Fetters Tamara, Rubayet Sayed, Sultana Sharmin, Nahar Shamila, Tofigh Shadie, Jones Lea, Samandari Ghazaleh, Powell Bill
Ipas, Chapel Hill, North Carolina USA.
Ipas Bangladesh, Dhaka, Bangladesh.
Confl Health. 2020 Jul 23;14:50. doi: 10.1186/s13031-020-00298-6. eCollection 2020.
Unintended and unwanted pregnancies likely increase during displacement, making the need for sexual and reproductive health (SRH) services, especially safe abortion, even greater. Attention is growing around barriers to safe abortion care for displaced women as donor, non-governmental and civil society actors become more convinced of this need and reports of systematic sexual violence against women are more widely documented around the world. Yet a reluctance to truly change practice remains tied to some commonly reported reasons: 1) There is no need; 2) Abortion is illegal in the setting; 3) Donors do not fund abortion services, and; 4) Abortion is too complicated during acute emergencies. While there is global progress towards acknowledging the deficit of attention and evidence on abortion services in humanitarian settings, improvements in actual services have yet to follow.
In August 2017, over 700,000 Rohingya refugees fled Myanmar for Bangladesh. Women and girls fled homes and communities - many experienced terrible violence - and arrived at camps in Bangladesh with SRH needs, including unwanted pregnancies. With funding from UNFPA and others, Ipas trained providers and established safe induced abortion (called menstrual regulation (MR) in Bangladesh) and contraception services in October 2017.Ipas Bangladesh initiated the trainings in coordination with the government's health system and international aid agencies. Training approaches were modified so that providers could be trained quickly with minimal disruption to their ability to provide care. Within one month of the arrival of refugees, MR services had been established in eight facilities, for the first time during an acute emergency. By mid-2019, over 300 health workers from 37 health facilities had attended training in MR, postabortion care (PAC), and contraception. Over 8000 Rohingya refugees have received abortion-related care, more than three-quarters of which were MR procedures; over 26,000 women and girls have received contraception at these facilities.
This study demonstrates demand for abortion care exists among refugees. It also illustrates that these needs could have been easily overlooked in the complex environment of competing priorities during an emergency. When safe abortion services were made available, with relative ease and institutional support, women sought assistance, saving them from complications of unsafe abortions.
流离失所期间意外怀孕和非意愿怀孕的情况可能会增加，这使得对性与生殖健康（SRH）服务，尤其是安全堕胎服务的需求变得更大。随着捐助方、非政府组织和民间社会行为体越发确信这种需求，且系统性暴力侵害妇女行为的报道在全球范围内得到更广泛记录，围绕流离失所妇女获得安全堕胎护理的障碍的关注度日益提高。然而，一些常见的原因仍然导致人们不愿真正改变做法：1）没有需求；2）当地堕胎是非法的；3）捐助方不为堕胎服务提供资金；4）在急性紧急情况下堕胎过于复杂。尽管在认识到人道主义环境中堕胎服务缺乏关注和证据方面取得了全球进展，但实际服务的改善仍未跟进。
2017年8月，超过70万罗兴亚难民从缅甸逃往孟加拉国。妇女和女孩逃离家园和社区——许多人遭受了可怕的暴力——抵达孟加拉国的营地时，她们有性与生殖健康需求，包括意外怀孕。在联合国人口基金和其他方面的资助下，国际人口服务组织（Ipas）于2017年10月培训了医护人员，并建立了安全人工流产（在孟加拉国称为月经调节（MR））和避孕服务。Ipas孟加拉国与政府卫生系统和国际援助机构协调开展了培训。培训方法进行了调整，以便能在对医护人员提供护理能力造成最小干扰的情况下快速对其进行培训。在难民抵达后的一个月内，在八家机构建立了月经调节服务，这是急性紧急情况下的首次。到2019年年中，来自37家卫生机构的300多名医护人员参加了月经调节、流产后护理（PAC）和避孕方面的培训。超过8000名罗兴亚难民接受了与堕胎相关的护理，其中超过四分之三是月经调节手术；超过26000名妇女和女孩在这些机构接受了避孕服务。
本研究表明难民对堕胎护理存在需求。它还表明，在紧急情况下众多优先事项相互竞争的复杂环境中，这些需求可能很容易被忽视。当安全堕胎服务在相对容易且有机构支持的情况下可用时，妇女会寻求帮助，使她们免受不安全堕胎的并发症之苦。
