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Sexual and reproductive health services for migrants. Asia-Pacific Conference on Reproductive and Sexual Health and Rights Beijing,18-20 October 2009 Dr Katherine Ba-Thike Department of Reproductive Health and Research, WHO. Migrants are more vulnerable to health problems.
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Sexual and reproductive health services formigrants Asia-Pacific Conference on Reproductive and Sexual Health and Rights Beijing,18-20 October 2009 Dr Katherine Ba-Thike Department of Reproductive Health and Research, WHO Insert file name
Migrants are more vulnerableto health problems..... • Psychological stress of departure and resettlement • Experiences of alienation and discrimination • Lowered socio-economic status • Face language barriers • Employed in sectors not covered by labour laws of destination countries • Feminization of labour migration - some occupations - greater vulnerability to abuse and sexual violence AP pictures Insert file name
and face challenges in accessing services • Financial burden • Unfamiliarity with health services • Cultural beliefs, norms and practices • May not be covered by insurance schemes • Lack of health services in areas where migrants are concentrated • May face prejudices of service providers • Denial of health services to migrant in irregular situations • Rely more on traditional medicine, private practitioners, NGOs • Fear of deportation when accessing services in public sector Insert file name
Poor sexual andreproductive health outcomes Data on specific determinants of health and use of health services are scarce: • Higher maternal mortality, experience poor pregnancy outcomes, have less access to services (Data from Shanghai) • Studies on young migrants (Greater Mekong sub-region and Nepal) - understanding of SRH issues was limited and inaccurate - reported receiving poor-quality services - lack of services for unmarried migrants • Migrants in irregular situations more likely to have unplanned pregnancies, STIs, unsafe abortions… Insert file name
HIV/AIDS interventionsfor mobile populations • Hot spots of HIV vulnerability – construction projects (construction workers, truck drivers, sex workers and local residents) – e.g. India- Bhoruka Public Welfare Trust • Comprehensive employment-based programmes (advocacy for management, peer education and counselling, training of managers and staff on SRH and HIV issues and provision of SRH services at either the work-site or through referral clinics) Insert file name
Chiang Rai Tak Bangkok Samutsakorn Ranong Pang Nga IOM-MOPH Comprehensive health interventions • Promdon “border” - cross-border (Cambodia-Thailand) project - three phases 1) Preventing HIV - Personal enabling strategies to increase individual knowledge and skills in HIV/AIDS prevention 2) Improving quality of life - individual, family, communities and organizational systems in both countries 3) Strengthening provision of information and care in the migration cycle - integrate the project’s strategies into the intercountry employment system • Reaching Across Borders project, India-Nepal • Improving Health Conditions of Migrants in Priority Provinces of Thailand Insert file name
SRH interventions • Needs assessment (non-homogeneity of groups as to social, economic and health backgrounds) • Pre-departure – health education and comprehensive skills development (Philippines – domestic workers) • Targeted community-level health care for migrant workers (addressing the needs of seasonal migrants in Nashik, Maharashtra, India) • Delivery of family planning and maternity services by NGOs • Re-integration programmes (including programmes for partners/spouses left behind) Insert file name
Elements of successful interventions • Implementing comprehensive approaches • Addressing source and destination countries • Engaging a wide range of stakeholders – e.g. migrant workers, migrant support organizations, trade unions, health authorities and local and national governments • Addressing different phases of the migration cycle • Including activities to develop life-skills IOM Photo gallery Insert file name
Elements of successful interventions • Ensuring HIV interventions address SRH issues • Using participatory approaches • Developing culturally-sensitive messages in native languages • Employing multiple channels of communication Insert file name Xinhua
Gaps to be addressed • Inaccurate perception of risk by migrants • Providers' lack of awareness regarding complex needs of migrants • Exclusion from formal HIV sentinel surveillance systems • Misconceptions related to HIV tests • Denial of information and services to migrants in irregular situations • Addressing financial barriers Insert file name
Migrants' Rights to Health – International instrumentsthat protect migrants • The most fundamental human rights instrument is the Universal Declaration of Human Rights (UDHR, 1948) • The Convention on the Elimination of all Forms of Discrimination against Women (CEDAW, 1979) applies to all women, citizens and non-citizens alike • ILO Convention No.155 concerning Occupational Safety and Health (1981) • United Nations General Assembly resolution on the protection of migrants (2001) Insert file name
International instrumentsthat protect migrants • ILO Convention No. 97 - Migration for Employment • and 143 - Migrations in Abusive Conditions and the Promotion of Equality of Opportunity and Treatment of Migrant Workers • 1990 International Convention on the Protection of the Rights of All Migrant Workers and Members of their Families • World Health Assembly Resolution 61.17 on the health of migrants Insert file name
Policy commitments to ensure rights of migrants are respected • The Vienna Declaration Programme of Action (1993) • Programme of Action of the ICPD (1994) • Beijing Platform for Action (1995) • Manila Call to Action (2008) • ASEAN - Plan of Action on Immigration matters Insert file name
Recommendations for sustainable health programmes for migrants • Human rights of migrant workers need to be respected, protected and fulfilled • Bilateral agreements between source and destination countries which lead to migration through regular channels • Develop migrant sensitive health policies to reduce financial and administrative barriers • Co-operation between government and local authorities for equal opportunities • Grass-roots activism by NGOs and civil societies • Continuous advocacy by international agencies Insert file name
Recommendations for sustainable health programmes for migrants • Develop approaches that enable migrants to participate in the design and implementation of SRH programmes • Define better needs of sub-population groups for promoting health and delivering care • Ensure linkages between HIV/AIDS and SRHR • Place equal emphasis on pre-departure, on-site and re-integration programmes - PWHA, women who experienced violence • Improve collection and use of standardized data • Further research to understand better the relationships between health-related behaviours and socio-cultural backgrounds of migrants Insert file name
ICPD Programme of Action All countries are called upon to strive to make reproductive health accessible to all individuals of appropriate age • MDGs 4 and 5 - Universal access to sexual and reproductive health Thank you Insert file name