Navigating the crisis landscape: engaging the ministry of health and United Nations agencies to make abortion care available to Rohingya refugees

Abstract

Background: 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. Case presentation: 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.

The Potential of Self-Managed Abortion to Expand Abortion Access in Humanitarian Contexts

“…Research conducted among Congolese refugees in Uganda suggest many were unable to navigate the legal restrictions on abortion in that country and were instead engaging in unsafe abortion practices, such as ingesting detergents or pain medications or inserting crushed bottles and sticks into the uterus; legal restrictions on induced abortion also posed a barrier to the provision of post-abortion care ( 14 ). Additionally, recent studies on the experience of training and implementing safe abortion services in Bangladesh to Rohingya refugees highlights the immense need for abortion services: less than two years after the influx of refugees, almost 8,000 people had received abortion-related care, over 75% of which were legal induced abortions ( 15 , 16 ). This case study from Bangladesh translates evidence-based findings into common practice and documents the first time legal induced abortion care, in the form of menstrual regulation in Bangladesh, has been offered and brought to scale during an acute emergency, showing both the demand for and feasibility of such a response.…”

Challenges and strategies in conducting sexual and reproductive health research among Rohingya refugees in Cox’s Bazar, Bangladesh

“…For adolescent girls, menstrual hygiene and related practices are of interest for their better SRH outcomes, however, insufficient access to safe facilities prevail [ 22 ]. Another important SRH-related service lacks attention and evidence – the abortion care [ 23 ]. Systematic sexual violence, unintended and unwanted pregnancies make the need for abortion care greater [ 23 ], however, extremely opposed by community religious leaders and influential, resulting in unsafe abortions [ 19 ].…”

“…Another important SRH-related service lacks attention and evidence – the abortion care [ 23 ]. Systematic sexual violence, unintended and unwanted pregnancies make the need for abortion care greater [ 23 ], however, extremely opposed by community religious leaders and influential, resulting in unsafe abortions [ 19 ]. Although some organizations are providing the “Minimum Initial Service Package (MISP) of SRH”, 5 access to these essential reproductive and maternal health services remains a major concern [ 12 , 24 ], especially in the new settlements and the hardest-to-reach camps.…”

The Current State of the Rohingya Refugee Crisis

“…Incidents of sexual violence have likewise been reported in the camps of Rohingya refugees. Sexual violence against Rohingya female refugees includes rape, sexual slavery, forced prostitution, forced pregnancy, forced abortion, human trafficking, and marriage [2]. The damage of sexual violence is lifelong for women because the emotional damage of sexual violence cannot be forgotten.…”