Abstract
Purpose The influx of Syrian refugees into Jordan and Lebanon over the last 5 years presents an immense burden to national health systems. This study was undertaken to assess utilization of maternal health services among Syrian refugees in both countries. Description A cross-sectional survey of Syrian refugees living in urban and rural (non-camp) settings was conducted using a two-stage cluster survey design with probability proportional to size sampling in 2014–2015. Eighty-six percent of surveyed households in Lebanon and 88% of surveyed households in Jordan included women with a live birth in the last year. Information from women in this sub-set of households was analyzed to understand antenatal and intrapartum health service utilization. Assessment A majority of respondents reported seeking antenatal care, 82% and 89% in Jordan and Lebanon, respectively. Women had an average of at least six antenatal care visits. Nearly all births (98% in Jordan and 94% in Lebanon) took place in a health facility. Cesarean rates were similar in both countries; approximately one-third of all births were cesarean deliveries. A substantial proportion of women incurred costs for intrapartum care; 33% of Syrian women in Jordan and 94% of Syrian women in Lebanon reported paying out of pocket for their deliveries. The proportion of women incurring costs for intrapartum care was higher in Jordan both countries for women with cesarean deliveries compared to those with vaginal deliveries; however, this difference was not statistically significant in either country (Jordan p-value = 0.203; Lebanon p-value = 0.099). Conclusion Syrian refugees living in Jordan and Lebanon had similar levels of utilization of maternal health services, despite different health systems and humanitarian assistance provisions. As expected, a substantial proportion of households incurred out-of-pocket costs for essential maternal and newborn health services, making cost a major factor in care-seeking decisions and locations. As health financing policies shift to account for the continued burden of refugee hosting on the health system, sustained attention to the availability and quality of essential maternal and newborn health services is needed to protect both refugee and host populations women’s rights to health and health care during pregnancy, childbirth, and the postpartum period.
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References
Amnesty International. (2016). Living on the margins: Syrian refugees in Jordan struggle to access health care. London: Amnesty International2016.
Alsaba, K., & Kapilashrami, A. (2016). Understanding women’s experience of violence and the political economy of gender in conflict: The case of Syria. Reproductive Health Matters, 24(47), 5–17. doi:10.1016/j.rhm.2016.05.002.
Bashour, H., & Abdulsalam, A. (2005) Syrian women’s preferences for birth attendant and birth place. Birth, 32(1), 20–26.
Benage, M., Greenough, P. G., Vinck, P., et al. (2015). An assessment of antenatal care among Syrian refugees in Lebanon. Conflicy and Health, 9, 8. doi:10.1186/s13031-015-0035-8.
Betrán, A. P., Ye, J., Moller, A. -B., et al. (2016). The increasing trend in caesarean section rates: Global, regional and national estimates: 1990–2014. PLoS ONE, 11(2), e0148343. doi:10.1371/journal.pone.0148343.
DeJong, J., Akik, C., El Kak, F., et al. (2010). The safety and quality of childbirth in the context of health systems: Mapping maternal health provision in Lebanon. Midwifery, 26(5), 549–557. doi:10.1016/j.midw.2010.06.012.
Doocy, S., Lyles, E., Akhu-Zaheya, L., et al. (2016). Health service access and utilization among Syrian refugees in Jordan. International Journal for Equity in Health, 15(1), 108. doi:10.1186/s12939-016-0399-4.
Doocy, S., Lyles, E., Hanquart, B., et al. (2016). Prevalence, care-seeking, and health service utilization for non-communicable diseases among Syrian refugees and host communities in Lebanon. Conflict and Health, 10(1), 21. doi:10.1186/s13031-016-0088-3.
Finlayson, K., & Downe, S. (2013). Why do women not use antenatal services in low- and middle-income countries? A meta-synthesis of qualitative studies. PLoS Medicine, 10(1), e1001373. doi:10.1371/journal.pmed.1001373.
Government of Lebanon and United Nations. Lebanon Crisis Response Plan 2014–2015 UN OCHA2014.
Hodgins, S., D’Agostino, A. (2014). The quality-coverage gap in antenatal care: Toward better measurement of effective coverage. Global Health: Science and Practice 2(2), 173–181. doi:10.9745/ghsp-d-13-00176.
Huster, K. M., Patterson, N., Schilperoord, M., et al. (2014). Cesarean sections among Syrian refugees in Lebanon from december 2012/january 2013 to june 2013: Probable causes and recommendations. The Yale Journal of Biology and Medicine, 87(3), 269–288.
Kabakian-Khasholian, T. (2013). ‘My pain was stronger than my happiness’: Experiences of caesarean births from Lebanon. Midwifery, 29(11), 1251–1256. doi:10.1016/j.midw.2012.09.001.
Koblinsky, M., Moyer, C. A., Calvert, C., et al. (2016). Quality maternity care for every woman, everywhere: A call to action. Lancet. doi:10.1016/S0140-6736(16)31333-2.
Miller, S., Abalos, E., Chamillard, M., et al. (2016). Beyond too little, too late and too much, too soon: A pathway towards evidence-based, respectful maternity care worldwide. Lancet. doi:10.1016/S0140-6736(16)31472-6.
Parkinson, S. E., & Behrouzan, O. (2015). Negotiating health and life: Syrian refugees and the politics of access in Lebanon. Social Science & Medicine (1982). doi:10.1016/j.socscimed.2015.10.008.
Spiegel, P. (2015). The state of the world’s refugees: The importance of work, cash assistance and health insurance. JAMA, 314(5), 445–446.
UNHCR (2015). Cash-based Interventions for health programmes in refugee settings: A review. Geneva: UNHCR2015.
United Nations High Refugee Agency (UNHCR). Health Access and Utilisation Survey Amongst Non-Camp Refugees in Jordan: UNHCR2014.
United Nations High Refugee Agency (UNHCR). Health Access and Utilisation Survey Amongst Non-Camp Refugees in Lebanon: UNHCR2014.
United Nations (2016). One Humanity: Shared Responsibility. Report of the Secretary General for the World Humanitarian Summit. 2 February 2016.
United Nations. 3RP: Regional Refugee & Resilience Plan, 2016–2017 in Response to the Syria Crisis2016.
United Nations. Global Strategy for Women’s, Children’s and Adolescents’ Health: 2016–2030. New York: United Nations2015.
UNFPA. (2015) State of the world’s population. New York: UNFPA2016.
Verme P, Gigliarano C, Wieser C, et al. (2016) The welfare of Syrian refugees: Evidence from Jordan and Lebanon. Washington DC: World Bank and UNHCR2016.
Wells, R., Steel, Z., Abo-Hilal, M., et al. (2016). Psychosocial concerns reported by Syrian refugees living in Jordan: Systematic review of unpublished needs assessments. The British Journal of Psychiatry: The Journal of Mental Science, 209(2), 99–106. doi:10.1192/bjp.bp.115.165084.
Yasmine, R., & Moughalian, C. (2016). Systemic violence against Syrian refugee women and the myth of effective intrapersonal interventions. Reproductive Health Matters, 24(47), 27–35. doi:10.1016/j.rhm.2016.04.008.
Zeid, S., Bustreo, F., Barakat, M. T., et al. (2015). For every woman, every child, everywhere: A universal agenda for the health of women, children, and adolescents. Lancet, 385(9981), 1919–1920. doi:10.1016/S0140-6736(15)60766-8.
Acknowledgements
Both surveys were implemented by the Center for Humanitarian Health at Johns Hopkins School of Public Health (JHSPH). The Jordan survey was also implemented by the School of Nursing at Jordan University for Science and Technology (JUST) and the Lebanon survey by Médecins du Monde (MdM). Technical support for the Jordan survey was provided by the World Health Organization (WHO), and the Ministry of Health (MoH) of the Hashemite Kingdom of Jordan. Administrative and technical support for the Lebanon survey was provided by International Medical Corps, the American University of Beirut Faculty of Health Sciences. The United Nations High Commissioner for Refugees (UNHCR) provided technical support for both studies. The study team would like to acknowledge Gilbert Burnham and William Weiss from JHSPH and Arwa Oweis and Laila Akhu-Zaheya from JUST for their many contributions to study design and implementation. We also extended our gratitude to the JUST and MdM interviewers, without whom this work would not have been possible. Finally, we would like to acknowledge Rick Brennan, Claudine Prudhon, Altaf Musani, Basel Al-Yousfi, Miranda Shami, Mary Sweidan and Said Aden from WHO and Paul Spiegel, Marian Schilperoord, Michael Woodman, and Frank Tyler from the UNHCR for their support and efforts to facilitate the survey.
Funding
The Jordan study was funded by the World Health Organization and the Lebanon study was funded by the European Commission Humanitarian Aid and Civil Protection Department.
Collaborators for the Jordan Health Access Study Team
including Arwa Oweis, Laila-Akhu Zaheya, Timothy Roberton, Gilbert Burnham and William Weiss.
Collaborators for the Lebanon Health Access Study Team
including Baptiste Hanquart, Lara Chela, Nour Aridi, Nour Kassab, Aline Keyrouz, Deena Al-Shatti, Francois de La Roche and Michael Woodman.
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Collaborators of the of the Jordan Health Access Study Team and Lebanon Health Access Study Team Working Groups are listed in “Acknowledgment”.
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Tappis, H., Lyles, E., Burton, A. et al. Maternal Health Care Utilization Among Syrian Refugees in Lebanon and Jordan. Matern Child Health J 21, 1798–1807 (2017). https://doi.org/10.1007/s10995-017-2315-y
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DOI: https://doi.org/10.1007/s10995-017-2315-y