Sexual and reproductive health services for migrants

1. Sexual and reproductive health services formigrants Asia-Pacific Conference on Reproductive and Sexual Health and Rights Beijing,18-20 October 2009 Dr Katherine Ba-Thike Department of Reproductive Health and Research, WHO Insert file name

2. Migrants are more vulnerableto health problems..... • Psychological stress of departure and resettlement • Experiences of alienation and discrimination • Lowered socio-economic status • Face language barriers • Employed 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 Insert file name

3. and face challenges in accessing services • Financial burden • Unfamiliarity with health services • Cultural beliefs, norms and practices • May not be covered by insurance schemes • Lack of health services in areas where migrants are concentrated • May face prejudices of service providers • Denial of health services to migrant in irregular situations • Rely more on traditional medicine, private practitioners, NGOs • Fear of deportation when accessing services in public sector Insert file name

4. Poor sexual andreproductive health outcomes Data on specific determinants of health and use of health services are scarce: • 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… Insert file name

5. 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) Insert file name

6. Chiang Rai Tak Bangkok Samutsakorn Ranong Pang Nga IOM-MOPH Comprehensive health interventions • Promdon “border” - cross-border (Cambodia-Thailand) project - three phases 1) Preventing HIV - Personal enabling strategies to increase individual knowledge and skills in HIV/AIDS prevention 2) Improving quality of life - individual, family, communities and organizational systems in both countries 3) Strengthening provision of information and care in the migration cycle - integrate the project’s strategies into the intercountry employment system • Reaching Across Borders project, India-Nepal • Improving Health Conditions of Migrants in Priority Provinces of Thailand Insert file name

7. 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 NGOs • Re-integration programmes (including programmes for partners/spouses left behind) Insert file name

8. 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 Insert file name

9. 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 Insert file name Xinhua

10. Gaps to be addressed • Inaccurate perception of risk by migrants • Providers' lack of awareness regarding complex needs of migrants • Exclusion from formal HIV sentinel surveillance systems • Misconceptions related to HIV tests • Denial of information and services to migrants in irregular situations • Addressing financial barriers Insert file name

11. Migrants' Rights to Health – International instrumentsthat 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) Insert file name

12. 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 Workers • 1990 International Convention on the Protection of the Rights of All Migrant Workers and Members of their Families • World Health Assembly Resolution 61.17 on the health of migrants Insert file name

13. 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 Insert file name

14. 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 channels • Develop migrant sensitive health policies to reduce financial and administrative barriers • Co-operation between government and local authorities for equal opportunities • Grass-roots activism by NGOs and civil societies • Continuous advocacy by international agencies Insert file name

15. 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 care • Ensure linkages between HIV/AIDS and SRHR • Place equal emphasis on pre-departure, on-site and re-integration programmes - PWHA, women who experienced violence • Improve collection and use of standardized data • Further research to understand better the relationships between health-related behaviours and socio-cultural backgrounds of migrants Insert file name

16. 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 you Insert file name