Population Reports is published by the Population Information Program, Center for Communication Programs, The Johns Hopkins School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland 21202-4012, USA

Migrants, refugees, and internally displaced persons are among the world's most vulnerable people. Clustered on the margins of cities or culturally isolated within them, housed in camps meant to be temporary, or without homes at all, they often have urgent health needs, including reproductive health. Programs and relief agencies are beginning to respond to this need.

People move for many different reasons, and their circumstances vary widely. Still, they are alike in three important ways:

• Disruption. Most have left behind the support of traditional values, extended families, friends, and familiar ways of life. With limited means, they face new and uncertain situations.
• Differences. Culture and language often set them apart from their new neighbors. Reproductive attitudes and behavior often differ as well.
• Difficulties of access. Many are ineligible for health care benefits, unfamiliar with family planning programs, and unable to obtain information easily.

An estimated 16 million people migrate each year from rural to urban areas of developing countries, excluding China, accounting for about half of recent urban growth. In addition, about 2 to 4 million people migrate internationally each year. Another 18 million people—over five times the number 20 years ago—have fled their own countries, as refugees. Also, about 20 million people are internally displaced. They have fled their communities and sought safety elsewhere within their own countries. The reproductive health of many migrants, refugees, and internally displaced persons suggests several concerns:

• Contraceptive access and use are limited. Recent migrants are less likely than other urban residents to use family planning. Attitudes explain part of the difference, but access is often a problem. Among contraceptive users, rural-to-urban migrants are more likely than urban nonmigrants to travel at least an hour to reach the nearest source of modern contraceptives.
• Risks of HIV/AIDS and other sexually transmitted diseases are high. The disruption of family and community life during moves, especially in situations of poverty and crisis, increases risky sexual behavior and exposure to STDs.
• Safe motherhood is difficult. Among refugees and internally displaced persons, childbearing can be life-threatening. During emergencies women often lack adequate food, shelter, and sanitation. Prenatal and delivery care often are minimal, and emergency care may be hours away.
• Violence against women is frequent. Women who move are especially vulnerable to sexual abuse. Among refugees, rapes occur frequently. Some women may have no choice but to trade sex for protection, money, and food.

While reproductive health programs often serve migrants along with others living in urban areas, few have recognized rural-to-urban migrants as a specific group with special needs. In urban areas health care providers need to reach out to new migrants. The first step is to assess migrants' needs and how they differ from others' needs. Then information and services must be tailored to meet these needs, made appropriate in language and culture, and provided with the involvement and often the help of the community.