Increasing Family
Planning and
Reproductive Health
Access to Internally
Displaced and
Refugee Populations
in Azerbaijan
Cathy Solter, SCM, MPH and Kathy Le, MPP
PATHFINDER INTERNATIONAL
131st Annual Meeting and Exposition of the American Public Health
Association
San Francisco, CA
November 17, 2003
Background Information
FACTS
 Population: 7,771,092
 Fertility Rate: 2.24
 Abortion is legal
 Lost 20% of territory
(Nagorno-Karabakh
region) to Armenia
One million people have been displaced by the
ten-year conflict with Armenia.
131st APHA Annual Meeting and Exposition
AHAP in Azerbaijan
Azerbaijan Humanitarian Assistance Program: six-year $45
million to support USAID's objective 3.1 - Reducing
Human Suffering in Conflict Affected Areas
Implementing Partners: ACDI/VOCA, Adventist
Development and Relief Agency, Cooperative
Housing Foundation, International Medical Corps,
International Rescue Committee, Pathfinder
International, Save the Children Federation, and
World Vision.
Pathfinder’s Program: Primary Health Care in Urban
Areas (May 2001-July 2003)
131st APHA Annual Meeting and Exposition
Increasing FP/RH Access at
Community and Facility Levels
Project Goal: To reach 90,000 internally displaced persons
(IDPs) (70,000 women, 10,000 men and 10,000 adolescents)
Geographic Area: 29
IDP settlement areas in
13 districts in Baku,
Apsheron, and Sumgait
regions
800,000 IDPs live in the
project areas
Ninety communitybased service (CBS)
workers with six
supervisors
Trained 50 public sector
service providers in
FP/RH
131st APHA Annual Meeting and Exposition
Accomplishments (1)
Community-based Services
 88,562 people of reproductive age, including 62,142
women, 7,350 men and 19,070 adolescents
 Increased use of modern contraceptives from 5,206
users to 12,906.
 Decrease in the number of abortions from 1,603 to
507 in the three months prior to each survey.
Contraceptive Use
Condoms
IUD
Pills
2003
6,624
4,386
1,659
2000
1,492
2,910
757
131st APHA Annual Meeting and Exposition
Accomplishments (2)
Training
 90 CBS workers and six supervisors were trained in
communication and FP/RH and adolescent health.
 44 public sector service providers were given refresher
trainings on FP/RH as well as maternal and child
health, ARH, HIV/AIDS, and gender issues.
 Environmental training was conducted for CBS
workers as part of the Environmental Action Plan.
Dissemination and Coordination
 Press releases, project bulletins, and newspaper articles
 Sharing of IEC materials, such as leaflets and posters.
131st APHA Annual Meeting and Exposition
Environmental Activities
 Creation of an
environmental
action plan
 Training for all CBS
workers
 4,000 information
leaflets and 52
posters distributed
 180 clean-up
campaigns
implemented
131st APHA Annual Meeting and Exposition
Sustainability and Cost Recovery
 Trained a group of 90
CBS workers and six
supervisors who remain
in the IDP communities.
 CBS workers trained to
measure blood pressure
and apply first aid. Fees
collected for services
and proceeds used for
training and equipping
additional CBS workers.
131st APHA Annual Meeting and Exposition
Knowledge, Attitude and Practices
Baseline survey: October 2000
Final survey: July 2003 showed significant changes, examples:
Decrease in % of women who had never visited a
gynecologist from 67.4% to 11.7%.
 Percent of women giving birth in a maternity home or
hospital increased from 53% to 96%.
 Increase in the % of men who visited a doctor or
urologist from 24.8% to 52.1%.
 Substantial decrease in the rate of abortions among the
target population from 1,603 to 507.
 Pregnancy in survey group decreased from 45% to 38%.

131st APHA Annual Meeting and Exposition
Frequency of Gynecological Visits by
IDP Women
80%
67,4%
70%
60%
46,2%
At least once a year
50%
Once in 1-2 years
Once in 3-5 years
40%
24,50%
30%
More rare than once in 5 years
Have never visited
13,50%
20%
10%
9,00%
2,2%
7,90%
12,70%
11,7%
5%
0%
2000
2003
131st APHA Annual Meeting and Exposition
HIV/AIDS and STI Knowledge Among
IDP Women
100%
95,2%
88,4%
90%
78,5% 79,1%
80%
70%
60%
49,4% 48,2%
50%
32,7% 34,6%
40%
32,0% 27,5%
30% 15,7% 16,3%
20%
8,4%
10%
1,2%
0,0%
0,0%
0,0%
0,0%
0%
Syphilis
Gonorrhea
Trichomoniasis
Condiloma
Vaginal Yeast
Genital Herpes
Chlamydeous
HIV infection
Infection
(AIDS)
Haven’t heard of
sexually
transmitted
infections
131st APHA Annual Meeting and Exposition
2000
2003
Knowledge of Contraceptive Methods
Among IDP Women
92.7%
100%
80%
79.8%
2000
74.2%
70.2%
2003
60%
40%
22.5%
27.0%
15.2%
12.4%
20%
3.4%
2.2%
0%
Pills
IUD (Spirali)
Injectables
Condoms
131st APHA Annual Meeting and Exposition
Diaphragm
RH Knowledge Among IDP
Adolescent Girls
83,6%
67,6%
75,2%
74,3%
70,8%
2000
29,4%
HIV/AIDS and
other sexually
transmitted
infections
19,6%
Abortion
Methods of
contraception
28,4%
How women
get pregnant
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
131st APHA Annual Meeting and Exposition
2003
Constraints and Consequences
Lack of resources for support and monitoring of
public health service facilities and providers.


Impact: low wages for providers; poor incentive
structure for the provision of quality services;
insufficient materials and supplies; lack of
logistics system.
Consequences: lack of contraceptives/supplies;
providers charge extra fees for services;
decreasing return visits by IDP clients.
131st APHA Annual Meeting and Exposition
Lessons Learned
 CBS activities must be accompanied by access to
quality services in order to achieve maximum
results.
 The CBS approach is very effective in reaching
IDP/refugees with FP/RH messages.
 Gender inequality limits contraceptive use.
 Increased use of modern contraceptive methods
can contribute to a decrease in abortion rates.
131st APHA Annual Meeting and Exposition
For more information, please contact:
Pathfinder International Headquarters
Nine Galen Street, Suite 217
Watertown, MA 02472 USA
Phone: (617) 924-7200
Fax: (617) 924-3833
Web: http://www.pathfind.org
Email: [email protected]