Hear from five grantees striving for better health outcomes for refugees

In the first of a two-part blog for World Refugee Day, we speak to grantees and hear why their focus areas— incontinence, menstrual hygiene and abortion —need more attention in research and innovation.

At Elrha, we fund research studies and innovation projects that address priority gaps in humanitarian response, and while we support numerous grantees working in refugee contexts, this World Refugee Day we wanted to spotlight a few of those working on some of the health issues which require more attention.

In the first of a two-part blog, we are featuring research and innovation projects that are exploring often stigmatised health concerns in refugee settings: Incontinence, menstrual hygiene management, and abortion.

Like in non-refugee populations, improving health outcomes in these areas will have a wider impact on the lives of those affected — Not just bettering their health, but also protecting their overall dignity, and giving them more control over their lives.

For this blog, we asked grantees to tell us:

• Why more focus is needed on these health issues in refugee settings
• How their research/innovation will affect health outcomes for refugees
• How improving health outcomes in these areas will have wider implications on the lives of refugees

Read on to discover what our grantees had to say…

Children and their caregivers’ experiences with incontinence

Partners: University of Leeds, University of York, Plan International UK, Plan International Uganda, World Vision Bangladesh, UNICEF Bangladesh, University of Western Australia

A partnership led by Leeds University, and supported by our Humanitarian Innovation Fund (HIF) has developed a novel research method to capture children’s experiences of incontinence in Adjumani District in Uganda, and Cox’s Bazar refugee camp in Bangladesh.

Why is more attention needed on incontence among refugee children? Claire Rosato-Scott (Leeds University), from the innovation team, says:

“Little is known about how refugee children understand and experience incontinence, and how they could be better supported. Yet the physical health of children who wet themselves can suffer, they could miss out on educational and social opportunities, and they may face increased protection risks.”

Gathering information without the need to ask direct questions, their innovative approach uses a ‘story book’ to “prompt discussions with children about incontinence, to understand how they experience the condition so that the support provided can be improved”, says Rosato-Scott.

She adds that, “Involving children in research — hearing their voices, perhaps for the first time — has also been found to be beneficial for them.”

Commenting on how the story book methodology could contribute to knowledge on how to engage children in research, Rosato-Scott explains: “The lessons learned…provide guidance for the participation of children in humanitarian research and programming. A better understanding of children’s needs could improve emergency programmes beyond WASH, including in the education, health and protection sectors.”

Read more about this innovation project: Children and their caregivers’ experiences with incontinence

Exploring the WASH needs of women with incontinence due to obstetric fistula

Organisation: Research and Grants Institute of Ghana

Women who suffer from incontinence secondary to obstetric fistula in emergency settings are already vulnerable, but there is little evidence on how they meet their water, sanitation and hygiene (WASH) needs.

A project at Buduburam Camp in Ghana, funded by our HIF programme, is applying a mixed-methods design, using individual in-depth interviews, focus group discussion and questionnaires to engage with and learn about displaced women’s lived experiences and struggles in relation to WASH.

Asked why more attention on incontinence is needed in refugee contexts, Dr. Samuel Adjorlolo (Research and Grants Institute of Ghana) said: “In humanitarian settings or refugee camps, there is limited access to opportunities to keep clean… Persons with incontinence also tend to suffer discrimination and stigmatisation due to urine or fecal odor associated with the continence.”

The team have placed particular emphasis on awareness, and this is where they feel the work they are doing will have wider implications on the living conditions of displaced women:

“Our innovation involves partnering with government and other development partners for public education and awareness creation to reduce the stigmatization. This would encourage women with incontinence to embrace sustainable efforts to improve their economic challenges through empowerment programs, resulting in an overall improvement in their living conditions.”

Read more about this innovation project: Exploring the WASH Needs of Women with Incontinence Due to Obstetric Fistula

Safe spaces for managing menstruation among displaced populations

Partners: Ylabs, Alight

In Uganda, HIF grantee YLabs, in partnership with Alight, want to improve understanding of the needs of displaced women and girls when it comes to sanitation facilities. As part of this, the team worked alongside women on their periods to co-design and pilot safe spaces and services in Uganda, including the Cocoon Mini, a semi-permanent latrine and bathing area that is built within household compounds.

Asked why more attention is needed on safe spaces, the YLabs team explained:

“Latrines are among the most dangerous areas mapped by refugee communities and existing facilities are limited by their accessibility, usability and practicality. Refugee menstruators go to great lengths to hide or destroy menstrual health products. Fear, misinformation, and stigma limit their ability to manage menstruation in safety and dignity.”

The team believe that their innovation, the Cocoon, will not only provide women with the space needed to manage their periods, but will also tackle the stigma surrounding the topic, as it includes men and boys in the conversation too.

The intervention is already showing promising results:

“95% of menstruators reported greater ease with menstrual health. 47 % of menstruators reported having more open discussion about menstrual health with boys and men. The Cocoon helps break down the stigma against one of the most basic life experiences for women and girls.”

Find out more about this study: Cocoon: Safe spaces for managing menstruation among displaced populations

Self-managed abortion: Barriers and opportunities in humanitarian settings

Partners: Ibis Reproductive Health, African Population and Health Research Center, Ipas, International Rescue Committee, &; Resilience Action International

According to our report on Innovation in Sexual and Reproductive Health (SRH), core SRH services are being neglected in crisis settings, and one of the biggest priority gaps identified in SRH was “safe abortion/post-abortion care and advocacy” services.

One study funded through our Research for Health in Humanitarian Crises(R2HC) programme is documenting the experiences of displaced women and girls in Kakuma Refugee Camp, Kenya and Bidibidi Refugee Settlement, Uganda — and comparing differences in their abortion experiences according to displacement, humanitarian setting and legal context.

They hope that results will shed light on abortion practices in humanitarian settings, including on abortion incidence. The evidence will help to show the amount and type of resources that will be needed to provide better abortion care, for example through self-managed abortion.

Asked why they want to see more attention on abortion among displaced populations, principal investigators Ruvani Jayaweera and Tamara Fetters said:

“We need evidence to highlight the need for abortion and the barriers to abortion access that pregnant people living in displacement face. Without evidence, abortion for displaced people continues to be under-resourced and under-prioritised.”

They hope this work will influence policy, ultimately getting refugees and other displaced people better access to quality abortion and post abortion care:

“We hope our findings will inspire those in power to be accountable to ensuring the reproductive autonomy of refugees, which includes high-quality abortion care.”

Read more about this R2HC study: Self-managed abortion: Barriers and opportunities in humanitarian settings

Overcoming challenges to accessing quality post‐abortion care in humanitarian crises

Partners: Columbia University, and International Medical Corps, UK

A completed R2HC study led by Columbia University focused on the need for post-abortion care (PAC); critical life-saving interventions including treatment of complications of abortion, counselling, provision of contraception and awareness. They did research in health centres in four internally displaced person and refugee camps in South Sudan.

Sara Casey, the principal investigator, explained why more attention is needed on post-abortion care:

“People still get pregnant during displacement, even though many do not want to be, including from rape. Often they have reduced access to good quality contraceptive services to prevent pregnancy. Many resort to unsafe abortions. Good quality post-abortion care and safe abortion care, including post-abortion contraception, are needed to reduce maternal mortality.”

Apart from assessing existing PAC services, the study team interviewed community members to understand perceptions on PAC, and found that while community members agree that women should have access to PAC, stigma prevents them from getting care.

“I’d like to see NGOs pay more attention to ensuring good quality post abortion care and safe abortion care in humanitarian settings, and not allow the fear of stigma to prevent them from providing this critical life-saving care.”

Read more about this study: Overcoming challenges to accessing quality post‐abortion care in humanitarian crises

In Part Two of our World Refugee Day blog, we will be spotlighting research studies that are looking to improve care for refugees suffering from non-communicable diseases (NCDs).