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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-ThikeDepartment of Reproductive Health and Research, WHO

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Migrants are more vulnerableto health problems.....

Psychological stress of departure and resettlementExperiences of alienation and discrimination Lowered socio-economic statusFace language barriersEmployed 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

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and face challenges in accessing services

Financial burdenUnfamiliarity with health services Cultural beliefs, norms and practicesMay not be covered by insurance schemesLack of health services in areas where migrants are concentrated May face prejudices of service providersDenial of health services to migrant in irregular situationsRely more on traditional medicine, private practitioners, NGOsFear of deportation when accessing services in public sector

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Poor sexual andreproductive health outcomes

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…

Data on specific determinants of health and use of health services are scarce:

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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)

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Comprehensive health interventions

Promdon “border” - cross-border (Cambodia-Thailand) project - three phases

1) Preventing HIV - Personal enabling strategies toincrease individual knowledge and skills inHIV/AIDS prevention

2) Improving quality of life - individual, family,communities and organizational systems inboth countries

3) Strengthening provision of information and care

in the migration cycle - integrate the project’sstrategies into the intercountry employmentsystem

Reaching Across Borders project, India-Nepal

Improving Health Conditions of Migrants in Priority Provinces of Thailand

Chiang Rai

Tak

Samutsakorn

Bangkok

Ranong

Pang Nga

IOM-MOPH

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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 NGOsRe-integration programmes (including programmes for partners/spouses left behind)

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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

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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

Xinhua

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Gaps to be addressed

Inaccurate perception of risk by migrants Providers' lack of awareness regarding complex needs of migrantsExclusion from formal HIV sentinel surveillance systemsMisconceptions related to HIV testsDenial of information and services to migrants in irregular situationsAddressing financial barriers

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Migrants' Rights to Health – International instruments

that 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)

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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 Workers1990 International Convention on the Protection of the Rights of All Migrant Workers and Members of their FamiliesWorld Health Assembly Resolution 61.17 on the health of migrants

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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

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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 channelsDevelop migrant sensitive health policies to reduce financial and administrative barriersCo-operation between government and local authorities for equal opportunitiesGrass-roots activism by NGOs and civil societies Continuous advocacy by international agencies

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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 careEnsure linkages between HIV/AIDS and SRHRPlace equal emphasis on pre-departure, on-site and re-integration programmes - PWHA, women who experienced violenceImprove collection and use of standardized dataFurther research to understand better the relationships between health-related behaviours and socio-cultural backgrounds of migrants

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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 youThank you