Social determinants of sexual and reproductive health in Europe focusing on migrant population
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1 Social determinants of sexual and reproductive health in Europe focusing on migrant population G.Lazdane Sexual and Reproductive Health Programme WHO Regional Office for Europe
2 Content WHO - who are WHO? Why social determinants of health? Migration in Europe Why it is important to know and what can be done to improve SRH of migrants in Sweden?
3 Content WHO - who are WHO? Why social determinants of health? Migration in Europe Why it is important to know and what can be done to improve SRH of all in Sweden?
4 GOVERNANCE World Health Assembly Executive Board WHO Constitution Executive Board, DG Resolutions and decisions Regional Committees September 2012 Malta Standing Committee of RC - only in WHO/Europe
5 WHO headquarters - Geneva DG Dr Margaret Chan F.Bustreo - ADG Family, Women s and Children s Health Ageing and Life Course Immunization, Vaccines and Biologicals Maternal, Newborn, Child and Adolescent Health Reproductive Health and Research O.Chestnov - ADG NCDs and Mental Health C.F.Etienne ADG Health Systems and Services M.-P.Kieny - ADG Innovation, Information, Evidence and Research Ethics and Social Determinants
6 Staff WHO Regional Office for Europe - Copenhagen RD Ms Zsuzsanna Jakab Division of NCD and Health Promotion Healthy ageing Child and adolescent health Sexual and reproductive health Social determinants of health including gender Health systems HIV/STI, VPI Health information
7 WHO Collaborating Centres working in the area of SRH in Sweden WHO CC for Research in Human Reproduction - Department of Woman and Child Health, Division for Obstetrics & Gynaecology Karolinska Hospital Director Prof.K.Gemzell-Danielsson WHO CC for Development of Quality Indicators to Improve Perinatal Health Systems -Department of Obstetrics and Gynaecology, University Hospital of Lund Director Prof.K.Marsal WHO CC for Research in Human Reproduction - Department of Women's and Children's Health, Section for International Maternal & Child Health, Uppsala University Hospital Director Prof.G.Lindmark
8 WHO Collaborating Centres working in the area of SRH in Sweden WHO CC for Research in Human Reproduction - Department of Woman and Child Health, Division for Obstetrics & Gynaecology Karolinska Hospital Director Prof.K.Gemzell-Danielsson WHO CC for Development of Quality Indicators to Improve Perinatal Health Systems -Department of Obstetrics and Gynaecology, University Hospital of Lund Director Prof.K.Marsal WHO CC for Research in Human Reproduction - Department of Women's and Children's Health, Section for International Maternal & Child Health, Uppsala University Hospital Director Associate Prof.E.Darj
9 Content WHO - who are WHO? Why social determinants of health? Migration in Europe Why it is important to know and what can be done to improve SRH of all in Sweden?
10 Why social determinants of health?
11 Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity WHO, 1946
12 Review of the Social Determinants of Health and the Health Divide in the WHO European Region The CSDH closing the gap in a generation The Marmot Review Fair Society Healthy Lives
13 Female life expectancy at birth, CIS and EU member states
14 Healthy life years and life expectancy at birth, 2008 Males Females
15 Percent reporting their health as good or very good by household income quintile in Latvia and Sweden, 2008 Source: Bradshaw & Mayhew (personal communication), 2007 data from EU SILC 2008
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17 Attention to service utilization barriers Source: WHO (2010). Social determinants of Sexual and Reproductive Health: Informing future research and programme implementation. Geneva, World Health Organization
18 Unmet need for family planning and wealth quintile (DHS) Albania 10 Armenia 05 Azerbaijan 06 Moldova 05 Turkey 08 Ukraine 07 Lowest wealth quaintile Highest wealth quaintile
19 Unmet need for family planning and education (DHS) Albania 10 Armenia 05 Azerbaijan 06 Moldova 05 Turkey 08 Ukraine 07 Primary Higher
20 Social exclusion, disadvantage and vulnerability (commissioned studies for the European Review) Roma Child poverty Migration/Displacement (focus on illegal migrants) Disability
21 MOVEMENT WITHIN OR ACROSS BORDER Free Coercion/Forced Migration Smuggling Trafficking Consent Legal Improvement of Livelihood Consent Illegal Brokerage fee Improvement of livelihood Forced Deception Debt Bondage For purpose of exploitation, servitude, entrapment Source: GAATW, Human Rights Practice, 1999
22 Developed regions 2 million migrants per year International migration 5-10% (20%) of all the population in WE are migrants
23
24 Factors influencing SRH of migrants
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26 SRH problems of migrants: 1. Epidemiology of diseases and risk factors (HIV/STI; unwanted pregnancy, abortion; contraceptive use, ) 2. Psychosocial and cultural aspects (norms, attitudes regarding family, social relationships, FGM, sexuality and gender ) 3. Communication (language, communication style) 4. Moral and ethical dilemmas (sexuality education, virginity, poligamy )
27 Non-nationals or immigrants as % of all HIV/AIDS cases NOTE: % of AIDS cases in countries not reporting HIV Sources: Euro HIV; national reports <20% 20-40% 40-60% 25.5% 30% 30% 60-80% >80% 65% 31% 53% 35% 3% 47% 44% 43% 38% 2% 49% 25% 46% 45% 56% 23% 23% 36% 1% 35% 16% 3% 3% 45% 15% 5% 4% 15% 21% 42% 47%
28 Psychosocial and cultural aspects Islam I am sinful anyway, why to use condoms? FGM Laws: UK(1982), Norway (1995) Regulations: Denmark (1981), ICRH (Ghent, Belgium) - WHO CC; Sweden, Denmark, SH of Young Black and Minority Ethnic People Project the Trust for the Study of Adolescents; UK Traditional Folk medicine in the family
29 Communication Language barriers when SRH issues are discussed Service providers perception the image of ethnic minority (i.e. denial of south Asian drug use) Multi-ethnic clinics
30 Moral and ethical dilemmas Sexuality education: - Cultural loss - Orientation in a new reality - Stigmatization
31 Barriers to access to health care services: Lack of basic information on sexual and reproductive health Legal framework Limited availability of different contraceptives and other SRH commodities Financial costs
32 I feel like they ve taken my smile and I can never have it back. Lithuanian woman trafficked to London
33 Nordic School of Public Health NORDIC COUNCIL OF MINISTERS
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35
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37 Trafficking and Health Increased vulnerability of trafficked person exacerbates health risks Little is known about morbidity or mortality during forced migration Living and work-situations of trafficked persons often are not conducive to good health
38 Conclusions In many European countries disaggregated data on SRH of migrant population are missing In improving SRH of ALL, social determinants of health should be analysed
39 WHO EURO assistance to countries Assistance in developing national policies and strategies focusing the SRH needs of migrant population Assistance to the member states in implementation WHO guidelines and standards Analysis of the existing information of SRH of migrants, defining the gaps, problems and ways to overcome them
40 HEALTH 2020
41 THANK YOU!
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