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Learn More. Guaranteeing the sexual and reproductive health and rights SRHR of populations living in fragile and humanitarian settings is essential and constitutes a basic human right. Compounded by the inherent vulnerabilities of women in crises, substantial complications are directly associated with increased risks of poor SRHR outcomes for displaced populations.
This study aims to provide an overview of the sexual and reproductive health SRH issues affecting migrant Venezuelan women in the state of Roraima, Brazil. Face-to-face interviews were conducted from 24 to 30 November Most commonly, the women reported unmet family planning needs. Although a ificant proportion of women were largely satisfied with the attention received at the maternity hospital, both before and during childbirth, Given the size of this migrant population, the Brazilian healthcare system has failed to adapt sufficiently to meet their needs; however, problems with healthcare provision are similar for migrants and Brazilian citizens.
Efforts need to be encouraged not only in governmental health sectors, but also with academic, non-governmental and international organisations, including a coordinated approach to ensure a comprehensive SRHR response. Assuring the sexual and reproductive health and rights SRHR of populations living in fragile and humanitarian settings is an essential part of guaranteeing human rights [ 1 ].
Over Compounded by the inherent vulnerabilities of women in crises, there are other substantial complications that are directly associated with increasing the risks of poor SRHR outcomes for displaced populations. These are often associated with increased rates of exposure to gender-based violence [ 4 ], complications during pregnancy and childbirth, unsafe abortions and increased rates of reproductive tract infections, among others [ 5 — 11 ]. Venezuela has been facing a complex economic situation and bearish markets since [ 12 ].
Last available estimates showed higher maternal mortality ratios and increased rates of adolescent pregnancy. Moreover, there have been increased rates of HIV infection, with limited availability of antiretrovirals [ 1314 ] and a lack of effective prevention of mother-to-child transmission of HIV and congenital syphilis [ 15 — 17 ]. The country has also been facing the resurgence of multiple vaccine-preventable diseases mumps, tetanus, diphtheria, measles and poliomyelitis and of vector-borne infections dengue, chikungunya, Zika, malaria that pose health risks to the population at the borders [ 1819 ], particularly women, infants and children.
A ificant of Venezuelans are leaving the country, representing the largest displacement in the history of Latin America [ 20 ]. To the best of our knowledge, comprehensive data on the SRHR needs of migrant Venezuelan women at the borders are limited. Obtaining data is an essential step in improving SRHR response, strengthening SRH services, improving quality and delivery, and meeting current needs.
reports indicated that Venezuelan women face multiple barriers that limit their access to SRH services in host countries. These barriers include language difficulties, the large of people seeking care, and in the particular case of Colombia, the cost of health services [ 2324 ]. The objective of this study was to provide an overview on the main SRH issues affecting migrant Venezuelan women of reproductive age in Roraima, Brazil.
The should not only give insight into the prevailing SRHR issues in this migrant female population, but also provide an important contribution given the limited availability of SRHR data on this humanitarian crisis. A large cross-sectional research study was conducted, combining both quantitative and qualitative data collection approaches. The quantitative study included face-to-face interviews with migrant Venezuelan women and the are presented here. The qualitative from the focus group discussions and the quantitative and qualitative findings on gender-based violence will be reported separately.
The Ethics Committee of the University of Campinas, Campinas, Brazil approved the study protocol and all participants ed an informed consent form before being interviewed. The study was conducted in two cities in Roraima, where the principal border crossing points between Venezuela and Brazil are located: Boa Vista, the state capital, and Pacaraima, located at the main land crossing points from Venezuela.
Roraima is a small state with a population ofinhabitants, located in north-western Brazil and sharing borders with Venezuela and Guiana. Boa Vista hasinhabitants and Pacaraima 17, According to the Brazilian constitution, healthcare is considered an obligation of the state and the right of all individuals nationals, residents and migrants, including non-legally documented persons.
The SUS offers full medical and surgical care within the public healthcare network at no cost to patients, including prescribed medication in accordance with a list of essential medicines, and contraceptives. In Boa Vista, there is only one public maternity hospital providing services in Obstetrics and Gynaecology.
Due to the increasing of migrant Venezuelan women the of deliveries has increased over recent years.
The proportion of deliveries performed for Venezuelan migrants at that hospital increased from 3. This paper is based on analysis of the quantitative data collected from non-indigenous and indigenous women. In Boa Vista, a sample was purposively selected from the five largest UN shelters. In Pacaraima, two additional shelters including one exclusively for indigenous persons established by the UNHCR were selected.
A total of women were interviewed, representing All the interviews were conducted in Spanish between 24 and 30 of November A team of five trained interviewers three women and two men performed the data collection. A pre-tested, semi-structured, electronic questionnaire was used that included both open-ended and closed-ended questions on sociodemographic characteristics age, race, cohabitation status, education, employment, income, place of residence and migration informationpregnancy and childbirth births and pregnancies, current pregnancy status, antenatal ANC or postnatal care and complicationsother SRH issues family planning preferences, other gynaecological issuesand availability of and access to SRH services, including user satisfaction.
Data were entered directly into tablets and saved in a secure online database at the University of Campinas. The data entry system included validation rules to minimise data entry errors during the survey. A unique pre-defined identification was attributed to each woman. Migrant women living at UNHCR shelters or elsewhere have access to SRH services free of charge exclusively within the public healthcare network, including primary healthcare units and hospitals.
All women give birth at the only public maternity hospital in Boa Vista. Normally, women in labour are transported to the hospital using transport services paid by the UN, the Brazilian army or other organisations.
Reversible contraceptives are available free of charge only within the healthcare system and it is very difficult for migrant women to obtain postpartum or interval tubal ligation. At the UN shelters, a small room is set aside for emergencies and in some cases doctors or nurses affiliated to UNICEF or humanitarian organisations provide some healthcare. In addition, the Brazilian army has health teams and mobile units that periodically visit the shelters, providing primary medical care, including vaccination.
Sample size was calculated to determine whether the SRH needs of migrant Venezuelan women are being adequately met in Roraima. This was increased to women, including 47 from the indigenous population. Since the were similar for the indigenous and non-indigenous women, the data were pooled together. When the distribution of the data was not normal, the Mann-Whitney test for two independent groups was used.
Univariate and multivariate analysis was performed with Stepwise criteria of variables selection in order to identify variables associated to lack of procurement for healthcare services. Table 1 summarises the baseline characteristics of the study participants. Most of the women were identified as biracial Most had high school or some higher education Many of the women interviewed Table 2 describes the main SRH issues and concerns reported by the women. Two-thirds of those interviewed had an unmet family planning need and also reported a range of gynaecological complaints and symptoms of sexually transmitted infections, reflecting the finding that around two-thirds had consulted for SRH care and ANC care.
However, the main issues concerned access to ANC consultations. Of 63 women Ten women Furthermore, 31 women Table 3 summarises the main issues pertaining to access to SRH services and use. The majority of women who had received ANC stated that they were satisfied with the care received, which was adequate and included assessment of their weight, blood pressure, and abdominal circumference, as well as urine and blood tests. In some cases, an ultrasound scan was provided and advice was given on alert s.
Intrapartum care at the maternity hospital was considered excellent and the women were satisfied, particularly because they were allowed to have a companion with them during labour, an uncommon practice in Venezuela. This was primarily attributed to overcrowding at these units, which in many cases obliged women to come to the healthcare unit more than once to obtain a consultation although this survey was conducted before the Covid pandemic.
Another source of dissatisfaction concerned women requiring contraception. Although contraceptives are provided free of charge within the public healthcare service, of the 79 women requesting contraception, 50 Injectable contraceptives, subdermal implants requested by Women reported no coercion regarding whether or not to use contraceptives.
The multivariate analysis showed that the lack of procurement for SRH services was ificantly associated with race indigenous women; 4. Conversely, many women Our paper aimed to provide an overview of the main SRH issues and concerns affecting migrant Venezuelan women in Roraima, Brazil, with showing that the main issues reported by these migrant women concerned unmet family planning needs and healthcare during pregnancy and following childbirth.
Access to good quality SRH services is a basic human right and has the potential to save lives; nevertheless, these findings show that the provision of adequate SRH services to this population of migrant Venezuelan women is lacking. This was particularly true with respect to meeting family planning needs use of and access to contraceptionability to use the required SRH services and access to ANC and postnatal care. Bearing in mind that most of the women interviewed in this study were actually residing in UN shelters, this finding suggests that such needs may be considerably greater among migrant women living in informal settlements.
Most of these migrant women were young, had migrated with a partner and children, and had more than 9 years of formal education. This is despite the fact that the women interviewed reported that their main reasons for immigrating to Brazil were lack of opportunities and the prevailing health problems in Venezuela. Migrants cannot be legally employed in Brazil unless they have documentation proving that they are legal residents in the country.
Furthermore, they need documentation before they can move to another state with a larger population where the possibilities of obtaining formal employment are greater. Regarding unmet family planning needs, access to LARC methods was particularly poor and this was a major concern of many women in this study.
Women stated that their inability to access LARCs prevents their family planning needs from being met and increases the likelihood of an unplanned pregnancy, which continues to pose an important challenge for them given the reality of their daily life. However, the SRH situation for migrant women is similar to that of many Brazilian women.
This has often been directly associated with the high prevalence of unplanned pregnancy in the country [ 30 ].
Although the copper IUD is generally available at all Brazilian public healthcare facilities, the prevalence of its use is low, while, implants and the hormonal intrauterine system are only available in a few public healthcare facilities.
In line with these findings, it is equally important to emphasize that these SRH issues faced by migrant Venezuelan women are an improvement on the situation of migrant Venezuelan women in Colombia, where they have to pay for medical care [ 31 ]. The free provision of SRH care to migrant women, including the provision of ANC, intrapartum and postnatal care, vaccinations and contraceptives by the SUS, is an important action to protect women and infants, and is considered an ethical one.
Conversely, in the United Kingdom, the decision by the National Health Service establishing that migrants and those not ordinarily resident in the country should have to pay for ANC, intrapartum and postnatal care has been considered a violation of bodily autonomy and a health risk to women and neonates [ 32 ]. According to the Brazilian constitution, all citizens have the right to free healthcare within the SUS. Venezuelan migrants in Brazil enjoy similar health rights and full access without charge to the public healthcare system [ 33 ]. Yet, it is an important point that in Roraima, the state in which the largest of these women is concentrated, the migrant population uses the same publicly funded programmes as the general population, and these programmes are facing severe shortages of healthcare providers, materials, medicines, contraceptives, tests and equipment.
These shortages are directly attributed to the fact that both the municipal and state healthcare systems have failed to adequately prepare for the large s of migrants received; consequently, healthcare resources at health facility level are crippled because of the inadequate distribution of healthcare providers and resources to meet this increased demand.
For example, the of Venezuelan migrant women giving birth at the Boa Vista public maternity hospital increased from in to inrepresenting 3. This limited capacity of the healthcare system poses important risks for all women including migrants.Women seeking sex Boa vista
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