Reaching out on sexual reproductive health - Bangladesh
Above: A woman and her child receive medicine at one of the health clinics managed by CARE in the Rohingya camps. Photo credit: Lisa Ritchie, AHP Support Unit.
Over the past two years, an escalation of violence in Rakhine province in Myanmar has seen thousands of Rohingya flee to neighboring Bangladesh and settle in refugee camps near Cox’s Bazar. There are now 914,998 displaced persons living in these camps, 52% of whom are women and girls. Daily life in the camps brings many challenges, including access to education, protection and health services. These challenges can be even more acute for women and girls.
With Australian Government funding received via the Australian Humanitarian Partnership, CARE has supported the renovation, maintenance and operation of two Government of Bangladesh community health clinics to support displaced Rohingya communities in Cox’s Bazar. The clinics are located in camps 12 and 13, with associated outreach programs run across camps 12, 13 and 14.
Above: Members of the RTM International and CARE teams outside one of the health clinics. Photo credit: Lisa Ritchie, AHP Support Unit.
CARE signed an MoU with the Government of Bangladesh Department of Health under which it is agreed that CARE will manage the clinics in line with sector and government standards. Local Bangladeshi partner Research, Training and Management International (RTM International) is supporting CARE and the government with the resourcing and management of the health services.
Above: A sexual and reproductive health outreach clinic operated out of a Rohingya shelter. Community members and volunteers open their small homes to allow the clinics to set up for a day. This means women can attend and seek services closer to where they are staying, without needing to attend the health clinic. Photo credit: Lisa Ritchie, AHP Support Unit.
Sexual and reproductive health care is a critical health service provided, both within the health clinics and via the outreach services.
Social norms mean many Rohingya women and girls are unable to move around the camps unaccompanied. This can mean that many women and girls spend the majority of their time in their shelters, small building of only 1-2 rooms. The requirement to be accompanied to a visit a health clinic can act as a deterrent to women and girls seeking sexual and reproductive health services. Furthermore, many Rohingya families have not had ready access to quality health services, including family planning, and understanding of sexual and reproductive health issues and the support available can be low.
Outreach clinics are often run from the shelters of Rohingya community members who volunteer the use of a room for a day. The outreach teams, consisting of qualified health staff, organisers and volunteers – and overseen by a medical doctor – provide ‘door-stop’ services in order to access the most hard-to-reach populations in the camps, including women, children and people with a disability.
In their initial discussions with households, the outreach teams assesses the health needs, including any family planning requirements. The outreach teams also conducts information and awareness sessions.
CARE and RTM are providing sexual and reproductive health services, including antenatal and postnatal care and family planning, as part of an integrated approach to health delivery.
Above: Jamila* shared her experience of the care and support she received in Bangladesh as she sought support to avoid a further pregnancy. Like many Rohingya women, she was a young mother and has since faced complications with a further pregnancy. Access to family planning provides women and their families with options, something that is appreciated in the challenging camp conditions. Photo credit: Asafuzzaman Captain, CARE Bangladesh.
Jamila’s Story
Jamila* came to Bangladesh from Myanmar in 2017 alongside hundreds of thousands of other Rohingya and now lives in camps with her husband and child. at 15, Jamila and her family, like many other people in her home village in Myanmar, relied upon traditional health care approaches. Many Rohingya, particularly women, have not had access to modern family planning methods.
CARE’s outreach team visited Jamila in her home. They Jamila to a sexual and reproductive health information session which she attended. As Jamila began to understand the family planning services available and the benefits of these services, she decided to delay her next pregnancy.
Jamila had very recently miscarried and felt that delaying any future pregnancies would be best for her and her family. The outreach team explained the different family planning methods available. Jamila then made an appointment with the paramedic, who assessed her eligibility for family planning and talked her through the options. Jamila was particularly interested in the injectable contraceptive and, after she secured the all-clear physically, she began using this method.
She unfortunately experienced side effects, but because of the care and information provided by the health clinic, she knew to return to the clinic immediately. The paramedic advised that Jamila stop using the injection method, and consider another type of family planning. After an assessment, the health staff Jamila switched to a contraceptive implant.
The implant offers three years of contraception, and the health staff have provided Jamila with follow-up care to monitor any further side-effects. Jamila happily reports that she has experienced no negative side effects with the implant method and is happy to be able to continue with this form of family planning.
*Names have been changed.