Sexual and Reproductive Health in Humanitarian Settings

As of today, there are 68.5 million people who have had to flee their homes, nearly 25.4 million of them being classified as refugees (UNHCR, 2018). We have reached the highest level of displacement in recorded history (UNHCR, 2018). There is a need to further discuss the unique and specific needs of displaced people and the complications surrounding effective services.

People who are affected by humanitarian crises, whether it be war, violence, or natural disasters, are particularly vulnerable to life-threatening ailments, including sexual and reproductive ill-health. The failure to effectively provide sexual and reproductive health services to this population is a leading cause of death, disease and disability and subsequently poses serious barriers in the advancement towards the Sustainable Development Goals (Foster et al., 2017). Those in a particularly vulnerable position are women and girls of reproductive age. According to the Women’s Refugee Commission, women and girls in humanitarian settings have a significantly increased risk of experiencing gender-based violence including exploitation and abuse (2019).

Improvements in sexual and reproductive health and rights is directly linked to an improvement in both social and economic development (CARE, 2013). However, in order to affectively address these issues we need to work towards not only improving direct services, we need to work towards creating real systemic change targeting gender inequality, power imbalances and policy barriers (CARE, 2013). The first step in developing meaningful health interventions is gathering reliable data and scientific evidence to support them. Unfortunately, there is a gap in this field of research done on women and girl’s health in these areas (WHO, 2016).

Due to the particular needs of this population, there is a need to encourage the unity and collaboration between different sectors to assure comprehensive sexual and reproductive health care (Foster et al., 2017). We need to be actively working towards implementing new strategies to increase prevention and response interventions as well as strengthening social and protective networks in these areas. There is a global obligation to assure that the right to sexual and reproductive health is upheld for everyone, including those living in humanitarian settings.

Despite these shortcomings, Canada is at the forefront of a feminist humanitarian movement and other countries are following in its wake. After announcing its Feminist International Assistance Policy, Canada pledged to better support women and girls’ health in developing countries and has launched 123 projects in 51 countries as of April 2019 (Government of Canada, 2017). With the investment of $650 million, the Canadian government has worked towards closing the gaps in sexual and reproductive health and rights of women and girls by providing and improving access to comprehensive health care, prevention and education (Government of Canada, 2017). The launch of this foreign policy is an important step in the advancement of a more feminist approach to humanitarian aid.

As the World Health Assembly (WHA) approaches along with the 25th Anniversary of the International Conference on Population and Development, the stage is set for the international community to implement sustainable change and uphold the rights of women and girls. It is important however that in these discussions we ensure that those who are affected by these crises are not only seen and heard within the humanitarian system but that they are main actors in leading the discussion and shaping the policies in question (CARE, 2019). The year 2019 has the potential to enact significant change in the way we carry out humanitarian aid and Canada must continue to be a leading voice in this global effort.

References

CARE. (2013, September). Sexual and Reproductive Health and Rights [Text]. Retrieved from https://www.care.org/work/health/sexual-and-reproductive-health-and-rights

Foster, A. M., Evans, D. P., Garcia, M., Knaster, S., Krause, S., McGinn, T., … Wheeler, E. (2017). The 2018 Inter-agency field manual on reproductive health in humanitarian settings: revising the global standards. Reproductive Health Matters, 25(51), 18–24. https://doi.org/10.1080/09688080.2017.1403277

Government of Canada, G. A. C. (2016). Canada’s Feminist International Assistance Policy. Retrieved from https://international.gc.ca/world-monde/issues_development-enjeux_developpement/priorities-priorites/policy-politique.aspx?lang=eng

UNHCR (2018, June). Figures at a Glance. Retrieved from  https://www.unhcr.org/figures-at-a-glance.html

WHO (2016). Sexual and reproductive health and rights of refugees and migrants. Retrieved from http://www.who.int/reproductivehealth/news/srhr-refugees-migrant/en/

CARE (2019, April). Womens and girls rights and agency in humanitarian action: A life-saving priority. Retrieved from https://care.ca/2019/04/womens-and-girls-rights-and-agency-in-humanitarian-action-a-life-saving-priority/

 

 

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Applied epidemiology: Investigation of outbreaks of foodborne illness

Recent, high-profile foodborne illness outbreaks have created confusion and concern for Canadian consumers. From a Salmonella outbreak in western Canada linked to cucumbers in early fall­­, to the current E. coli outbreak linked to romaine lettuce, public health is working overtime to identify and solve illness outbreaks linked to the food supply. This post will provide an overview of the investigation of foodborne illness outbreaks in Canada. Continue reading Applied epidemiology: Investigation of outbreaks of foodborne illness

THE NEED FOR AN INTERSECTIONAL APPROACH TO HEALTH: THE CASE OF BREASTFEEDING

Author: Annick Vallières

(The article is available in French only)

Abstract

Intersectionality is a concept that describes the various ways multiple forms of oppression or privilege are interconnected. Today, the concept also applies to the interconnection of different determinants of health in the study of health inequalities. This article describes the concept of intersectionality and how it relates to determinants of health by stating the factors that drive researchers to focus on intersectionality within the scope of determinants of health. It also explains how treating interconnected inequalities as multiple determinants affects people’s health, and how intersectionality can fill the gaps in knowledge surrounding the health of marginalized groups and the general population. The example of breastfeeding is used to show how the intersectional analysis framework could benefit the advancement of knowledge on a specific topic. In conclusion, the article addresses the methodological challenges that are left to overcome to advance the knowledge in this area.

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EXITING STREET-LEVEL PROSTITUTION IN CANADA: THE TRANSDISCIPLINARY APPROACH OF THE INTEGRATED MODEL IN POPULATION HEALTH

Author: Émilie Lessard

(The article is available in French only)

Abstract

This article examines the influence of social determinants of health on the entry into, the continuance in, and the exit out of street-level prostitution in Canada. The complexity of street-level prostitution in young women creates multiple challenges in implementing a theoretical model to identify issues affecting the health of prostituted women. Street-level prostitution, being closely linked to substance abuse and homelessness, leads to increased health risks associated with drug dependence, sexually transmitted and blood-borne infections, mental health problems, increased exposure to physical, emotional and sexual abuse, and a high mortality rate. It is imperative to establish a transdisciplinary theoretical model to understand the entry, the continuance and the exit mechanisms of prostitution to better target preventative interventions and better support women wishing to leave street-level prostitution. The transdisciplinary approach also aims to provide courses of intervention for leaving the prostitution system and for guiding future research.

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Ontario Election 2018 — What About Health?

June 6, 2018 – In our long awaited second episode, Stephen Kutcher and Raywat Deonandan discuss the upcoming Ontario provincial election.

A couple of documents were cited in this episode:

The election happens on June 7, 2018.


Dans notre deuxième épisode tant attendu, Stephen Kutcher et Raywat Deonandan discutent des prochaines élections provinciales en Ontario. Quelques documents ont été cités dans cet épisode:

L’élection a lieu le 7 juin 2018.

The Global Burden of Surgical Disease: An Analysis of Inaccessible Surgical Care in Low and Middle Income Countries

Authors: Chau Huynh, Minh NQ Huynh

Abstract

Worldwide, 4.8 billion people do not have access to safe, adequate surgical care and anaesthetic management. Surgical care has been deemed “the neglected child of global health,” a startling reminder of the disparities in health services. The provision of surgical interventions can avert 11% of the global burden of disease and 1.5 million deaths each year. Many obstacles exist for low- and middle-income countries (LMIC) to progress towards accessible surgical care. The first challenge is delivering cost-effective surgical care despite financial constraints and political turmoil. Foreign aid was established to alleviate the financial burden and its contributions have been pivotal. However, based on the political climate in certain countries, funds are siphoned to government sectors other than health care. Moreover, the lack of infrastructure, equipment, and personnel in LMIC compound the issue. The other challenge is determining if surgery is as feasible and effective as non-surgical health interventions. Surgical care is crucial and this paper aims to assess the challenges that limit its stature in global health discussions. The paper will address the influence of financing, infrastructure, workforce, service delivery, and information management on surgical care, and the current resolutions, such as humanitarian aid missions.

Continue reading The Global Burden of Surgical Disease: An Analysis of Inaccessible Surgical Care in Low and Middle Income Countries

Mortality prediction with a single question

“On a scale from 1 to 5, how would you rate your own health?”

Self-reported or self-rated health status (SRH) is a commonly used indicator in both clinical epidemiology and population health. It is a subjective measure of health that is thought to reflect an individual’s integrated perception of the domains of health, including biological, psychological, and social dimensions. The World Health Organization considers SRH to be a reflection of population health and healthy life expectancy within countries1. It is assessed either by a questionnaire or by a single question which asks subjects to rate their own health, usually on a four or five-point scale from poor to excellent. SRH has been used as a health indicator in epidemiological studies since the 1950s, and has been found to predict future health outcomes independent of physical, socio-demographic, and psychosocial indicators2-5. It is widely considered to be a valid indicator of health status.

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An overview of scientific-based knowledge on sedentary behaviour among the pediatric population – A conceptual model development

Author: Salomé Aubert

Abstract

Sedentary behaviour has been identified as a specifically deleterious personal practice on multiple levels of health of individuals at all ages, including the pediatric population (i.e., 0 to 18 years of age). The aims of this paper are to (I) summarize the literature concerning the definition, the characteristics, the context, the determinants and the consequences of sedentary behaviour among children and youth; (II) propose a conceptual model that summarizes these findings; and finally (III) highlight research gaps in the literature. Sedentary behaviours are common and complex behaviours that can potentially affect the health of children and youth on the physiological and psychological levels. Those deleterious effects on health can vary depending on how they are accumulated throughout the day, for example with or without interruption, or in which context. While childhood engagement in sedentary behaviours is too high in the majority of countries where it has been assessed, developing research and policies that target the reduction of sedentary behaviours among children and youth must be ranked as a top priority for all public health organizations worldwide. Although further research is needed concerning the identification of the specific determinants and consequences of different types and patterns of sedentary behaviours in various contexts, the Conceptual Model for the Study and Understanding of Children and Youth’s Sedentary Behaviour, which I have proposed in this paper, gives an overview of the topic and supports the development of policy and further research.

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Healthcare and Climate Change

The healthcare sector has come to represent an environmental concern, due to its facilities’ massive consumption of energy and production of biomedical waste. As such, we observe a troubling paradox: while the healthcare sector seeks to ensure population health and prevent illnesses, it contributes directly to greenhouse gas emissions, which in turn greatly hinders population health and well-being.

Continue reading Healthcare and Climate Change

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