CONTENTS
HIGHLIGHTS
November, 1996 |
Reproductive health programs and urban planners typically do not anticipate providing services to an influx of migrants from rural areas or from other countries (28, 252, 270). When a large new group arrives, services and supplies often are not available to meet the increased demand. Nor are staff prepared to deal with people who may speak different languages and have different cultural preferences. Nevertheless, as much as possible, health programs should anticipate migration and plan to provide services to the migrants. At the beginning of an irrigation project in the Kou Valley of Burkina Faso, for example, planners concluded that social and health services should be in place before the project began. Then migrants attracted by the project would have services available when they arrived (75). Similarly, to deal with movements of refugees and internally displaced persons, service protocols, training manuals, service delivery guidelines, and informational materials should be prepared in advance and made available as quickly as possible (335). Rural-to-urban migrants often have poor access to reproductive health care. DHS data suggest that migrant communities are not as well served as other areas. Among contraceptive users, rural-to-urban migrants are more likely than urban nonmigrants to travel an hour or more to reach the nearest source of modern contraceptives (see Figure 6). Having to travel long distances to reach providers discourages use of services (329). Refugee camps may be located far from hospitals and clinics. When services are unavailable in camps, refugees or internally displaced persons may have to travel many hours to find services in the surrounding communities, if they dare to leave the camps at all (205). In the Great Lakes Region refugee camps, women with complications of pregnancy were referred to district hospitals often 45 minutes to 90 minutes from the camp (222). In contrast, when reproductive health services are available in camps, refugees may have even better access than they did at home (95, 196).
People who move often can be served better if health care programs reach out to them where they work and live (42, 178, 192, 344). Often this can be done by adapting existing services (117, 225). In other cases new services are needed. For example, a program in the Adana region of Turkey reached some 24,000 seasonal migrant farm workers and their families by operating from mobile vans. Special clinics stayed open during evening hours to accommodate the workers (340). Use of modern contraceptives rose from 10% to 50% among migrant married women of reproductive age (2). The program followed up after migrants returned home, making sure that they had continued access to family planning (2, 340). In South Africa projects have provided reproductive health services specifically for temporary migrant workers and their families in mining areas (208). In Azerbaijan mobile teams periodically visit settlements where internally displaced persons are living (117). In Pakistan and China programs have offered nomads unique services, such as audio tapes about reproductive health that women could listen to while herding (124, 254). Programs also can reach out to refugees living in camps. For example, use of health services often increases when services are located more conveniently (11, 129, 242). In Pakistan, when refugee women were not allowed to leave their homes, health workers went to their homes (333). Factory-based family planning programs have reached migrants in Mauritius, Thailand, and elsewhere (49, 178, 192, 232, 244). Marie Stopes International has run employment-based reproductive health care projects for refugees and migrants in Bangladesh, Malawi, Madagascar, and elsewhere. They have proved so successful that in some cases employers have begun to help pay their costs (255). |