title: Assessment of reproductive health and violence against women among displaced Syrians in Lebanon.
abstract: BACKGROUND
  The current conflict in Syria continues to displace thousands to neighboring countries, including Lebanon. Information is needed to provide adequate health and related services particularly to women in this displaced population.
  
  
  METHODS
  We conducted a needs assessment in Lebanon (June-August 2012), administering a cross-sectional survey in six health clinics. Information was collected on reproductive and general health status, conflict violence, stress, and help-seeking behaviors of displaced Syrian women. Bivariate and multivariate analyses were conducted to examine associations between exposure to conflict violence, stress, and reproductive health outcomes.
  
  
  RESULTS
  We interviewed 452 Syrian refugee women ages 18-45 who had been in Lebanon for an average of 5.1 (± 3.7) months. Reported gynecologic conditions were common, including: menstrual irregularity, 53.5%; severe pelvic pain, 51.6%; and reproductive tract infections, 53.3%. Among the pregnancy subset (n = 74), 39.5% of currently pregnant women experienced complications and 36.8% of those who completed pregnancies experienced delivery/abortion complications. Adverse birth outcomes included: low birthweight, 10.5%; preterm delivery, 26.5%; and infant mortality, 2.9%. Of women who experienced conflict-related violence (30.8%) and non-partner sexual violence (3.1%), the majority did not seek medical care (64.6%). Conflict violence and stress score was significantly associated with reported gynecologic conditions, and stress score was found to mediate the relationship between exposure to conflict violence and self-rated health.
  
  
  CONCLUSIONS
  This study contributes to the understanding of experience of conflict violence among women, stress, and reproductive health needs. Findings demonstrate the need for better targeting of reproductive health services in refugee settings, as well as referral to psychosocial services for survivors of violence.
authors.forename: Amelia
authors.initials: A
authors.lastname: Reese Masterson
authors.forename: Jinan
authors.initials: J
authors.lastname: Usta
authors.forename: Jhumka
authors.initials: J
authors.lastname: Gupta
authors.affiliation: Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT 06510, USA. adrienne.ettinger@yale.edu.
authors.forename: Adrienne S
authors.initials: AS
authors.lastname: Ettinger
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006301:Health Services Needs and Demand; D006304:Health Status; D006801:Humans; D007226:Infant Mortality / Q000208:ethnology; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007861:Lebanon / Q000453:epidemiology; D008599:Menstruation Disturbances / Q000208:ethnology; D008875:Middle Aged; D020380:Needs Assessment; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D017699:Pelvic Pain / Q000208:ethnology; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000208:ethnology*; D012036:Refugees / Q000523:psychology / Q000706:statistics & numerical data*; D060728:Reproductive Health; D060737:Reproductive Tract Infections / Q000208:ethnology; D012742:Sex Offenses / Q000208:ethnology / Q000523:psychology; D013315:Stress, Psychological / Q000208:ethnology*; D013593:Syria / Q000208:ethnology; D014754:Violence / Q000208:ethnology* / Q000523:psychology; D014857:Warfare; D016387:Women's Health / Q000208:ethnology; D055815:Young Adult