By Susan Bryar December 1, 2021 The number of refugees in the world is at its highest level ever, doubling since 2010. There were 82.4 million people displaced at the end of 2020, among them nearly 26 million refugees. About 1 in 25 is a pregnant refugee woman. Concern for pregnant refugee women Compared to women who are not displaced, pregnant refugee women are at greater risk of developing pregnancy complications like preterm birth. Sickness, injury and death are more likely for pregnant refugee women than other refugees. They are also more likely to experience sexual violence, including rape, either during the displacement or in the camps and settlements to which they arrive. Refugee women are also at higher risk than others for mental health issues such as postpartum depression, possibly as a result of the stress and loss of support networks that displacement often creates. By targeting care of pregnant refugee women, we can prevent suffering and death for many. Imaculé, a Congolese refugee, does skin-to-skin with one of her twin babies, born in a Medical Teams clinic. The big impact of small interventions Pregnancy can be a challenging time for many women, and leaving home introduces many more challenges. Nutrition, poor sanitation, and inadequate access to care can all contribute to poor outcomes. Pregnancy places many stresses on women’s bodies, and some women may develop diabetes or high blood pressure during pregnancy. Anemia, or low red blood cells, is a problem related to poor nutrition that may affect the baby’s growth and can worsen after delivery. Pregnant refugee women are more likely than women who are not displaced to develop complications during their pregnancies, such as premature labor, still birth, birth defects and low birth weight. Prenatal care aims to address these issues. Prenatal care for pregnant refugee women Health care workers can screen for these issues through routine blood and urine tests, blood pressure measurements and weight checks. Then, they can provide preventative care and appropriate treatment if problems occur. Prenatal care helps prevent complications by informing women about important steps they can take to protect their infant and ensure a healthy pregnancy. This may include improving nutrition, which can increase birthweight and decrease the risks of sickness and death in mothers and babies. Monicah, a nutritionist at a Medical Teams clinic in Uganda, discusses treatment with a mother and her baby. Health promotion Prenatal care also includes health promotion — the process of enabling people to increase control over, and to improve, their health. Teaching women ways to improve sanitation or promoting vaccinations and breastfeeding can decrease their family’s risk of illness. Pregnant refugee women learn skills to improve the health of their entire families. Skilled birth attendants Giving birth in a clinic or hospital with a skilled birth attendant (a trained midwife or doctor) is another intervention that can be the difference between life and death. Although most babies are delivered safely, complications can arise for women and babies. For mothers, these can include obstructed labor, infections or excessive blood loss, all of which can lead to death if untreated. Babies may suffer birth injuries such as a lack of oxygen during birth that can lead to seizures, disabilities or even death. In the remote and conflict-affected communities where Medical Teams often works, women may not easily be able to reach the nearest health facility. Some women may fear hospitals and choose to give birth at home. Building trust in health facilities and helping women access skilled birth attendants can save the lives of mothers and babies. Medical Teams is helping pregnant refugee women There are many strategies to improve the health of pregnant refugee women. Depending on the country and context, here’s what Medical Teams is doing to help. Community Health Workers Community Health Workers are people from the community who share language and culture and are trusted advocates for the community. Training and equipping community health workers in places like Bangladesh and Colombia helps them gain skills, and it benefits the larger community. Community health workers walk to the far reaches of a settlement to ensure everyone has access to care. They help build trust with women, so they are encouraged to visit clinics and hospitals for care. They also provide health education and act as mediators between the health system and the community. Partners Medical Teams also partners with various organizations to promote the health of mothers and babies. In Guatemala, Medical Teams partners with Providence St. Joseph to provide pregnant women with prenatal and postnatal care and teach them about warning signs in pregnancy. Uganda has the largest refugee population in Africa with more than a million displaced people. Eighty percent of Uganda’s refugees are women and children. Medical Teams is recognized by the United Nations for the quality of their work to make sure refugees throughout Uganda have access to life-saving medical care. Because of that, they have been the chosen partner for providing refugee health care in Uganda by the UNHCR since 2009. Health Officer Robert Businge speaks to a mother prior to surgery. Health clinics Lastly, Medical Teams has health clinics, like in Tanzania, to provide basic prenatal care and deliveries. Medical Teams also works with government health facilities to provide more comprehensive services such as C-sections, ventilators and incubators for preterm babies. Help improve the health of a pregnant refugee woman by donating or sending a safe delivery kit. Susan Bryar, ARNP Susan Bryar is a guest writer for Medical Teams. She is a nurse practitioner specializing in maternal fetal medicine in the Seattle area. She is grateful to care for women from all over the world, many of whom traveled to the US as migrants or refugees.