Lydia Nyaketcho
At least 300,000 women and girls get pregnant in Uganda’s refugee camps annually, but reproductive health services remain sparse.
Imagine yourself as a refugee from South Sudan, Burundi, Congo, Eritrea, Somalia, or any other country like Ethiopia has crossed into Uganda. It could be a long journey that includes travel through conflict zones. When you first arrive, your top considerations are likely to be food and shelter, as well as protecting your loved ones; family planning is likely to be the last thing on your mind.
Pregnancy does, however, occur in refugee camps, and conflict zones are no exception. Unfortunately, access to family planning may be limited in Uganda’s most vulnerable areas.
Although Ugandan refugees do not encounter the same difficulties, Scovia Tabaria, a 30-year-old refugee in Pagirinya camp with three children, claims that challenging pregnancies occur frequently when refugees are forced to escape their homes.
Some women are forced to give birth alone; others make it to clinics but are in desperate need of blood transfusions and are kilometers away from the nearest blood bank. In Uganda, pregnant women and newborns are at danger of contracting sexually transmitted infections, mortality, and impairment.
According to Robert Andeoye, Settlement Commandant at Pagirinya refugee camp in Uganda, which houses 240,161 refugees, this is especially true for vulnerable people like refugees. Nearly one-third of deliveries in refugee camps are likely to result in life-threatening complications, necessitating immediate medical assistance that can only be provided by an expert.
When a woman has experienced the stress of escaping a crisis, delivery is more likely to be complicated, and medical help, such as antenatal care, is less likely to be accessible. Yes, the risks of pregnancy are increased, but in an emergency, reproductive health and rights are frequently overlooked.
Uganda had a poor functioning health system before the country’s home countries for refugees collapsed into civil conflict and natural disaster. Family planning was not free, and only around ten percent of women utilized it on a regular basis.
Despite this, only 7% of non-pregnant married women in Uganda used contraception the last time a major survey was conducted among refugees. According to the United Nations Population Fund (UNFPA), 300,000 Ugandan women and refugees will become pregnant in the next year. Refugees in Uganda frequently confide in charity workers that they are afraid of becoming pregnant, so why is family planning so uncommon?
Part of the explanation, according to Pauline Idia, Adjumani district Assistant Health Officer for Maternal and Child Health, is rooted in the same reasons that women lack information and healthcare in general. Uganda is failing to meet the need for basic healthcare among refugees, which has increased to 1.4 million.
Most refugees reside in makeshift camps outside of cities and have no idea where they may access healthcare, including family planning. Cost, knowledge, and transportation are all important considerations. The majority of clinics are privately owned and unreasonably expensive: a medicine prescription and a consultation fee may be only a few shillings, but most Ugandan refugees are completely dependent on their funds, which are rapidly depleting.
People will, understandably, be concerned about medical care for those who are already unwell, as well as obtaining food and housing for refugee populations. Colleagues from other NGO’s have told stories about putting up focus groups to evaluate family planning requirements, only to be interrupted by migrants who demanded to talk about food and jobs instead.
The solution, according to Annet Kyarimpa, Safe Motherhood Manager at Reproductive Health Uganda (RHU), rests in adjusting to the individual needs of refugees, whether they live in camps, host communities, or informal settlements. RHU, for example, uses outreaches and fixed clinics to bring healthcare to remote Ugandan villages.
With support from the Danish International Development Agency (DANIDA), we are prioritizing such clinics in Uganda to provide sexual reproductive healthcare and rights by choice, including integrated family planning services, to unregistered refugees in 19 settlements of Adjumani district, as well as Kampala urban refugees.
Integrated Family Planning (IFP) remains a less expensive approach of lowering pregnancy-related fatalities, and it is something that refugee women and those from host communities have frequently informed us they require. However, in comparison to Ugandan residents, vulnerable communities receive 50% less planning, financing, and attention for reproductive health.
However, Norbert Anyase, acting In-Charge of Pagirinya Health Centre III, which is run by RHU partner Medical Teams International (MTI), says that by addressing this diverse and often complex set of challenges, pregnancy can be the natural and life-affirming process it should be for refugee women who have already endured conflict and disaster.