GAZA STRIP, Palestine: The 15-year Israeli-imposed embargo, movement restrictions, and Palestinian political fragmentation aggravate the humanitarian crisis for estimated 2.17 million people in Gaza. Facing these challenges, institutions cannot deliver services properly, while the demand increases and exacerbates the system instability.
According to the Palestinian Central Bureau of Statistics (PCBS), the population in 2021 was 2.11 million in the Gaza Strip (GS); the population is young, with 41% below age 15. The number of females of the reproductive age (15- 49 years) in the Gaza Strip in 2020 is 504,021 (24.3%) of the total population and 49.2% of entire females. The total fertility rate in 2020 was 3.2 for women of reproductive age. The number of women who attended governmental and UNRWA Primary Healthcare Centers (PHC) was 48,029, 29% of at-risk pregnancies. The number of females attending the centers for family planning was 14,537, and women attending for postnatal care was 42,733.
In order to respond to sexual reproductive health (SRH) needs, UNFPA supported the Palestinian Family Planning and Protection Association (PFPPA) and Palestinian Medical Relief Society (PMRS), through the Midwifery Led Counseling Home Visits (MLCHV) Programme, by deploying midwifery teams to visit women at home in various neighborhoods covering all governorates of the Gaza Strip.
“20 implementing teams underwent two months of orientation” says PMRS coordinator. “Each team included an experienced and a qualified midwife, a nurse, and a psychologist, and the targeted areas were distributed amongst PMRS and PFPPA” she continued
PMRS and PFPPA carried out services that included providing information on reproductive health (RH) services (ANC, PCC, safe delivery, PNC, FP, adolescent health, postmenopausal, genital infections), and psychosocial support services (PSS). They are targeting pregnant women, lactating women, married and unmarried women, adolescent girls, and postmenopausal women.
Among those women, a 37-year-old mother of seven children who was diagnosed with severe malnutrition and anemia. "She looked pale, skinny, and weak" one of the service providers said to UNFPA. The woman, who lived in dire socio-economic and psychological conditions, was unable to maintain good nutrition standards. "It was hard for me to feed my children, I had no idea how to deal with this issue and no money to buy drugs" she says. "I could not take care of myself either", she continued.
With help from the midwifery team, the woman received recommendations on nutritional needs and was provided with vitamin supplements for free to recover from nutritional insufficiency. "We went back to visit her for several weeks in a row to check on her. Finally, she looked healthier" said the service providers.
Focus group discussions (FGD) were also conducted for women and girls. “Girls were in tears during these FGD” one of the psychologists said. “I hope you will come back” a woman shouted. “You have come at the right moment” saying blissfully.
“We test the waters while entering any building to conduct these home visits” PFPPA coordinator said. If welcomed, “the midwife assesses the general condition of the pregnant/lactating women and accordingly provides them with supplements.” PFPPA coordinator said. PSS sessions were provided to the females in the household. “My daughter is timid and ashamed to talk to me about her menstrual cycle” one mother said. “the team explained it to her in a comfortable way” she continued. Another mother complained about her teenage daughter who was jealous of her married sister. “I could not deal with this at all” the mother explained. “We both received counselling. Their advice to me was fruitful” she continued.
Should any attended woman or girl require medical attention or GBV protection or support, “the midwife filled in the designated referral form for follow-up” PFPPA nurse explained. “We received calls from unvisited families, and we complied” one of the psychologists explained.
Despite the several challenges faced during these home visits, UNFPA is stepping up its support to women and girls while hoping to enforce the teams with doctors and pharmacists and include family counselling, and is drawing recommendations to advise on future programming.
