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Sexual Health Awareness In Ugandan Refugee Camps Shockingly Low: On Ground Report

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By Debanjana Choudhuri:

I work for the International Planned Parenthood Federation (IPPF). We are a global NGO advocating for sexual and reproductive rights across the world, and also during crisis and conflict situations. As part of the NGO, I had a chance to closely interact with the refugee population of Nakivale, Uganda. Nakivale refugee settlement, with an area of 185 sq. km, is in the south-western part of the land-locked east African country of Uganda. It hosts refugees from all the war-torn neighbouring countries.

Image Source: Wikimedia commons

I travelled to Nakivale to assess the situation of an International Planned Parenthood Federation’s Humanitarian assistance programme-SPRINT (IPPF-SPRINT) intervention, that aimed to provide key sexual and reproductive health services to refugees at ground zero. A chat with the health workers there opened a can of worms. Most of the refugees who have escaped conflict situations and civil wars in their nations of Rwanda, Democratic Republic of Congo, South Sudan, Burundi and Ethiopia have hardly heard about HIV or family planning. Tackling the ever growing problem of HIV/AIDS in refugee settlements gets worse with prevalent religious and cultural beliefs. According to Dr. Joy a senior health worker, “In order to tackle HIV and  promote family planning, we need the buy-in of religious leaders, as most of the displaced population here are averse to it. In fact, they are so ignorant about HIV that we need to counsel them to make them realise the dangers of the infection. We tell them and their partners about the lifestyle changes that they need to adopt and also prepare them with the knowledge to tackle any pregnancies during the infection period, so that we can avoid mother-to-child transmission.” A walk into the reproductive health camps and clinics also re-emphasised the need for SRH (sexual and reproductive health) intervention among the refugee population.

The more I probed and talked to refugees, the scarier their stories became. Recent population-based surveys demonstrate that Sexual and Gender Based Violence (SGBV) is common in the East and Southern Africa region and cuts across nationality, ethnicity, and socio-economic status. SGBV affects a large proportion of women across the region.

In many cases, the perpetrator is known to the survivor, and intimate partners (such as husbands and boyfriends) are frequently identified as the perpetrators. Other data indicates that girls in the region frequently experience coerced sexual initiation which is often viewed as a normal part of relationships.

Malaria Clinic in Tanzania helped by SMS for Life and IBM cloud computing.  (PRNewsFoto/IBM)
Image Source: Wikimedia commons

 SGBV is a public health problem and women and girls who suffer SGBV are more likely to be infected with HIV, other sexually transmitted infections (STIs), and experience other reproductive health problems.

At the settlement, I met Jenna (name changed), a 39 year-old Burundian refugee, who had crossed over to Uganda two months ago, following civil unrest in Burundi. Tears rolled down her eyes, as she started talking about her escape from Burundi. She was 36 weeks pregnant when she was brutally gang-raped by goons at her village, and after ravaging her, they killed her husband. As soon as she regained consciousness, she picked up her 9 year-old son and ran for her life. After a gruelling trek of 3 days, she managed to reach Nakivale. She was soon attended to by health workers at the IPPF-SPRINT clinic, but, unfortunately, her pregnancy had to be terminated. Jenna broke down as she talked about her 36-week pregnancy. She has been checked for HIV, STI and a cervical cancer screening too has been done. Though she is healing physically, mentally she is far from good. Dr. Joy, who has been treating her, said, “We are counseling her, but the loss of her husband and the rape still gives her nightmares. Her son however, has started going to school.” She hopes that Jenna too shall be able to carry on with her normal life soon.

Violence against women is a commonly practiced method of subjugation during civil unrest and all the refugees have heart-breaking stories to share.

But among the stories of despair, hopelessness and darkness, I got a chance to meet 20 year-old Anunciata. This newly married lady not only got an Intra-Uterine device (IUD) implanted, but has also involved her husband in the decision, which is rare in this settlement owing to the patriarchal setting in the community. “I have seen my mothers, sisters suffer, IUD will help me deciding on when I am prepared to welcome a child,” she adds smilingly.

SGBV and HIV are a curse, and most African refugee households have some bone chilling experience to share. With no land to go back to (as most fear execution in the most brutal forms on returning), these refugees have become families and have formed a strong bonding welcoming each other as newer ones cross the border to enter Uganda.

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An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

Read more about his campaign.

Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

Read more about her campaign.

MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Read more about her campaign. 

A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Find out more about the campaign here.

A native of Bhagalpur district – Bihar, Shalini Jha believes in equal rights for all genders and wants to work for a gender-equal and just society. In the past she’s had a year-long association as a community leader with Haiyya: Organise for Action’s Health Over Stigma campaign. She’s pursuing a Master’s in Literature with Ambedkar University, Delhi and as an MHM Fellow with YKA, recently launched ‘Project अल्हड़ (Alharh)’.

She says, “Bihar is ranked the lowest in India’s SDG Index 2019 for India. Hygienic and comfortable menstruation is a basic human right and sustainable development cannot be ensured if menstruators are deprived of their basic rights.” Project अल्हड़ (Alharh) aims to create a robust sensitised community in Bhagalpur to collectively spread awareness, break the taboo, debunk myths and initiate fearless conversations around menstruation. The campaign aims to reach at least 6000 adolescent girls from government and private schools in Baghalpur district in 2020.

Read more about the campaign here.

A psychologist and co-founder of a mental health NGO called Customize Cognition, Ritika forayed into the space of menstrual health and hygiene, sexual and reproductive healthcare and rights and gender equality as an MHM Fellow with YKA. She says, “The experience of working on MHM/SRHR and gender equality has been an enriching and eye-opening experience. I have learned what’s beneath the surface of the issue, be it awareness, lack of resources or disregard for trans men, who also menstruate.”

The Transmen-ses campaign aims to tackle the issue of silence and disregard for trans men’s menstruation needs, by mobilising gender sensitive health professionals and gender neutral restrooms in Lucknow.

Read more about the campaign here.

A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

A Gender Rights Activist working with the tribal and marginalized communities in india, Srilekha is a PhD scholar working on understanding body and sexuality among tribal girls, to fill the gaps in research around indigenous women and their stories. Srilekha has worked extensively at the grassroots level with community based organisations, through several advocacy initiatives around Gender, Mental Health, Menstrual Hygiene and Sexual and Reproductive Health Rights (SRHR) for the indigenous in Jharkhand, over the last 6 years.

Srilekha has also contributed to sustainable livelihood projects and legal aid programs for survivors of sex trafficking. She has been conducting research based programs on maternal health, mental health, gender based violence, sex and sexuality. Her interest lies in conducting workshops for young people on life skills, feminism, gender and sexuality, trauma, resilience and interpersonal relationships.

A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform, demanding that the Government of Assam install
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in’s flagship program ‘She Creates Change’ having run successful online advocacy
campaigns, which were widely recognised. Through the #BleedwithDignity campaign; she organised and celebrated World Menstrual Hygiene Day, 2019 in Guwahati, Assam by hosting a wall mural by collaborating with local organisations. The initiative was widely covered by national and local media, and the mural was later inaugurated by the event’s chief guest Commissioner of Guwahati Municipal Corporation (GMC) Debeswar Malakar, IAS.

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