Abstract
Delivering integrated sexual and reproductive health services (SRHS) in emergencies is important in order to save lives of the most vulnerable as well as to combat poverty, reduce inequities and social injustice. More than 60% of preventable maternal deaths occur in conflict areas and especially among the internally displaced persons (IDP). Between 2016 and 2018, unprecedented violence erupted in the Kasaï's region, in the Democratic Republic of Congo (DRC), called the Kamuina Nsapu Insurgency. During that period, an estimated three million of adolescent girls and women were forced to flee; and have faced growing threat to their health, safety, security, and well-being including significant sexual and reproductive health challenges. Between August 2016 and May 2017, the "Sous-Cluster sur les violences basées sur le genre (SC-VBG)" in DRC (2017) reported 1,429 Gender Based Violence (GBV) incidents in the 49 service delivery points in the provinces of Kasaï, Kasaï Central and Kasaï Oriental. Rape cases represented 79% of reported incidents whereas sexual assault and forced marriage accounted for respectively 11% and 4% of Gender Based Violence (GBV) among women and adolescent girls. This study aims to assess the availability of SRHS in the displaced camps in Kasaï; to evaluate the SRHS needs of young girls and women in the reproductive age (12-49). Studies of sexual and reproductive health (SRH) in the Democratic Republic of Congo (DRC) have often included adolescent girls under the age of 15 because of high prevalence of child marriage and early onset of childbearing, especially in the humanitarian context. According to the 2013 Demographic and Health Survey (DHS), about 16% of surveyed women got married by age 14 while the prevalence of early child marriage (marriage by 15) was estimated at 30%; to assess the use of SRHS services and identify barriers as well as challenges for SRH service delivery and use. Findings from this study will help provide evidence to inform towards more needs-based and responsive SRH service delivery. This is hoped for ultimately improve the quality and effectiveness of services, when considering service delivery and response in humanitarian settings. We will conduct a mixed-methods study design, which will combine quantitative and qualitative approaches. Based on the estimation of the sample size, quantitative data will be drawn from the community-based survey (500 women of reproductive age per site) and health facility assessments will include assessments of 45 health facilities and 135 health providers' interviews. Qualitative data will comprise materials from 30 Key Informant Interviews (KII) and 24 Focus Group Discussions (FGDs), which are believed to achieve the needed saturation levels. Data analysis will include thematic and content analysis for the KIIs and FGDs using ATLAS.ti software for the qualitative arm. For the quantitative arm, data analysis will combine frequency and bivariate chi-square analysis, coupled with multi-level regression models, using Stata 15 software. Statistic differences will be established at the significance level of 0.05. We submitted this protocol to the national ethical committee of the ministry of health in September 2019 and it was approved in January 2020. It needs further approval from the Scientific Oversee Committee (SOC) and the Provincial Ministry of Health. Prior to data collection, informed consents will be obtained from all respondents.
Highlights
Delivering integrated sexual and reproductive health services (SRHS) in emergencies is important in order to save lives of the most vulnerable as well as to combat poverty, reduce inequities and social injustice
Qualitative data will comprise of Focus Group Discussions (FGDs) and key informant interviews (KIIs) with a broad range of stakeholders involved in SRH service delivery and response
FGDs will be conducted with displaced married men and women. These FGDs aim to provide an overview about men and women prevailing perceptions around access to SRH services, needs and use among the families
Summary
Delivering integrated sexual and reproductive health services (SRHS) in emergencies is important in order to save lives of the most vulnerable as well as to combat poverty, reduce inequities and social injustice. Civil Society Organizations (CSO) and Non-Governmental Organizations (NGOs) reported massacres, public executions, and rapes During this period, about three million adolescent girls and women were forced to be displaced; and faced growing threat to their health, safety, security, and well-being including significant sexual and reproductive health challenges [3]. Rape cases represented 79% of reported incidents, whereas sexual assault and forced marriage represented respectively 11% and 4% of Gender Based Violence (GBV) among women and adolescent girls With this context in mind, the world health organization (WHO) and its partners through the Health Cluster, are working in three countries (Cox-Bazar in Bangladesh, Yemen, and the region of Kasaï in the Democratic Republic of Congo) to strengthen its internal capacity and that of local health providers to enhance the provision and delivery of SRHR services and to help reduce unmet needs among IDP [1]. The specific objectives of this assessment are to: a) assess the availability of SRH services in areas where displaced people are living in the three provinces; b) evaluate the SRH needs of displaced girls and women of reproductive age (12–49); c) identify barriers and challenges in the field of SRH in villages with concentration of displaced people; and d) describe current provider’s capacity to provide SRH services (including health workers capacity and other issues as specified as well) in those villages
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