So where’s the sexual and reproductive health in emergency response?
Millions of people around the world have been displaced from their homes this year. They are running from natural disasters – hurricanes, mudslides, floods, wildfires, drought – and some that are at least partially man-made – violence, famine, epidemics. As theses crises continue to increase in frequency and severity, we must be prepared.When an emergency occurs, aid agencies spring into action, providing clean water, food, and temporary shelter to those who are affected. Some may also provide urgent medical care, treating physical injuries caused by the disaster. These efforts are obviously critical, and must continue – but they are not enough.
After an earthquake levelled villages and caused an avalanche on Mount Everest in Nepal, killing nearly 9,000 people and injuring more than 20,000, CARE was one of the agencies to respond. Our team found that most of the health clinics in the area had been destroyed, and pregnant women had no choice but to give birth out in the open without sanitary equipment, qualified birth attendants, or private facilities. This was dangerous and distressing to everyone involved, and it could have been prevented.
The United Nations Population Fund (UNFPA) has shared many stories illustrating the horrific circumstances currently facing women and girls – especially pregnant ones – in emergency settings, from Nepal to Nigeria to the Democratic Republic of Congo. We know that over two-thirds of preventable maternal deaths happen in fragile and conflict-affected countries. We also know that sex happens every day, everywhere, and that incidents of gender-based violence tend to increase after disasters and during armed conflict.
We know that family planning saves lives, and if everyone who wanted to use contraception could do so, an estimated 104,000 maternal deaths could be averted each year. So, if we know all of this, why isn’t more being done to prioritize sexual and reproductive health during emergencies?
Fortunately, the tide is turning. The Inter-Agency Working Group on Reproductive Health in Crises (IAWG) has been working to expand access to quality sexual and reproductive health services for people affected by conflict and natural disaster. CARE and other members of IAWG helped to develop the Minimum Initial Service Package (MISP) – a set of priority activities for first-responders to help protect women and girls at the onset of a humanitarian emergency – including basic sexual and reproductive health services, comprehensive family planning, gender-based violence response, and HIV/AIDS treatment.
At this year’s Family Planning 2020 Summit in London, governments of the UK, Canada, Netherlands, Denmark, and Australia committed to put resources toward improving sexual and reproductive health services in crisis settings. These are exciting developments, and we know they will make a big difference in the lives of women and girls living in these difficult circumstances.
At CARE, we have seen the need firsthand. Through our Supporting Access to Family Planning and Post Abortion Care (SAFPAC) program, we have helped more than a quarter of a million women in crisis-affected countries to prevent unwanted pregnancies and deaths from unsafe abortion. We provide assistance, training, and medical supplies to health facilities and partner with governments to ensure implementation of MISP activities in established communities and camp settings. We also help to create opportunities where community members (including adolescents and young people) and health providers can discuss challenges and generate mutually-acceptable solutions.
The impact of these efforts is meaningful – contraceptive use in SAFPAC regions of Chad (Moyen Chari and Logone Oriental) has risen to over twice the rates of the rest of the country (11% vs. 5%). In Djibouti, the government was so impressed by the increase in family planning use in two SAFPAC-served refugee camps that they adopted the approach in health facilities around the country.
The need is vast, but fortunately feasible solutions have already been developed. Sex does not stop in emergencies, and neither does pregnancy. Women and girls must have access to comprehensive sexual and reproductive health services, including family planning, wherever they are. When these services aren’t available during a humanitarian emergency, vulnerable people face increased risks with fewer lifelines, too often with deadly consequences.