Improving access and utilization of Sexual and Reproductive Health (SRH) for homeless women in their reproductive age

Homelessness is a serious challenge in Ethiopia, with recent estimates of more than 24,000 homeless individuals living in Addis Ababa, according to the report by the Ministry of Labor and social affairs. This number is told to have multiple methodological challenges and the actual number is estimated to be even higher.  This is the result of cumulative impact of several factors, including poverty, family conflict and experience of abuse at home.

A significant proportion of homeless individuals constitute women in their reproductive ages. These women are at increased risk of sexual violence, substance abuse, unintended pregnancy and several other threats. They usually are victims of crime and engage in informal work to earn an income, which further increases their susceptibility. They are also denied from formal education and unaware of how and where to access essential reproductive health services. 

Since its establishment, St. Paul Institute for Reproductive Health and Rights (SPIRHR) has been promoting sexual and reproductive health through training, research, advocacy and clinical services. The advocacy pillar of the program is uniquely designed to increase access through improving awareness of vulnerable groups. SPIRHR identified homeless women and started intervention by reaching out to multiple stakeholders to create awareness for vulnerable groups that disproportionately face poor reproductive health and adverse pregnancy outcomes. 

Cognizant of the challenges, SPIRHR coordinated and successfully conducted a half day awareness session for 20 homeless on SRH to improve access and utilization of SRH services, as well as help women get the knowledge necessary to achieve and enjoy SRH. The training was conducted in collaboration with Bole Kifle Ketema and Woreda 4 children and women affairs, St. Paul’s Hospital Millennium Medical College staff, SCORA team, and the host site MICHU 22 Center for Fertility and Reproductive Medicine (CFRM). 

Focused areas of the training were carefully selected, considering homeless living conditions that lead to poor uptake and engagement with SRH, including unintended pregnancies, increased burden of STI, including HIV/AIDS, and unsafe sexual behaviors. Thus, topics covered and discussed during the session were family planning services, Risky sexual behaviors, Safe sex practices, access to safe abortion services, Prevention of sexually transmitted infections, including HIV/AIDS. 

Participants also visited MICHU clinic at CFRM, where comprehensive reproductive health service is provided free of charge 24 hours for seven days. An enthusiast nurse, Sr Winta Mekasha, led the tour and described services provided to encourage utilization of the services at the clinic. Pregnancy test and FP services were also offered on the spot for those who were interested. 

The event was successfully concluded with the women reflecting on the importance of having similar sessions to other sites and pledging to utilize SRH clinics available in their vicinity. This participatory exercise with practical examples from participants has provided insight to SPIRHR in advocating equal access to SRH services while empowering vulnerable groups to utilize SRH services and exercise their rights.

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