by Kwala Adline Okorafor, Joseph Okeibunor, Funmilola Folasade Oyinlola, Leopold Ouedraogo, Femi Rufus Tinuola
PLOS One. 6 December 2024. Open access.
Northern Nigeria. Image by Joi Lee: Al Jazeera
Abstract
Context: Women and girls form a substantial proportion of the population of internally displaced people (IDP) in Nigeria, these vulnerable populations are at risk of sexual and reproductive health (SRH) rights violations and greater risk of unsafe abortion and high maternal deaths. IDP women’s living conditions are often precarious, exposing them to health risks, challenges are often faced due to lack of finance and other related factors to access health care services leading to them improvising health care services which is considered dangerous to their health. There is a gap in the study regarding the SRH needs of the IDP women and the alternative they opt for in meeting their sexual needs.
Objective: This study explores the SRH needs, barriers and coping strategies of women of reproductive age in North Central IDP camps.
Data and methods: A qualitative study was conducted between January 8th and February 28th, 2024, in four internally displaced camps in Abuja and Benue among women of reproductive age. Using a well-structured interview guide for an in-depth interview, 14 respondents were purposively selected for the study. The women were interviewed to provide insight into the SRH needs, coping strategies and barriers to utilizing SRH services in the selected camps. Data analysis was conducted using Nvivo Version 11.
Results: The study revealed the SRH needs for specific family planning methods, free SRH services and antenatal facilities in the camp and the need for toilets. Without the SRH services women cope using herbs and concoctions, they also patronize traditional birth attendants. Some of the barriers include finance, husbands’ approval and distance to health facilities.
Conclusion: In conclusion, women in the IDP camp have SRH needs that need to be met as their coping strategies are not adequate but could complicate their sexual health. It therefore recommended the government should provide adequate medical personnel in the camp for easy access to SRH services.
Background
Internally displaced people (IDPs) refer to individuals who have been forced out of their place of permanent residence but remain within a state border recognized by international law. Displacement in societies occurs due to war, natural disasters, and the unfavourable effects of climate change, often leading to human rights abuses and causing displacement in various settings. Displacement in Nigeria is primarily due to insurrection, terrorism, and flooding, leading to people escaping their homes, belongings, and employment places.
Globally, 82 million individuals have been forced to flee due to political unrest and violence, with over half of them under 18. Over the past decade, there has been a significant rise in IDPs, reaching 51 million, with one-third of them residing in Africa. Humanitarian crises, including forced relocation and unstable environments, heighten the vulnerability of sexual and reproductive health (SRH), particularly for women and girls. Approximately 3 million Nigerians (as of November 2021) had been forced from their homes due to violence from the Boko Haram terrorist group, other armed groups, and conflicts between farmers and herders, mostly in parts of the northeast region and the Middle Belt of the country, but also increasingly in North-West Nigeria….
Conflicts and forced migration burden healthcare systems, limiting access to essential sexual and reproductive health (SRH) treatments. According to the United Nations High Commissioner for Refugees data, 2.3 million girls and 1.6 million women in Northeastern Nigeria require humanitarian assistance. Women and children in IDP situations face health issues and are particularly vulnerable to sociocultural, economic, and SRH challenges, which include sexual and gender-based violence (GBV) during and after relocation, increased risks of unsafe abortions, sexual assaults, early and forced marriages, and sexual exploitation among others. In Northern Nigeria, there are 709 maternal fatalities for every 100,000 live births, which is much higher than the 20 in affluent countries. Unsafe abortion is one of the main causes of maternal mortality in Nigeria, and its prevalence has increased in Northeastern Nigeria as a result of the Boko Haram insurgency. Sexual risk-taking and irregular intake of contraceptives are linked to mental health issues, which can result in risky abortions, STIs, and unintended pregnancies. The ongoing insecurity in the IDP camps and the regular attacks on IDPs who go in search of jobs outside of it contribute to the continuation of these traumas. In IDP situations, violence and abuse of alcohol and drugs are prevalent, which has detrimental effects on young women and girls who are already at risk.
Chiabuotu et al. (2021) reported that men concealed their failures and incapacity to cope with the difficulties of displacement by being physically aggressive, particularly against their spouses, heavy alcohol consumption, sexual promiscuity, as well as taking on multiple marriages in their research on married persons living in an IDP camp in northeast Nigeria. Hunger and poverty have an impact on the sexual and reproductive health of girls and young women due to the possibility of trading sex for food or cash. In one study, participants talked about how their inability to afford food or other necessities prompted them to trade sex for food and money and how parents push their teenage daughters into forced or young marriages or similar situations, putting them at risk for STIs, premature pregnancy, and gender-based violence.
Due to the stigma associated with their age and marital status, younger single women and girls were reluctant to seek pregnancy assistance in camp clinics. In other camps for IDPs in Africa, it has been shown that girls and young women under-utilize health care because of feelings of humiliation, embarrassment, fear of reprisals, and social discrimination. Since the camp only provided post-abortion care and did not offer induced abortion services, young women were forced to conceal their abortions and seek care from providers outside of the camp or use unsafe or unapproved procedures like salt or Flagyl. Young, vulnerable girls and women are more likely to undergo these kinds of unsafe abortions and abortion techniques, particularly in countries where abortion is prohibited (like Nigeria) or severely regulated.
Relevant governmental and non-governmental organizations have shifted their efforts to make it easier for internally displaced people to go back home to places where security has since improved. Collectively, they assisted citizens in overcoming the various difficulties brought on by relocation. However, despite the growing focus on improving health outcomes for this population, they still face limited access to quality SRH treatment. Poverty, sociocultural disparities, language and literacy issues, and other factors may hinder access to SRH services like contraception and sexually transmitted infections (STI) prevention and treatment. Populations that have been internally displaced are more vulnerable in terms of their sexual and reproductive health, particularly women and girls. This includes a rise in the prevalence of unsafe abortions, high maternal mortality, and sexual assault, especially in the Nigerian context. The results of this study could be very important in developing more efficient health interventions and policies that are adapted to the requirements of displaced women, enhancing their general health and quality of life…
[Editors’ Note: The article continues at length to cover many sexual and reproductive health problems and needs. And yet, having been acknowledged as a serious issue, unsafe abortion is never mentioned again.]