Can Condoms and Culture Co-Exist?
Lynn Eagle, The Unmentionables' Sexpert
The need for family planning among refugees and displaced peoples isn’t always considered a priority. The reality is that these populations are at a much higher risk of unwanted pregnancies and infections. For women living a life in limbo, an unwanted pregnancy adds significant hardship to an already desperate and dangerous situation. Studies have shown that one of the most common complaints displaced women have are related to reproductive health; yet reliable access to family planning options and reproductive health remain elusive and inconsistent.
Condom use and its benefits are almost universally known therefore, the solution should be simple; give everyone in refugee camps access to an abundance of condoms and the problem is solved.
Unfortunately, it’s not that simple. The problem transcends the simple mindset that providing condoms will solve the problem facing women in refugee camps.
Even if people take condoms, it does not mean they are being used correctly - or at all. Several studies have indicated that many displaced people lack the education and knowledge to know how to successfully use a condom or know the benefits of such a barrier method. Common misconceptions about condom use are also rampant. Some myths are that condoms will actually increase the chances of infection, that condom use is associated with witchcraft or that asking your partner to use a condom means that you yourself have an infection. Dispelling these myths is a critical step in ensuring the acceptance of condoms.
Accessibility and acceptance is another barrier to condom use particularly given the lack of information in refugee camps. Attention to other issues has overshadowed those related to unprotected sexual contact, which can be prevented with condom use. For example, untreated STIs can lead to complications in pregnancy, infertility, reproductive cancers, and enhanced transmission of HIV. One of the more striking and urgent findings of a 2015 study published in Conflict and Health was that even when reproductive health services were in place, the uptake of these services was insufficient. Many affected communities were unaware of existing services or did not know of their benefits. The report goes on to state that the few people who knew about the reproductive and family planning services available largely avoided them due to shame and anxiety about possible repercussions from their communities. This finding challenges the “if you build it, they will come” assumption that at times permeates health programming (Chynoweth, 2015).
On the other side of the coin, a recent study based out of the Zaatari refugee camp in Jordan revealed that despite knowing condoms were available at health clinics, no one would use them. Alarmingly, most clinics at the Zaatari camp would not supply condoms to non-married women. The problem with this situation is two fold. Firstly, cultural sensitivities may have inhibited providers from making free condoms visible and readily attainable. In some conservative cultures for example, the idea of an unmarried woman having sex is unthinkable. The reality is that the woman may not have a choice. She may, for example, be in a situation where she is engaging in survival sex. Denying women the freedom of choice or shaming them into an alternative is a grave human rights concern.
Secondly, it has been reported from some women in refugee camps that husbands simply refuse to use condoms. This may be due to cultural beliefs or to pressure for women to have more children. Although it is a challenge to tackle the issue of family planning and reproductive health in a manner that is culturally sensitive, some agencies are attempting to raise awareness. For example, UNFPA holds seminars about early marriage and family planning methods in some refugee camps.
Successful family planning among displaced communities involves much more than simply making condoms available. Providing culturally sensitive educational programs on reproductive health and family planning is a key component to condom uptake.
Community mobilization to increase awareness, dispel taboos and change the messaging around condom use is another crucial element. According to several studies, a significant increase in reproductive health service access has been the result of outreach and community mobilization. Additionally, reproductive health services need to be targeted to the audience you seek to impact. We cannot expect to have the same impact of condom use uptake in teaching a class to newly married couples as to teenagers. Specific, targeted interventions are key.
Combining coordination, teaching and community involvement for successful condom use in refugee camps could be an economical and feasible way to protect women from disease and unwanted pregnancies.