In addition, about 2 to 4 million people migrate internationally each year. Another 18 million people over five times the number 20 years ago have fled their own countries, as refugees. Also, about 20 million people are internally displaced. They have fled their communities and sought safety elsewhere within their own countries. Recent migrants are less likely than other urban residents to use family planning.
Attitudes explain part of the difference, but access is often a problem.
The disruption of family and community life during moves, especially in situations of poverty and crisis, increases risky sexual behavior and exposure to STDs. Safe motherhood is difficult. Among refugees and internally displaced persons, childbearing can be life-threatening. During emergencies women often lack adequate food, shelter, and sanitation. Prenatal and delivery care often are minimal, and emergency care may be hours away.