1 / 22

Does Displacement Affect Use of Efficacious Contraception in Colombia? Results from the Reproductive Health Assessment T

Does Displacement Affect Use of Efficacious Contraception in Colombia? Results from the Reproductive Health Assessment Toolkit for Conflict-Affected Women. Kerry A. Thomson, MPH 1, 2 Marianne E. Zotti, DrPH, MS, FAAN 2 Stacy L. De Jesus, MPH 2 Roger Rochat, MD 3

tatiana
Download Presentation

Does Displacement Affect Use of Efficacious Contraception in Colombia? Results from the Reproductive Health Assessment T

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Does Displacement Affect Use of Efficacious Contraception in Colombia?Results from the Reproductive Health Assessment Toolkit for Conflict-Affected Women Kerry A. Thomson, MPH 1, 2 Marianne E. Zotti, DrPH, MS, FAAN 2 Stacy L. De Jesus, MPH 2 Roger Rochat, MD 3 1 Oak Ridge Institute for Science and Education 2 Centers for Disease Control and Prevention, Division of Reproductive Health 3 Rollins School of Public Health, Emory University The findings and conclusions in presentation are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

  2. Outline • Background • Objectives • Data Collection • Analysis • Selected Results • Limitations • Discussion • Public Health Implications Photo: Médecins Sans Frontiérs

  3. Internally Displaced Persons (IDPs) • Forced to flee their homes and relocate within their country of origin • Conflict • Violence • Natural Disaster • ~24 million worldwide • 80% women and children Photo: UNHCR

  4. Prolonged Conflict in Colombia • Violent, internal, political conflict • Drug trafficking • Control over natural resources (e.g. land) • Migration from rural areas to urban centers • ~ 3 million displaced persons • Limited and uncoordinated international response • Registration requirements from local government • Fear Map: CIA

  5. Study Objective • To explore the effect that displacement has on current use of contraception • Non-permanent efficacious contraceptive methods: efficacy rate of 90% or higher with typical use, excluding permanent methods* • Pill, IUD, injectables, implants • Regular access to health or pharmacy services for physical exam and/or re-supply *Trussell J. Contraceptive efficacy. In: Hatcher RA, Trussell J, Stewart F, Nelson A, Cates W, Guest F, Kowal D. Contraceptive Technology. Eighteenth Revised Edition. New York, NY, Ardent Media, 2004.

  6. Data Collection Methods • Reproductive Health Assessment (RHA) Toolkit for Conflict-Affected Women • Provides tools to assess RH needs of conflict- affected women aged 15-49 • Comprehensive reproductive health questionnaire: safe motherhood, family planning, STI/HIV, violence • Collaboration with Fundación PROSER • February – March 2006 • Bogotá, Colombia (Soacha and Bolivar) • 89% response rate

  7. Study Sample WRA = Women of Reproductive Age (15-49) Population (weighted sample) Questionnaire Sample representing 602 WRA 433 WRA Excluded: -- Permanent methods (150) -- Not yet sexually active (34) -- Currently pregnant (21) -- Could not classify method (17) representing 293 WRA 211 WRA

  8. Analysis Methods • Outcome: Non-permanent efficacious contraceptive methods • Yes = Pill, IUD, injectables, implants • No = Condoms, calendar/rhythm, withdrawal, no method • Main Effect • Displaced = Displaced due to conflict or other reasons • Non-displaced = A local resident

  9. Analysis Methods • SAS complex survey • Bivariate analysis (Rao-Scott Chi-Square) • Displaced vs. non-displaced women (n=433) • Users vs. non-users of non-permanent efficacious contraceptives (n=211) • Multivariate model • Displaced status and Use of non-permanent efficacious contraceptives (n=211) • IRB approved

  10. Selected Descriptive Results (n=433)

  11. Residence Age Level of education Current relationship status Say in personal healthcare Head of household Religion Ever sexually active Sexually active last 30 days Ever pregnant Currently pregnant Pregnant last 2 years Want baby in future Number of living children History of IPV (intimate partner violence) Selected Bivariate Results Displaced WRA vs. Non-Displaced WRA (n=433)p = < .05

  12. Selected Descriptive Results(n=211)

  13. Residence (Bolivar or Soacha) Age Current relationship status Sexually active last 30 days Ever pregnant Number of living children Selected Bivariate Results Users vs. Non-users (n=211)p = < .05

  14. Results: Multivariate Model

  15. Results: Multivariate Model (Confounders)

  16. Limitations • Sample • Questionnaire • Misclassification • Fear of reporting displaced status • Survey • Self-report • Response bias • Sensitive questions

  17. Discussion • Displaced status not statistically significant • May be a reflection of sample • Location • “Equal access” to services • Integration into community • Size • Age • Youngest (15-19) and oldest women (45-49) • Sex in the last 30 days • Sex not always anticipated in advance and/or consensual Photo: UNHCR

  18. Public Health Implications • Reproductive health of displaced women should remain a priority • CDC MCH Epi Team • Cali • Medellín • Bogotá (Bolivar and Soacha) Map: CIA

  19. Acknowledgements • Fellow authors • Oak Ridge Institute for Science & Education (ORISE) • Fundación PROSER and survey team • Interview respondents in Colombia

  20. Thank you and Questions? Contact information: Kerry A. Thomson kthomson@cdc.gov For more information on the RHA Toolkit and to order a copy: www.cdc.gov/reproductivehealth/Refugee

  21. References (1) 1. Girard, F., & Waldman, W. (2000). Ensuring the Reproductive Rights of Refugees and Internally Displaced Persons: Legal and Policy Issues. International Family Planning Perspectives, 26(4), 167-173. 2. United Nations High Commissioner for Refugees. (2006). Internally Displaced People: Questions and Answers: United Nations High Commissioner for Refugees (UNHCR) 3. Schreck, L. (2000). Turning Point: A Special Report on the Refugee Reproductive Health Field. International Family Planning Perspectives, 26(4), 162-180 4. Garfield, R., & Morales, C. P. L. (2004). The public health context of violence in Colombia. Pan American Journal of Public Health, 16(4), 266-271 5. Meertens, D. (2002). Colombia: Internally Displaced Persons and the Conditions for Socio-Economic Reintegration (No. WriteNet Paper No. 12/2002). Geneva: United Nations High Commissioner for Refugees (UNHCR) Emergency & Security Service. 6. Arboleda, N. (2002). The effects of war on the Colombian population. Medicine, Conflict & Survival, 18(4), 394-399 7. Franco, S. (2003). A social-medical approach to violence in Colombia. American Journal of Public Health, 93(12), 2032-2036

  22. References (2) 8. Zapata, G. D. P. (2003). Terrorism in Colombia. Prehospital & Disaster Medicine, 18(2), 80-87. 9. Internal Displacement Monitoring Centre. (2006). Colombia: Government "peace process" cements injustice for IDPs: Internal Displacement Monitoring Centre. 10. United Nations High Commissioner for Refugees. (2006a). 2005 Global Refugee Trends: Statistical Overview of Populations of Refugees, Asylum-Seekers, Internally Displaced Persons, Stateless Persons, and Other Persons of Concern to UNHCR. Geneva: United Nations High Commissioner for Refugees (UNHCR) 11. Médecins Sans Frontiérs. (2006). Living in Fear: Colombia's Cycle of Violence. 12. Project Counseling Services. (2002). Deteriorating Bogota: displacement and war in urban centres: Project Counseling Services 13. Marie Stopes International. (2003). Displaced and Desperate: Assessment of Reproductive Health for Colombia's Internally Displaced Persons. New York: Marie Stopes International, Women's Commission for Refugee Women and Children.

More Related