POLICY AND PEOPLE
Call for increased commitment to promote reproductive health of refugees of displacement, says Therese McGinn (Colombia University, NY, USA), who has analysed the current
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eeting the reproductive health needs of the 50 million refugees and internally displaced people worldwide remains a challenge, and governmental and non-governmental organisations (NGOs) need to work together to confront the issues, according to a special supplement in this month’s International Family Planning Perspective (December 2000; 26). This collection of articles chronicles the international efforts to identify and serve the reproductive health needs of refugees in a time of escalating political emergencies. In the first article, Laurel Schreck, associate editor of the journal reports that now is a critical time for reproductive health in this group of people. “Despite some positive developments in this field”, explains Schreck, “delivery of reproductive health services to refugees remains uneven.” Not all humanitarian relief groups agree that reproductive health care should be a priority during an emergency, she explains, “and there is insufficient research upon which to base policy or programmatic decisions”. It is women and children who are most vulnerable to the consequences
At higher risk
data on the health effects of forced migration. “Emergency contraception is an important family planning service for refugees”, she notes, “for those whose access to regular contraceptive supplies has been disrupted and where women have been raped.” She goes on to highlight that poor outcomes in pregnancy are common in many war-affected populations, and that such populations are disproportionately at risk for sexually transmitted diseases, including HIV. “Conditions of refugee life are particularly conducive to sexual violence”, she adds.
In a study of Cambodian refugees in Khao Phlu camp, on the Thailand–Cambodia border, Virginia Morrison reports that although 82% of married women in the camp wanted to stop or delay childbearing, only 12% of all women interviewed reported using a modern method of contraception. Nearly all midwives indicated that they would not provide contraceptives to an unmarried woman, and “few midwives, no traditional birth attendants, and none of the women or men knew about emergency contraception”. It is time to transfer the policies and strategies to the field, explains Schreck. “The refugee reproductive health initiative requires the commitment of governments first and foremost to provide a sufficient level of funding to enable UNHCR [United Nations High Commissioner for Refugees] and NGOs working on the ground to develop and implement comprehensive reproductive health services. Furthermore, she adds “Consistent pressure must be maintained by refugee reproductive health advocates.” Sally Hargreaves
Tonga sells genetic heritage to Australian firm
he Sydney-based biotechnology company, Autogen, announced on Nov 22 that it had struck a deal with the government of Tonga granting Autogen exclusive rights to the genetic make-up of its inhabitants. The South Pacific archipelago has 108 000 inhabitants, of whom two-thirds live on the main island of Tongatapu. According to Autogen, the isolated Tonga population is genetically homogeneous, because the people are probably descended from a single Polynesian family.
Diabetes and obesity are highly prevalent in Tongans. Since the genealogy and genetic heritage of this small population can be retraced, “Tonga provides a unique opportunity to study the genetic basis of diabetes and obesity”, says Joe Gutnick, director of Autogen. This is the third deal in which the gene pool of genetically homogeneous populations has been sold to biotechnology companies. In 1998, the parliament of Iceland gave deCode Genetics permission to
genotype the population. Earlier this year, deCode was also granted access to medical files in order to build up the Icelandic Health Database with which the genetics data can be correlated. The Estonian parliament is currently debating legislation that would enable the Estonian Genome Project to carry out a similar endeavour with data from the country’s 1·4 million inhabitants. Wim Weber
Launch of first trans-European telemedicine network t the MEDICA medical technology fair in Düsseldorf (Nov 22–25), the Berlin-based OP 2000 research group announced that it has developed a standardised, low-cost network to link 14 clinics in six coutries to promote the use of telemedicine. The network is part of the GALENOS Project (Generic Advanced Low Cost Trans-European Network Over Satellite) which will
provide a range of facilities, including on-line teleconsultation. The countries involved are Bulgaria, France, Germany, Greece, Italy, and Tunisia and the OP 2000 group is based at the Robert Rössle Cancer Clinic, Berlin Buch, under the leadership of Peter Schlag, the director of surgery and surgical oncology. The system will provide rapid swapping of patient data, including computed axial tomographic, magnetic reso-
nance, and radiographic images; videos of ultrasound, endoscopic, and laparoscopic investigations; as well as on-line access to surgical operations in real time. The OP 2000 Project is jointly funded by the German Ministry for Education and Research and the European Union with contributions from industry and other bodies. David Jack
THE LANCET • Vol 356 • December 2, 2000
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