cathy solter, scm, mph and kathy le, mpp pathfinder international 131st annual meeting and...

131st APHA Annual Meeting and Exposition

Cathy Solter, SCM, MPH and Kathy Le, MPP

PATHFINDER INTERNATIONAL

131st Annual Meeting and Exposition of the American Public Health Association

San Francisco, CANovember 17, 2003

Increasing Family Planning

and Reproductive Health Access to Internally

Displaced and Refugee

Populations in Azerbaijan


Background Information

FACTS

Population: 7,771,092

Fertility Rate: 2.24

Abortion is legal

Lost 20% of territory (Nagorno-Karabakh region) to Armenia

One million people have been displaced by the ten-year conflict with

Armenia.


AHAP in Azerbaijan Azerbaijan Humanitarian Assistance Program: six-

year $45 million to support USAID's objective 3.1 - Reducing Human Suffering in Conflict Affected Areas

Implementing Partners: ACDI/VOCA, Adventist Development and Relief Agency, Cooperative Housing Foundation, International Medical Corps, International Rescue Committee, Pathfinder International, Save the Children Federation, and World Vision.

Pathfinder’s Program: Primary Health Care in Urban Areas (May 2001-July 2003)


Increasing FP/RH Access at Community and Facility

LevelsProject Goal: To reach 90,000 internally displaced persons (IDPs) (70,000 women, 10,000 men and 10,000 adolescents)

Geographic Area: 29 IDP settlement areas in 13 districts in Baku, Apsheron, and Sumgait regions

800,000 IDPs live in the project areas

Ninety community-based service (CBS) workers with six supervisors

Trained 50 public sector service providers in FP/RH


Accomplishments (1)Community-based Services

88,562 people of reproductive age, including 62,142 women, 7,350 men and 19,070 adolescents

Increased use of modern contraceptives from 5,206 users to 12,906.

Decrease in the number of abortions from 1,603 to 507 in the three months prior to each survey.

Contraceptive Use

Condoms IUD Pills

2003 6,624 4,386 1,659

2000 1,492 2,910 757


Accomplishments (2)Training

90 CBS workers and six supervisors were trained in communication and FP/RH and adolescent health.

44 public sector service providers were given refresher trainings on FP/RH as well as maternal and child health, ARH, HIV/AIDS, and gender issues.

Environmental training was conducted for CBS workers as part of the Environmental Action Plan.

Dissemination and Coordination Press releases, project bulletins, and newspaper

articles Sharing of IEC materials, such as leaflets and

posters.


Environmental ActivitiesCreation of an

environmental action plan

Training for all CBS workers

4,000 information leaflets and 52 posters distributed

180 clean-up campaigns implemented


Sustainability and Cost Recovery Trained a group of 90

CBS workers and six supervisors who remain in the IDP communities.

CBS workers trained to measure blood pressure and apply first aid. Fees collected for services and proceeds used for training and equipping additional CBS workers.


Knowledge, Attitude and PracticesBaseline survey: October 2000Final survey: July 2003 showed significant changes, examples:

Decrease in % of women who had never visited a gynecologist from 67.4% to 11.7%.

Percent of women giving birth in a maternity home or hospital increased from 53% to 96%.

Increase in the % of men who visited a doctor or urologist from 24.8% to 52.1%.

Substantial decrease in the rate of abortions among the target population from 1,603 to 507.

Pregnancy in survey group decreased from 45% to 38%.


Frequency of Gynecological Visits by IDP Women

7,90% 5%

67,4%

2,2%

46,2%

24,50%

9,00% 12,70%

13,50%

11,7%

0%

10%

20%

30%

40%

50%

60%

70%

80%

2000 2003

At least once a year

Once in 1-2 years

Once in 3-5 years

More rare than once in 5 years

Have never visited


HIV/AIDS and STI Knowledge Among IDP Women

15,7%

88,4%

16,3%

78,5%

8,4%

79,1%

0,0%

32,7%

0,0%

34,6%

0,0%

49,4%

0,0%

48,2%

32,0%

95,2%

27,5%

1,2%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Syphilis Gonorrhea Trichomoniasis Condiloma Vaginal Yeast

Infection

Genital Herpes Chlamydeous HIV infection

(AIDS)

Haven’t heard of

sexually

transmitted

infections

2000

2003


Knowledge of Contraceptive Methods Among IDP Women

22.5% 27.0%

2.2% 3.4%

74.2%

15.2%

92.7%

12.4%

79.8%70.2%

0%

20%

40%

60%

80%

100%

Pills IUD (Spirali) Injectables Condoms Diaphragm

2000

2003


RH Knowledge Among IDP Adolescent Girls

67,6%

28,4%19,6%

75,2% 74,3%

29,4%

83,6% 70,8%

0%10%20%30%40%50%60%70%80%90%

How

wom

enge

t pre

gnan

t

Met

hods

of

cont

race

ptio

n

A

bort

ion

HIV

/AID

S a

ndot

her

sexu

ally

tran

smitt

edin

fect

ions

2000

2003


Constraints and ConsequencesLack of resources for support and monitoring of public health service facilities and providers.

Impact: low wages for providers; poor incentive structure for the provision of quality services; insufficient materials and supplies; lack of logistics system.

Consequences: lack of contraceptives/supplies; providers charge extra fees for services; decreasing return visits by IDP clients.


Lessons Learned CBS activities must be accompanied by

access to quality services in order to achieve maximum results.

The CBS approach is very effective in reaching IDP/refugees with FP/RH messages.

Gender inequality limits contraceptive use.

Increased use of modern contraceptive methods can contribute to a decrease in abortion rates.


For more information, please contact:

Pathfinder International HeadquartersNine Galen Street, Suite 217Watertown, MA 02472 USA

Phone: (617) 924-7200Fax: (617) 924-3833

Web: http://www.pathfind.orgEmail: [email protected]

cathy solter, scm, mph and kathy le, mpp pathfinder international 131st annual meeting and...

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