Sexual and reproductive health comes of age in Cox’s Bazar

The humanitarian emergency in Cox’s Bazar, Bangladesh is one of three around the world where a Dutch Government funded pilot project is taking place, targeting the sexual and reproductive health (SRH) needs of forcibly displaced women and girls. Bangladesh is sheltering nearly 1 million Rohingya refugees who have crossed over from Myanmar to Cox’s Bazar and are living in camps there.

A 2-day SRH workshop on 4-5 November 2018, brought together senior representatives of Bangladesh’s national and local government, WHO Headquarters and health Sector coordinators in Cox’s Bazar. The workshop, held to plan the roll-out of the SRH programme in the year ahead, was part of the health sector’s global support to such SRH initiatives for level 3 emergencies in Yemen, Democratic Republic of Congo and Bangladesh.

WHO’s outgoing project manager for Sexual and Reproductive Health, Dr Veronique Urbaniak, said the aim of the project was to strengthen the capacity of health partners in Cox’s Bazar.

‘Despite the tremendous development of sexual and reproductive health services for Rohingya refugees, huge gaps remain,’ she said. ‘It was therefore very exciting and inspiring to see so many partners actively participating in the workshop. This is the first step to producing a detailed workplan that will support our partners transition from minimum standards, to offering comprehensive sexual and reproductive health services.’

The SRH Working Group comprises 53 partners and is coordinated by the UN Population Fund (UNFPA). Although some partners provide the minimum SRH package, many face significant challenges in providing access to family planning and maternal and new-born health services.

Transporting women in labour to safe birthing facilities, especially at night, has proven difficult as such services can be far away or hard to reach, resulting in avoidable maternal and infant deaths. Sexual violence against women is also an issue. A recent survey found that over 40% of households feared sexual violence is against adolescent girls.

Many workshop participants commented that the meeting was an ideal opportunity to discuss their priorities for next year and push for better data to inform their planning. Community Partners International, represented by Shoshon Tama-Sweet, voiced this issue saying that the organisation was planning to invest in a centre dedicated to helping women and girls, and needed more statistics about childbirth and birthing trends.

‘Our aim for next year is to invest in the Bangladeshi workforce and Rohingya volunteers, to set up a centre specializing in all aspects of sexual and reproductive care and gender-based violence, as well as having female community health workers assigned to each block,’ he said.

‘What we’d like to see is more comparative trend data, for example on neonatal and maternal mortality in the camps, true maternal age, whether more women are getting antenatal care, how many are giving birth in facilities and if not then why not, and how post-natal care is being delivered to babies that are born at home.’

‘We know we need to have more 24/7 clinics up and running, but given about 50% of births still occur at home, we need new working models to extend care to the most vulnerable.’

Ipas Bangladesh supports the Ministry of Health & Family Welfare strengthens family planning, maternal and post-abortion care in public health facilities. The organisation has been working through partner agencies in Cox’s Bazar for the past year.

Ipas’ Health System Advisor, Dr Kaneez Hasnain, said the workshop gave Ipas the opportunity to unveil a long-term plan to offer different contraception methods to all Rohingya women and ensure that the services it supports are integrated into outpatient and in-patient clinics.

‘We are concentrating on building the capacity of paramedics, medical and field staff, and strengthening relationships with providers so that safe family planning is widely accepted by the Rohingya population,’ Dr Hasnain explained.