Assessment of reproductive health and violence against women among displaced Syrians in Lebanon

Amelia Reese Masterson1, Jinan Usta2, Jhumka Gupta1, Adrienne S. Ettinger1
1Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06510, USA
2Department of Family Medicine, American University of Beirut Medical Center, Riad El Solh, Beirut, 1107 2020, Lebanon

Tóm tắt

Abstract Background The current conflict in Syria continues to displace thousands to neighboring countries, including Lebanon. Information is needed to provide adequate health and related services particularly to women in this displaced population. Methods We conducted a needs assessment in Lebanon (June-August 2012), administering a cross-sectional survey in six health clinics. Information was collected on reproductive and general health status, conflict violence, stress, and help-seeking behaviors of displaced Syrian women. Bivariate and multivariate analyses were conducted to examine associations between exposure to conflict violence, stress, and reproductive health outcomes. Results We interviewed 452 Syrian refugee women ages 18–45 who had been in Lebanon for an average of 5.1 (± 3.7) months. Reported gynecologic conditions were common, including: menstrual irregularity, 53.5%; severe pelvic pain, 51.6%; and reproductive tract infections, 53.3%. Among the pregnancy subset (n = 74), 39.5% of currently pregnant women experienced complications and 36.8% of those who completed pregnancies experienced delivery/abortion complications. Adverse birth outcomes included: low birthweight, 10.5%; preterm delivery, 26.5%; and infant mortality, 2.9%. Of women who experienced conflict-related violence (30.8%) and non-partner sexual violence (3.1%), the majority did not seek medical care (64.6%). Conflict violence and stress score was significantly associated with reported gynecologic conditions, and stress score was found to mediate the relationship between exposure to conflict violence and self-rated health. Conclusions This study contributes to the understanding of experience of conflict violence among women, stress, and reproductive health needs. Findings demonstrate the need for better targeting of reproductive health services in refugee settings, as well as referral to psychosocial services for survivors of violence.

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Tài liệu tham khảo

Coutts A, Fouad FM: Response to Syria’s health crisis—poor and uncoordinated. Lancet. 2013, 381 (9885): 2242-2243. 10.1016/S0140-6736(13)61421-X.

[No authors listed]: A medical crisis in Syria. Lancet. 2012, 380 (9841): 537-10.1016/S0140-6736(12)61309-9.

Barmania S: Undercover medicine: treating Syria’s wounded. Lancet. 2012, 379 (9830): 1936-1937. 10.1016/S0140-6736(12)60842-3.

United Nations High Commissioner for Refugees (UNHCR): Syria Regional Refugee Response, Information Portal. http://data.unhcr.org/syrianrefugees/country.php?id=122.

United Nations Development Program (UNDP): Poverty, Grown and Income Distribution in Lebanon. 2008, UNDP report, http://www.lb.undp.org/content/lebanon/en/home/library/poverty/poverty--growth-and-income-distribution-in-lebanon-.html.

United Nations Development Program (UNDP): UNDP report (Arabic). Human Poverty map and Living Conditions in Lebanon 2004. 2008, http://www.lb.undp.org/content/lebanon/en/home/library/poverty/mapping-of-human-poverty-and-living-conditions-in-lebanon-2004.html.

Inter-agency Working Group on Reproductive Health in Crisis (IAWG): Revision for Field Review. Inter-Agency Field Manual on Reproductive Health in Humanitarian Settings. 2010, http://www.searo.who.int/entity/emergencies/documents/field_manual_rh_humanitarian_settings.pdf.

Al Gasseer N, Dresden E, Keeney GB, Warren N: Status of women and infants in complex humanitarian emergencies. J Midwifery Womens Health. 2004, 49 (suppl 1): 7-13.

Gagnon AJ, Merry L, Robinson C: A systematic review of refugee women’s reproductive health. Refuge. 2002, 21 (1): 6-17.

McGinn T: Reproductive health of war-affected populations: what do we know?. Int Fam Plan Perspect. 2000, 26: 174-180. 10.2307/2648255.

Jamieson DJ, Meikle SF, Hillis SD, Mtsuki D, Mawji S, Duerr A: An evaluation of poor pregnancy outcomes among Burundian refugees in Tanzania. JAMA. 2000, 283 (3): 397-402. 10.1001/jama.283.3.397.

Falb KL, McCormick MC, Hemenway D, Anfinson K, Silverman JG: Symptoms associated with pregnancy complications along the Thai-Burma border: the role of conflict violence and intimate partner violence. Matern Child Health J. 2014, 18 (1): 29-37. 10.1007/s10995-013-1230-0.

Usta J, Farver JAM, Zein L: Women, war, and violence: surviving the experience. J Women’s Health. 2008, 17 (5): 793-804. 10.1089/jwh.2007.0602.

Stark L, Ager A: A systematic review of prevalence studies of gender-based violence in complex emergencies. Trauma Violence Abuse. 2011, 12 (3): 127-134. 10.1177/1524838011404252.

World Health Organization (WHO): Reference Number 978-92-4-156462-5. Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and non-partner sexual violence. 2013, Geneva: World Health Organization, http://www.who.int/reproductivehealth/publications/violence/9789241564625/en/index.html.

Campbell JC: Health consequences of intimate partner violence. Lancet. 2002, 359: 1331-36. 10.1016/S0140-6736(02)08336-8.

Lederman RP: The relationship of anxiety, stress, and psychosocial development to reproductive health. Behav Med. 1995, 21 (3): 101-112. 10.1080/08964289.1995.9933748.

Ouyang H: Syrian refugees and sexual violence. Lancet. 2013, 381 (9884): 2165-2166.

Amnesty International: MDE 24/016/2012. March 14, 2012. I Wanted to Die: Syria’s Torture Survivors Speak Out. http://www.amnestyusa.org/research/reports/i-wanted-to-die-syria-s-torture-survivors-speak-out.

Human Rights Watch: Syria: Sexual Assault in Detention. 2012, http://www.hrw.org/news/2012/06/15/syria-sexual-assault-detention.

International Rescue Committee: Syrian women and girls: fleeing death, facing ongoing threats and humiliation, A gender-based violence rapid assessment. http://www.eldis.org/go/display&type=Document&id=63829#.UdAj8j772bI.

Emenike E, Lawoko S, Dalal K: Intimate partner violence and reproductive health of women in Kenya. Int Nurs Rev. 2008, 55: 97-102. 10.1111/j.1466-7657.2007.00580.x.

Okenwa A, Lawoko S, Jansson B: Contraception, reproductive health and pregnancy outcomes among women exposed to intimate partner violence in Nigeria. Eur J Contracep Repr. 2011, 16: 18-25. 10.3109/13625187.2010.534515.

Leserman J: Sexual abuse history: prevalence, health effects, mediators, and psychological treatment. Psychosom Med. 2005, 67: 906-915. 10.1097/01.psy.0000188405.54425.20.

Center for Disease Control and Prevention (CDC): Proceeding of the Technical Workshop on Setting Research Priorities for Reproductive Health in Crisis Settings. 2011, Atlanta, GA: Inter-agency Working Group on Reproductive Health in Crisis (IAWG) and the Center for Global Health, Division of Global Disease Detection and Emergency Response

Reproductive Health Response in Conflict Consortium (RHRC): Gender-based Violence Tools Manual–For Assessment & Program Design, Monitoring & Evaluation in Conflict-Affected Settings. 2003, New York, NY: RHRC, http://www.rhrc.org/resources/gbv/gbv_tools/manual_toc.html.

Centers for Disease Control and Prevention (CDC): Reproductive Health Assessment Toolkit for Conflict-Affected Women. 2007, Atlanta, GA: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Coordinating Center for Health Promotion, Centers for Disease Control and Prevention, Department of Health and Human Services, http://www.cdc.gov/reproductivehealth/Global/CrisisSituations.htm.

United Nations Children’s Fund (UNICEF): Syria: Multiple Indicator Cluster Survey (MICS), Monitoring the Situation of Children and Women. 2006, [referenced in hard copy]

Hamad KA, Abed Y, Hamad BA: Risk factors associated with preterm birth in the Gaza Strip: hospital-based case–control study. East Mediterr Health J. 2007, 13 (5): 1132-1141.

Kramer MS, Seguin L, Lydon J, Goulet L: Socio-economic disparities in pregnancy outcome: why do the poor fare so poorly?. Paediatr Perinat Epidemiol. 2000, 14: 194-210. 10.1046/j.1365-3016.2000.00266.x.

Yanit KE, Snowden JM, Cheng YW, Caughey AB: The impact of chronic hypertension and pregestational diabetes on pregnancy. Am J Obstet Gynecol. 2012, 207 (4): 333-e1–6

Bánhidy F, Ács N, Puhó EH, Czeizel AE: Iron deficiency anemia: pregnancy outcomes with or without iron supplementation. Nutrition. 2011, 27: 65-72. 10.1016/j.nut.2009.12.005.

World Health Organization (WHO): WHO/FCH/GWH/01.1. Putting women’s safety first. Ethical and safety recommendations for research on domestic violence against women. 2001, Geneva: World Health Organization, http://www.who.int/gender/violence/womenfirtseng.pdf.

Garcia-Moreno C, Jansen HAFM, Ellsberg M, Heise L, Watts C: Reference number 92-4-159358-X. WHO multi-country study on women’s health and domestic violence against women. 2005, Geneva: World Health Organization, http://whqlibdoc.who.int/publications/2005/924159358X_eng.pdf.