ABSTRACT
Contraception is one of the four essential determinant factors of fertility identify by Bongart (1978). The role of contraceptive usage in population reduction and reproductive health cannot be overemphasized. Over the years, Ghana has been promoting the modern usage of contraceptives, yet there has not been appreciable and consistent increase in its usage among citizens and to some extent refugees in the country. The extent of meeting the needs of vulnerable groups such as female refugees has not been extensively studied. The study, therefore, examined the modern contraceptive usage among female refugees in Ghana the case of Fetenta refugees‟ camp. The research design that was adopted was a mixed method. The sample size was made up of 70 female refuges selected through systematic sampling procedure. Instruments were structured questionnaires and in-depth interview guides. The quantitative data was analysed using SPSS and the qualitative through the use of thematic analysis. The result shows that perception and knowledge of contraceptives were positive in terms of the types and reasons for the usage. With regards to accessibility, the findings indicated that it was difficult accessing it since it was not available and knowledge on its usage was lacking. The major reasons for its usage were the prevention of pregnancy and birth spacing. It is concluded that modern contraceptive usage should be made available within the camps for easy patronage. Based on the findings of the study, it is recommended that healthcare providers, friends, and the mass media are the source of information on contraceptives, therefore GHS should have a policy on how to reach out to people including refugees with in-depth knowledge on the benefits of contraceptive usage.
CHAPTER ONE
Background of the study
The incident of refugees has become paramount among governments, civil society organizations, and intergovernmental organizations in recent times. This is due to the steady increase in the number of refugees and the uncongenial conditions under which they found themselves. With a total of 68.5 million people forcibly displaced, close to one third (25.4 million) of them were refugees (United Nations High Commissioner for Refugees, 2017). Whereas natural disasters such as floods, drought, earthquakes, and tidal waves have displaced several people, conflict and violence have caused a lot of refugee situation in some parts of the world. Consequently, these people end up in places either than their home country. Africa continues to experience a refugee situation in terms of producing, hosting, and sending a large number of refugees to different countries. The United Nations High Commissioner for Refugees (UNHCR) 2017 Report reveals that out of the top five countries with a high number of refugees, two were African countries – South Sudan and Somalia. Although East and North Africa are conspicuously known for producing and hosting a chunk of refugees, parts of West Africa continue to experience displacement and refugee-like situations of people.
Since the early 1990s, Ghana has become one of the preferred destinations for refugees from neighbouring countries such as Liberia, Sierra Leone, Togo and Cote d’Ivoire (Tanle, 2013). This has led to the establishment of some refugee camps in Ghana such as Buduburam, Krisan, Ampain, Fetenta, Egyeikrom, among others to host the influx of these refugees. Several studies have been conducted to understand the various dimensions of the refugee situation in Ghana. The economic livelihood of refugees in Ghana has extensively been explored (Trapp, 2018; Antwi, 2015; Manteaw, 2014; Teye & Yebleh, 2014), also the
integration of the refugees (Acheampong, 2015; Agblorti, 2011), as well as the challenges refugees encounter in Ghana (Dako-Gyeke & Adu, 2017; Bortu, 2009). However, little attention has been paid to the sexual practices of refugees in Ghana although it forms an important part of refugee‟s lives in the various camps.
Apart from the arduous conditions, refugees found themselves including; lack of access to social amenities such as schools, water, food, accommodation, health facilities (Ahimbisibwe, 2018; Schilling et al., 2017), they are also prone to sexual violence and sometimes engage in risky sexual behaviours. Apparently, the most vulnerable group of people that tend to endure the burden of these risky sexual behaviours is female refugees (World Health Organization, 2018; Okanlawon, Reeves & Agbaje, 2010). Thus, some end up in early marriages, unwanted pregnancies, and maternal morbidity. This has, therefore, become a major concern to the United Nations and its subsidiary unit (i.e. United Nations High Commissioner for Refugees) mandated to handle the affairs of refugees.
In spite of the fact that the sexual pursuits of refugees have taken a centre stage in the policy discourse of relevant stakeholders and international organizations such as the UNHCR, most studies in Ghana tend to focus on the economic livelihood of refugees in the various camps. This study is, therefore, undertaking to understand how refugees within the Fetenta camps perceive the usage of contraceptives and their accessibility to these items.
Problem Statement
As stated earlier, the conditions under which refugees found themselves in host countries have become a lurid situation to both the refugees and relevant stakeholders. Despite the efforts of some host countries, Civil Society and International Organizations in ameliorating the ordeals of refugees, they still continue to experience exclusion from socio-economic, political, education and health services (Chuah, Tan, Yeo & Legido-Quigley, 2018). In mitigating the challenges refugees are confronted with, they tend to adopt varied strategies. Whereas some
of them are victims of circumstances under which they are sexually abused, a section of them consciously engages in risky sexual practices as a surviving strategy. Consequently, their vulnerability is exacerbated due to issues such as unwanted pregnancies and diseases.
Understanding the various dimensions of sexual activities of refugees within the camps have attracted the attention of both policymakers and academia. Thus, several studies have been carried out in other geographical areas that host refugees such as Kakuma and Dadaab refugee camp in Kenya (Spiegel, Schilperoord & Dahab, 2014; Tanabe et al., 2015), Rwamwanja and Kyaka II refugee camp in Uganda (Odwe, Undie & Obare, 2018; IGAD, 2010), refugees in Ethiopia (Stark et al., 2018), Oru refugee camp in Nigeria (Agbaje, 2011; Okanlawon, Reeves & Agbaje, 2010), Syrian refugee women in Lebanon (Yasmine & Moughalian, 2016), among others. However, studies that have been conducted in the various camps Of Ghana focus on understanding a certain aspect of their lives (Trapp, 2018; Teye & Yebleh, 2014; Dako-Gyeke & Adu, 2017) either than their sexual pursuits – little attention is paid to their sexual engagement. Thus, there is a dearth of literature on the sexual activities of refugees in Ghana refugee camps, therefore, it requires prompt attention from all relevant stakeholders (Starrfmonline, 2017).
Using the Fetenta refugee camp as a case study, this study, therefore, explores the perception, accessibility, and usage of modern contraceptives among refugees. It also tends to identify some of the impediments among refugees in the usage of modern contraceptives. Whereas lessons will be drawn from different geographical contexts through review of relevant literature, this study will also bring into limelight the situation of modern contraceptives usage within refugee camps in Ghana – contribute to the lacuna that exists within refugee sexual engagement in Ghana.
Research Questions
The general research question is to examine the extent to which contraceptives are used in Fetenta refugee camp. The specific research questions are to investigate:
- How does the knowledge of modern contraceptives influence the perception and usage among female refugees in the Fetenata refugee camp?
- How do the personal and external factors facilitate the usage of modern contraceptives among female refugees in the Fetentaa refugee camp?
- What are some of the strategies needed to increase the usage of modern contraceptives among female refugees in the Fetentaa refugee camp?
Research Objectives
The overriding objective of the study is to understand the situation of modern contraceptive usage among female refugees within Fetenta refugee camp in Ghana. The following specific objectives will be addressed:
- To assess the socio-demographic characteristics of the female refugees.
- To find out the perception and knowledge of female refugees about the usage of contraceptives.
- To examine the accessibility of contraceptives among female refugees.
- To make policy recommendations based on the findings of the study.
Rationale of the study
Understanding all aspects of refugees‟ lives should be a concern to all institutions mandated in managing the affairs of refugees. This should even be more crucial to Africa – a continent that is seen as one of the leading producers and hosts to refugees (United Nations Africa Renewal, 2017; (African Parliamentary Union, 2004)). Hence, respective countries need to streamline the activities of refugees into their policies. To have sound policies in addressing
the challenges of refugees, the role of academia cannot be overemphasized. Several painstaking kinds of research have been conducted to understand the various dimensions of refugee lives. Whereas similar studies have been undertaken in Ghana, it is appalling to know that most of these studies are skewed towards the scope of the economic livelihood and reintegration of refugees in various refugee camps of Ghana.
This study will be particularly useful since the sexual lives of refugees will be explored, with a focus on understanding the usage of modern contraceptives and some of the issues that inhibit their utilization among female refugees in the Fetenta refugee camp of Ghana. This study is timely – at a time that the sexual behaviours of refugees have become a critical area of concern to the international community such as the United Nations High Commissioner for Refugees. Although this study perhaps is not the first of its kind, findings from this study will be relevant to policymakers and the international bodies that place refugees at the core of their programs. Because lessons are expected to be drawn from different jurisdictions through desktop review of relevant literature which will in tandem be compared to the case of Ghana by focusing at the Fetenta refugee camp. Lastly, the study will contribute to the gap that exists within the sexual lives of refugees in Ghana.
Organization of the study
The study will be organized into five chapters. Firstly, the general background to the study, problem statement, research questions and objectives, relevance of the study will be captured in chapter one. Subsequently, chapter two will delve into relevant pieces of literature that are related to the study. Whereas studies from different geographical areas will be explored, the general patterns of challenges confronting refugees, the economic and social livelihood of refugees, and the sexual exploits of refugees from different places other than Ghana will be presented in chapter two. Also, the theoretical underpinning of the study will be elaborated in this chapter.
Chapter three of this study will be devoted to the research methodology. Hence, the research design, type of data to be used, the sampling techniques, and how the data will be analyzed will be presented in this chapter. Also, all ethical issues that will arise from the study will be included in chapter three.
The findings of the study will be presented in chapter four. It is anticipated that the socio- demographic characteristics of respondents, the perception of refugees with regards to the usage of contraceptives, the challenges in using these contraceptives will all be encapsulated in chapter four.
Lastly, summary, conclusion, and recommendations expected to emanate from the study will be outlined in chapter five.
