Shirin Heidari, Director and Editor, RHM (Regrets)
Therese McGinn, Professor of Population and Family Health, Columbia University Mailman School of Public Health, and Director, RAISE Initiative
Sexual and Reproductive Health in Humanitarian Settings: Policy, Evidence and Gaps – Rajat Khosla, Human Rights Advisor for the Department of Reproductive Health Research, World Health Organization
Impossible Nowhere: Family Planning for Women and Girls in Crises – Ashley Wolfington, Senior Advisor for Reproductive Health, International Rescue Committee
The Minimum Initial Service Package as a Standard of Care: Progress, Gaps and Next Steps – Sandra Krause, Women’s Refugee Commission
What Does It Mean to be an “Evidence Gap”? The Crisis in Nigeria and the Cries for Help – Hauwa Shekarau, Country Director, Ipas Nigeria
Summary: Today, 65.4 million people are living in fragile settings, displaced from their homes by conflict or persecution, of which an estimated 26 million are women and girls of reproductive age. In crisis settings, women and girls experience increased levels of exploitation, sexual violence (including rape as a weapon of war) and transactional sex, which can and often does, lead to unwanted pregnancy. Amidst the complex and varied contexts of humanitarian crises, access to services, such as family planning, abortion and emergency obstetric care, can too easily be compromised or denied. Policy barriers, failed health systems, a lack of effective interventions, and other socio-cultural and economic factors, such as insufficient funding, all contribute to inadequate realisation of sexual and reproductive rights.
Rajat Khosla, Human Rights Advisor at WHO, highlighted how the low resilience of health systems and absence of quality data hindered our ability to plan any systematic interventions. The healthcare needs of women and girls of reproductive age included access to contraception, safe abortion services, emergency obstetric and post-partum care. Khosla said one of the key problems was the massive funding gap that obstructed the implementation of interventions, despite the growing recognition of these issues in multilateral fora and negotiations. Khosla went on to highlight the four critical areas related to comprehensive sexual and reproductive health and rights in humanitarian settings: 1) access to safe abortion, 2) access to contraceptive methods, 3) adolescent sexual and reproductive health, and 4) access to better data and monitoring. He emphasised the need for better data so that evidence-based approaches could be put into practice anywhere in the world.
Ashley Wolfington, Senior Advisor for Reproductive Health at IRC, observed that countries in crisis received 57% less funding for reproductive health than non-conflict affected areas. Her presentation challenged certain misconceptions held by key stakeholders when it came to family planning and contraception. First, she contested the notion that contraception services were too difficult to provide in these settings. Wolfington said that for effective provision of services, it was essential to collaborate with and train local practitioners in the field, as well as organising the transport of the necessary commodities in advance. Secondly, she challenged the notion that only short-acting methods were being provided for women in these circumstances. Experience has shown that when long-lasting contraception methods were available, there was an overwhelming preference for them over short-term ones because they were easier to maintain. Finally, Wolfington added that a common belief was that communities in fragile settings were too conservative to accept these services. However, experience had shown that if practitioners worked with conservative community and religious leaders, and explained what these services were for, such leaders had often proven to be their best allies.
Sandra Krause, Reproductive Health Program Director at IWCR, presented the Initial Minimum Services Package for Reproductive Health (MISP) — an internationally accepted minimum standard of care to be implemented at the onset of an emergency in a resource-constrained environment. The four main pillars of the MISP are: ensuring the health sector/cluster identifies an organisation to lead the implementation of reproductive health services, preventing and responding to sexual violence, reducing the transmission of HIV, preventing excess maternal and newborn morbidity and mortality and, planning to implement comprehensive reproductive health services. Implementation of the MISP in the late 1990s and early 2000s got off to a slow start. However, concerted efforts to further its implementation through online training modules and incorporation into humanitarian policy, in disaster risk management, such as the RAISE and Sprint Initiatives, at a local and global level, have proven successful, in the latest global evaluation. The MISP is now undergoing a new set of revisions to improve the positioning of contraception, to update HIV response, to integrate safe abortion care, to improve the coverage of newborn care and to better focus on “transitioning from the MISP to comprehensive reproductive health using the health system building blocks.”
Hauwa Shekarau, IPAS Country Director in Nigeria, discussed the widespread displacements and human rights violations that constituted the humanitarian crisis in Nigeria provoked by Boko Haram. In 2015, the UN confirmed that over 90% of women and girls rescued from Boko Haram were pregnant. Among the key reproductive health services this population needed was access to safe abortion, yet access to this service had been systematically denied, despite having been recognised by international governing bodies as protected medical care under international humanitarian law. Shekarau, pointed out that safe abortion technologies were available, yet facilities were often unprepared. Reluctance to provide abortion care was often compounded by “organisational ambiguity, resource barriers, cultural and religious barriers, or a lack of political will”. Shekarau said there was an urgent need for action, to ensure that safe abortion services became an integral part of a comprehensive response to sexual and reproductive health needs for women and girls in fragile contexts.
Moderator Therese McGinn emphasised the need and growing demand for quality and comprehensive sexual and reproductive health services among women and girls in fragile settings. She said that, despite the incredible progress achieved through policy level work at both the international and regional levels, the concerted efforts of humanitarian organisations in the field, and the development of health protocols and guidelines, there were gaps and barriers that continued to endanger women’s health and rights in these settings. In particular, there was a lack of accessible safe abortion services . This had been indicated clearly by all speakers during their presentations. She asked the audience to use international platforms, such as the Commission for the Status of Women, to continue raising awareness on these issues. She stressed that the sexual and reproductive health and rights of women and girls in humanitarian contexts needed to take centre stage instead of continuing to be placed at the margins of international discussions.
New York, 13 March 2017