BEIRUT: It can be difficult enough to raise children under normal circumstances, to say nothing of times of war. With millions displaced from their homes due to the Syrian conflict, the first priorities can be food, shelter and money. All too often thoughts of family planning are low on the agenda of refugees or aid agencies coping with the emergency.
In part due to the transient nature of their lives in Lebanon, many refugee families – and particularly women – are actively choosing to have smaller families. But the challenges of being a refugee can make accessing services more difficult.
“I would have had more children if I were still in my home, independent and free,” 21-year-old Israa Abdel-Dayem said. Having fled from the Syrian city of Homs in 2012, she now lives in an informal tented settlement in the Bekaa Valley town of Bar Elias.
Two months ago, Abdel-Dayem had a baby girl – her third and, she said, her final. Alaa was the daughter she was waiting for after two sons.
Abdel-Dayem received family planning awareness sessions from Doctors Without Borders, which goes by its French initials MSF, at one of its 12 clinics across Lebanon. The sessions help educate and provide free family planning services so that couples are more informed about their options. Thanks to MSF, Abdel-Dayem recently got an IUD – a small T-shaped contraceptive inserted into the uterus – to prevent further pregnancies. Her husband, Mohanad, who is a painter and decorator, has been supportive of her choice.
But this isn’t always the case. “Some people resist the idea,” said Dr. Rene Bou Raad, head of medical activities at MSF. For that reason, MSF family planning awareness sessions also target husbands so that they too understand the issues. As Bou Raad puts it, “It takes two to tango.”
Some resist for cultural or religious reasons, while others fear side-effects or a loss of fertility. There are many misconceptions surrounding contraception and family planning that MSF is looking to counter, but it can be a real challenge. “You cannot work against this kind of fear,” Bou Raad said.
There are some 1.1 million Syrian refugees registered with UNHCR in Lebanon, although the real number is thought to be higher. An MSF report in November 2014 found that around 27 percent of Syrian women were either pregnant or had given birth in the last 12 months. Two-thirds of those pregnancies were not planned.
“Babies that are not well-spaced [between pregnancies] increase infant mortality rates,” Bou Raad said. “You often see large families,” she added. Syrian families in Lebanon have an average of five children, slightly higher than the Lebanese average.
But “the fewer children you have, the more you can invest in them,” Bou Raad said.
Between January and June of 2016, MSF conducted 42,318 sexual health care consultations with Syrian refugees.
“When it comes to family planning, one of the biggest challenges is social and family norms [or] who has the right to decide for a woman,” said Dr. Waleed Ikram of United Nations Population Fund (UNFPA). Still, Ikram said that 42 percent of Syrians are using some form of contraception.
Last year, UNFPA reached out to 20,000 women living in settlements to help raise awareness about family planning. “There is a lot of work going on, but there are also challenges,” Ikram said.
But after five years of conflict in Syria, humanitarian aid remains stretched and agencies have to make tough choices about provision of service. And many factors can affect willingness to use contraception, including residing in remote areas, social status, personal interest or education level.
“[Some] want to make up for men and boys lost in the war. This is how they think,” Ikram said.
Source & Link : The Daily Star