Stronger voices, healthier choices: Access, agency and bodily autonomy for sexual and reproductive health
Conflict, displacement and humanitarian crises are placing refugee women and girls at risk across the globe at an alarming rate. The Middle East and North Africa (MENA) region shoulders much of this burden. The onset of the plight of refugees and migrants can begin suddenly but increasingly has become a chronic and entrenched reality, lasting for years or even decades.
In these contexts, women and girls experience weakened access to healthcare and diminished sexual and reproductive health and rights (SRHR). They are consistently underserved, with their health needs misunderstood and left unmet – resulting in desperation and hopelessness. The problem is further amplified by poverty, traditional gender and cultural norms, early marriage, frequent and complicated pregnancies, and programming gaps for refugee populations. Moving from despair to hope requires solutions that respond to local needs and prevalent social and cultural norms; it also requires concerted efforts, including from health research funders.
Research for positive outcomes and policy change
Through projects funded by IDRC, local researchers in the MENA region are working with communities to find creative, impactful and acceptable solutions to address important SRHR issues, including:
- Gender-based violence (GBV) and reproductive rights
- Drivers and outcomes of early marriage
- Reproductive health education needs in refugee camps
Suppressing rights: Gender-based violence and discrimination
In Lebanon, one project examined the link between GBV and sexual and reproductive health and rights (SRHR) among Syrian women refugees, capturing the lived experiences of women in their own voices. These women reported fear, intimidation and violence, both within and outside the home. The stress of being uprooted due to war, facing long-term poverty and experiencing limited opportunities as refugees can compound tensions at home and in the community.
At home, the tensions are further augmented by unequal gender power relations. As one focus group participant, Samah, reported, “When anything bad happens, he beats me up, he takes all of his anger out on me. Twelve days after giving birth, he still beats me up.”
When they leave home, many Syrian refugee women face harassment in public, in taxis and on public transportation. While both transportation hurdles and financial barriers can impede their access to healthcare, when they do seek health services, many face discrimination and disrespect. One Syrian refugee woman said she felt silenced by her physician: “[My doctor] told me: ‘I will tie your tubes so you would stop having children! The [rest of your children] are in the street selling paper tissues and begging.’ I told her that’s not true, that it’s God’s will if I get pregnant or not […] I didn’t like how she spoke to me.”
These first-person accounts represent the reality of Syrian refugee women’s experiences related to harassment in public, loss of bodily autonomy, unfulfilled reproductive rights, denial of respectful care, and various forms of violence experienced on a regular basis. They also underscore the importance of timely, respectful and equitable access to healthcare for this group experiencing vulnerabilities.
Results from the study point to the power of creating safe spaces for women to share their experiences. One woman involved in the study stated, “[t]his research project changed my life and showed me how women can be empowered and change their destiny.” The research team’s findings, including personal stories from women and girls, are captured in the e-book, Sexual and Reproductive Health Rights in Times of Conflict.
- To strengthen the agency of refugee women and girls, programs must help destigmatize, organize and educate them. Research designed for and by refugee and displaced populations can support women and girls in boosting their agency and using it improve their access to rights, services and opportunities.
- For women and girls to become change agents, they must be actively engaged in their sexual and reproductive health. Their voices and involvement can help alter gender norms and improve access to healthcare.
- To empower women and girls to assert their sexual and reproductive health and rights, awareness, counselling and education are essential tools for change.
- For refugee women and girls seeking support from healthcare providers, staff in NGOs and healthcare institutions need training, especially in how to support survivors of gender-based violence.
- To improve the programs and systems supporting refugee girls, future work on early marriage and the sexual and reproductive health of adolescents should be undertaken with a clear focus on their mental health and well-being.
Strength through solidarity: Expressing agency and exercising bodily autonomy
Across the MENA region, many refugee women and girls lack agency and bodily autonomy. This means they have limited control over their opportunities, decisions and actions — from what they eat to who they marry or whether they go to school. With regards to sexual and reproductive rights, women and girls have little control over their health and bodies. As one Syrian refugee woman in Lebanon stated, “You feel like you’re not a human being. Sometimes he doesn’t let me wear new clothes or even buy the food I like.” They are often socialized to lack agency at a very early age. Parental violence and forced marriages, including early marriage, are common and normalized.
An IDRC-funded project created a movement for change and a sense of solidarity among adolescent girls living in refugee camps in the West Bank and Gaza. The research team co-developed an outreach and education program with the girls and community that drew on the girls’ creativity and vision for agency in their future. The girls developed an interactive website that explores adolescent SRHR issues in an accessible and culturally sensitive manner. The localized content includes culturally relevant information that engages young girls in a welcoming way. For example, the platform, piloted with 300 girls, hosted live weekly discussions with adolescent girls, counsellors, nurses and educators. There are plans to upgrade the technology and scale up the project once funds are available.
The research team also worked with students to translate their findings into an interactive app and comic strips covering the themes of mental health, nutrition and menstruation. They ran improv competitions in refugee camps to provide space for girls to be leaders and creators. Based on the results from this inclusive and successful pilot, the Ministry of Education in Palestine and the United Nations Relief and Works Agency for Palestine Refugees (UNWRA) have adopted and adapted the curriculum created through this project.
Empowering through education: Improving access to health information and services
Equally important is giving adolescent girls access to information on sexual and reproductive health to help destigmatize puberty and start conversations about topics including early marriage. A project team in Lebanon created an eight-week educational curriculum on SRHR for adolescent girls living in Syrian refugee camps and their families.
The program equipped adolescent girls with important life skills like assertive communication and self-confidence. It also provided information on gender and human rights, including early marriage. As one participant reported, “I was weak; I would be afraid when walking down the street… Even my mother is now surprised at how much I have changed.” The program included competitive games and group activities to encourage collective problem-solving. The research team contextualized the content to address their socio-cultural realities and translated the program into the Arabic dialect used by participants.
The project included eight sessions for mothers, to allow them to openly discuss challenges related to adolescent girls and early marriage with a strong focus on gendered norms, mother-daughter dialogue and intergenerational communication. The response from mothers was positive: “I wish someone provided me with some information about the sexual and reproductive health changes before I reached puberty. Now, I am ready not to repeat this experience with my children.”
Toward a better future
Trends of displacement, both short and long term — whether due to conflict, climate or other drivers — are on the rise worldwide. These projects demonstrate the need for research and solutions that will address the health needs of refugee and displaced populations. Investments in research, networks and institutions represent an integrated approach to leverage context-specific and localized health research efforts. This approach empowers refugees and displaced persons through refugee innovations tailored to their realities.
Across all projects, one lesson is clear: solutions must be localized, inclusive, empowering, long-term and system wide to truly serve the SRHR and health needs of refugee and displaced women and girls.