Maryam Namazie
This report is provided by Mariam Namazi, President of the Committee for Humanitarian Assistance to Iranian Refugees (CHAIR) and Vice President the International Federation of Iranian Refugees (IFIR), in assistance with the IFIR’s Women’s Committee -Turkey Branch and the Women’s Commission for Refugee Women and Children
REPRODUCTIVE HEALTH OF REFUGEE WOMEN IN KAYSARI, TURKEY
- Introduction
In November 1996, the Committee for Humanitarian Assistance to Iranian Refugees (CHAIR), the International Federation of Iranian Refugees (IFIR), the Women’s Committee -Turkey Branch and the Women’s Commission for Refugee Women and Children conducted a reproductive health needs assessment survey of 27 self-identified refugee women living in Kaysari, Turkey. Additional, qualitative information was gathered through two focus groups of another 15 refugee women and 12 refugee men. Kaysari was selected because of its large refugee population.
The following findings reveal a lack of access to reproductive health services due to: fear, lack of Turkish language skills, insufficient information on available resources and financial constraints, and indicate areas for advocacy and education.
Demographic Profile of Surveyed Refugee Women
Of the 12 Iranian refugee and refugee claimant women surveyed, 63% had been
recognized by the United Nations High Commissioner for Refugees (UNHCR), 30% were
awaiting a UNHCR decision and 7% were rejected by the UNHCR. Despite the
November 1994 Regulation requiring Iranians to register with the authorities prior to
introduction to UNHCR, 83% of those surveyed had not introduced themselves to the
government. Only 3% had been recognized by the government and 3% had been
rejected. 52% of the refugee women had been in Turkey for more than 6 months; 48%
had been in Turkey for less than 6 months. 22% had no formal education, 45% had one
to five years of education; 11% had six to eight years of education and 22% had nine to
twelve years of education. 40% of the women were between the ages of fifteen to
twenty-five; 26% were between the ages of twenty-six to thirty; 30% were between the ages
of thirty-one to forty; and 4% were over forty years of age. The average number of
children was 3.1, given a range of 1-7 children totaling 84 children. The majority
were of Kurdish origin. Most had come to Turkey via Iraq.
Needs Assessment Findings
Safe Motherhood/Emergency Obstetrics
7% of the women were pregnant. 3% had given birth while in Turkey. 82%
stated that they were not discouraged from learning about sex and the birthing
process. 96% stated that men were supportive of women availing themselves of
maternal health services. 93% practiced breast feeding.
Family Planning
74% could name three modern forms of contraceptives and had used a method in the
past. The method preferences were IUD (62%), the pill (19%) and the condom
(19%). 67% stated that they had nowhere to go for services.
HIV/AIDS/STD
70% had not heard about HIV/AIDS. 60% stated that they had some form of
vaginitis/infection for which 25% had received treatment and 75% had not.
Sexual Violence
33% stated that they or someone they knew had experienced sexual violence before or
during flight and in Turkey. 26% had heard of current reports of rape, domestic
violence or sexual coercion. The survivors of the violence were married and single
women, women heads of households and children. The perpetrators of the violence were
the police, other refugees, family members and members of the locality in which they
lived. 96% stated that female genital mutilation is a common practice in Iran but
89% said that the practice did not continue in Turkey.
Other
Other issues raised by the women were language and safety barriers in accessing
services (since most were undocumented and the hospitals required residence permits), as
well as the inaccessibility of sanitary napkins. Refugee children also did not have
access to education which was of concern to the women surveyed.
Focus Group Findings
1. Both the refugee women and men stated that security, finances and resettlement in a
safe country were primary to reproductive health issues.
2. Both stated that reproductive health care was not available to those without UNHCR
recognition or a government-issued residence permit.
Both also mentioned that lack of Turkish language skills, security and financial
constraints prevented women from accessing services. Both groups gave varying and
often contradictory opinions on how to access health care. Refugee men mentioned
that the 20% they must pay towards the cost of pharmaceuticals placed a financial burden.
3. Women refugees stated that reproductive health issues were not easily discussed but
that men were, in principle, supportive of their spouses seeking services. The
refugee men stated that they supported their spouses’ access to health care, but
various constraints prevented that access. They also stated that cultural and
religious constraints prevented some women from disclosing their health problems to their
spouses. Since husbands were often times the women’s link to the public sphere,
they mentioned that the situation forced them to become more involved in their
spouses’ problems that they would have like.
4. Family planning was acceptable to both refugee women and men but both mentioned that
“mistakes” could often occur. Women would use a contraceptive method if
available. Methods of preference were pills, condoms and IUDs. Men stated that
many of their spouses were sick because of the contraceptive methods used or had uterus
infections. The refugee men also mentioned that family planning had been used by the
government of Iran to either promote or discourage family planning, through contradictory
religious reasonings, for the sake of political opportunism.
5. Most of the women in the focus group had not heard of HIV/AIDS; those who had held
misconceptions about the disease and stated that cultural and religious norms prevent the
spread of the disease. None of the refugee men were apprehensive of getting
HIV/AIDS; like the women, they had many misconceptions about the disease’s
transmission methods.
6. Contrary to the needs assessment findings, the refugee women in the focus group stated
that they had not faced or heard of reports of sexual violence (including domestic
violence) before or during flight and in Turkey. They stated that their spouses were
“good Muslims.” On the other hand, most of the refugee men admitted that
domestic violence existed but blamed psychological and security pressures which cause the
breakdown of the family. They agreed that such violence was wrong, had intervened in
other homes where violence had occurred but admitted committing abuses themselves.
Recommendations and Achievements
1. To Increase Refugee Women’s Access to Reproductive Health Care
UNHCR-Recognized Refugees
In a meeting with five UNHCR staff, including UNHCR Representative Barry Rigby and
Regional Advisor on Refugee Women Issues Nara Luvson, it was recommended that the UNHCR:
· inform the hospitals that they were to request only UNHCR recognition letters from
the refugees and not government-issued residence permits;
· allow refugees access to both hospitals in Kaysari since a baby had died during
delivery in the state hospital and women preferred access to the university hospital;
· inform recognized refugees about the resources available to them, including access to
sanitary napkins at the UNHCR pharmacy paying only 20% of the cost. Since this was
not mentioned in the UNHCR pamphlet handed to recognized refugees, it was requested that
this information be added;
· add girls of reproductive age to the list sent to pharmacies so that both mothers and
daughters can have access to low-cost sanitary napkins;
· provide women translators so that refugee women may better access the services;
· remove the requirement that refugees must pay 20% toward pharmaceutical costs.
The UNHCR agreed to implement all of the above except the last two recommendations. They stated that translators were too costly given that refugees were divided in numerous cities. Also, the 20% requirement was similar to that required of Turkish nationals and could not be eliminated. On the matter of translation, it was requested that the UNHCR reconsider its decision, given that female translators were critical in gaining access. On improving the UNHCR pamphlet to address the reproductive health needs of refugee women, the UNHCR agreed to work with the Women’s Committee-Turkey Branch.
UNHCR-Pending Refugees
It was recommended that the UNHCR provide reproductive health services to refugee
women whose claims were pending with the UNHCR. The UNHCR stated that it would
provide emergency health services up to $1,000 for pending refugees if it was a
doctor-affirmed emergency.
UNHCR-Rejected Refugees
Given that UNHCR rejected refugees did not have access to the above-mentioned
services, one hospital was approached to provide free services to this group of women.
Upon receipt of a fax from IFIRIC, the hospital agreed to provide free services to
those refugee women. To cover pharmaceutical expenses, Women’s Committee
members in Kaysari decided to organize a fund, sharing such expenses among them.
2. To Provide Refugee Women with Information on Reproductive Health and Rights
The Women’s Committee and IFIRIC are to develop fact sheets on various issues
raised, including domestic violence, female genital mutilation and HIV/AIDS.
UNICEF has also been approached to develop educational resources for women and children.
Conclusion
Although a majority of refugees worldwide are women, their reproductive health needs
have rarely been addressed in a comprehensive manner. Agencies working with refugee
women have often excused their gender-insensitivity by asserting that food and shelter
have precedence over sanitary napkins. Even
though resources for survival, security and resettlement in a safe country are of primary
concern to all refugees, lack of access to comprehensive reproductive health care,
precludes refugee women’s full participation in asserting and promoting their rights.