Around one in 10 women refugees traveling through Europe is pregnant. Better coordinated approaches from states and NGOs are urgently needed to keep women and their newborn babies safe and well.
Tehmina was traveling through Greece from Syria when she went into labor. However, the first-time mother was determined to continue her journey and have her baby once she reached Germany. Finally, her family convinced her to go to the hospital and she agreed to give birth in Greece. Just hours later, Tehmina and her newborn left the hospital and continued to walk.
Her story is by no means unique. For the first time since the refugee and migrant crisis hit Europe, there are now more women and children on the move than male adults. Women and children account for 60 percent of refugees and migrants.
Every day, some 500 women die in pregnancy or childbirth in humanitarian settings. Sixty percent of preventable maternal deaths and 53 percent of under-five fatalities take place in countries affected by, or prone to, conflict, forced displacement or natural disaster.
The situation prompted 13 countries to announce at the first World Humanitarian Summit on May 23-24 their commitment between now and 2030 to increase their support for sexual and reproductive health services and supplies.
The plight of pregnant refugees is illustrated by a recent joint field assessment from the United Nations refugee agency (UNHCR), its Population Fund (UNFPA) and the Women’s Refugee Commission (WRC). Researchers looking into the risks for refugee and migrant women and girls in Greece and Macedonia heard from humanitarian agencies that women often left hospitals less than 24 hours after giving birth, some having had a Caesarean section.
Pregnant and lactating women, even those with health problems, are reluctant to access services or visit hospitals for fear of delaying their journey, losing their baby or being separated from their family. Most of the women seen in Greece and Macedonia had suffered severe physical and psychological stress while traveling. Even if they were otherwise healthy, they were at higher risk of complications, premature delivery or even death.
Deni Robey, the WRC’s director of strategic communications, says assessments show very little readily available sexual and reproductive health care: “Pregnant women were waiting until the last possible moment to go to a hospital to deliver and then were back out walking within a day.”
These expectant and new mothers receive no cards or flowers. As they make their way through Europe on foot, with numerous stops and practically nonexistent antenatal or postnatal care, they will be lucky to have a bed for the night or collect basic supplies such as diapers and formula.
Many will experience fatigue from walking, heavy bleeding or other complications related to pregnancy or recent birth. Others may be weak from dehydration and poor nutrition. Some are already caring for one child or more.
The report from UNHCR, UNFPA and WRC highlights single women traveling alone or with children, pregnant and lactating women, and early-married children – sometimes with newborn babies – as among those who are particularly at risk of extortion and exploitation, including multiple forms of sexual and gender-based violence (SGBV).
The E.U.-Turkey deal that came into effect March 20 only exacerbates the situation for women. Doina Bologa, the UNFPA representative for Bosnia and Herzegovina, was assigned in mid-May as the organization’s senior emergency coordinator for Europe. She says: “Currently, the migration flow through the Balkans has practically halted, with only an estimate of 200-300 illegal or irregular migrants being counted by UNHCR in transit towards the Western European countries. Some 50,000 refugees or migrants are reported to be currently stranded in Greece and accommodated in some 40 camps.”
In an open letter this month to E.U. member states and institutions, Médecins Sans Frontières international president Joanna Liu brands the official welcome offered by Europe to those stranded in Greece as “shameful,” and says camps on the Greek islands have “virtually no safeguards” in place. “Women fear to go to the toilet once darkness falls, mothers beg for milk formula to feed their babies,” she wrote.
But care and services for pregnant women are slowly starting to improve. In the last few months, UNFPA has introduced four mobile health clinics with ultrasound equipment in Serbia and Macedonia, although border closures now limit women’s access to these.
Meanwhile, UNHCR is rolling out 20 Blue Dot centers: Child and family support hubs located at strategic sites (such as border entry or exit points) that will provide a package of services including mother and baby/toddler spaces, counseling, psychosocial first aid and social workers.
Providing information in a language that pregnant women understand and having female translators at transit centers remain challenges, as does access to contraception and family planning advice, says Bologa at UNFPA.
Signatories to the 13-state WHS pledge will ensure that financing for humanitarian action includes access to sexual and reproductive health. The group also backs a rollout by 2017 of the Minimum Initial Services Package (MISP) within 48 hours of an emergency. This series of crucial actions includes an objective to prevent maternal and newborn illness and death.
Sandra Krause, director of the sexual and reproductive health program at WRC, says: “We want the commitment from all humanitarian actors to implement the MISP from the onset of every humanitarian emergency, and to comprehensive sexual and reproductive health care for all women and adolescent girls as soon as the situation stabilizes.”
Krause would like to see more mobile clinics serving this itinerant refugee population, and emergency response training for local health workers.
Bologa at UNFPA says there is a need for “more systemic and sustained attention” to gender-based violence issues, given that some of these women are pregnant because they have been involved in trafficking, transactional sex or domestic violence: “This migration is quite unprecedented, and the international community is still struggling to come to terms with these problems.”