Sexual and reproductive health needs of refugee women on Lesbos, Greece: a participatory cross-sectional study.
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OBJECTIVE: To describe the prevalence of common sexual and reproductive health (SRH) indicators and healthcare access among women of reproductive age residing in Closed Controlled Access Centre (CCAC) Mavrovouni on Lesbos, Greece. METHODS: A household survey comprising 119 questions across eight SRH domains was completed by 247 refugee women of reproductive age residing in CCAC Mavrovouni. Nine refugee coresearchers were engaged in a participatory action research process, contributing to question development, recruitment, data collection and analysis in June and July 2023. RESULTS: Most women reported adequate antenatal care (25/28, 89%) and healthcare-assisted births (14/14, 100%), but postpartum care was suboptimal with 47% (7/15) not accessing any services despite 63% (10/16) reporting complications. About half (56/120, 47%) of women with children were single mothers. Two women had a child die at sea. Family planning showed considerable unmet need, with only 24% (42/178) of women using modern contraception and over 25% (17/66) desiring fertility treatment but none accessing it. Despite 84% (173/207) reporting adequate access to menstrual materials, only 14% (29/207) were able to consistently alleviate pain. Of 247 women, 151 (61%) experienced gynaecological symptoms yet 68 (45%) did not access healthcare. Low screening for sexually transmitted infections (43/240, 18%) and cervical cancer (1/246, 0.4%) was reported. Of 244 women, 74% (180/244) experienced verbal, 52% (127/244) physical and 36% (87/244) sexual abuse in their lifetime. Gender-based violence was most reported in home countries, during travel and during pushbacks. 54% (133/247) of women experienced at least one pushback and 23% (57/247) reported denial of medical care. Across all domains except breastfeeding, most women (67%-91%) had not received healthcare information. CONCLUSION: In refugee camp Mavrovouni, there is an urgent need for comprehensive SRH services that address diverse unmet health and information needs. Strengthening responses require cocreated, tailored interventions that are both data-driven and community-informed. Simultaneously, action must be taken to eliminate pushbacks and ensure equitable healthcare access irrespective of legal status.