This post is part of a monthly blog series profiling viewpoints from leaders in reproductive health who are members of the Bellagio Group on Long-Acting Reversible Contraception. The Bellagio Group is a coalition of experts who convene annually to discuss practices for expanding contraceptive choice and accelerating progress toward the Millennium Development Goal of universal access to reproductive health services. This post represents the views of the authors, and is not a representation of the Population Council or the Bellagio Group. Please direct any questions to the author at firstname.lastname@example.org.
The screams emanating from the delivery room did not beckon me to enter, but such was my introduction to reproductive health in refugee settings. Like 51 million people around the world, the Palestinian woman in labor was forcibly displaced. As in any population, about half of refugees are women and girls, and pregnant women account for 20% of women of reproductive age. As can be imagined, some of the women do not wish to be, or become, pregnant, so the provision of a range of short- and long-acting, reversible contraceptives as part of reproductive health education and care is essential.
Sadly, as has been the case through much of human history, rape may be used as a strategy of war, and violence in refugee settlements is often seen as a result of decreased stability and security. In addition, desperate conditions may force unaccompanied women and adolescents to exchange sex for food, shelter, or protection. The sexual activities—whether consensual or not—bring risk of sexually transmitted infections (including HIV) as well as unwanted pregnancies.*
Owing to the increasing convergence of man-made and natural disasters, the need for reproductive health care and services for women and girls living in refugee settlements continues to grow. Despite this urgent need, in disaster situations, needs for water, food, shelter, and sanitation are usually addressed first. However, progress is being made to focus attention on sexual and reproductive health needs, including the prevention of unintended pregnancy and sexually transmitted infections.
Thanks to the work of UNFPA, RAISE, DFID, and other organizations, sexual and reproductive health care and education are increasingly offered within humanitarian settings to enable safe pregnancy and birth (including caesarian sections), post-birth care, post-abortion and post-rape care, as well as the provision of contraceptives (including LARCs and emergency contraception). By providing assistance for these needs, maternal deaths, unintended pregnancies, and the risk of acquiring sexually transmitted infections, including HIV, can be reduced—thus allowing the women and families affected by disasters to overcome the inherent challenges associated with residing in a crisis setting and live healthy and productive lives.
Nonetheless, humanitarian health care provides a range of challenges including obtaining reliable data, working collaboratively, and facing economic, political, military, and ethical barriers amidst the growing and complex needs.
The urgency to set aside financial resources both before and after a humanitarian crisis—as well as integrating all aspects of health care into relief efforts (including sexual and reproductive health)—will continue to grow as we face the increasing impact of human conflict and natural disasters across the globe. Likewise, human resources and goods to assist with humanitarian needs must be prepared in advance in order to be deployed when disaster strikes. Conducting advocacy about the needs and building relationships with disparate and even conflicting stakeholders are difficult tasks requiring many resources. Balancing the immediate needs of the present against the possibility of future needs is a critical issue for policymakers, governments, and donors. Their—our—decisions have immeasurable impact on those who bear the brunt of difficult labor, unintended pregnancies, and survivors of rape. Without careful balancing of these conflicting needs, millions more like the Palestinian woman in labor will face unnecessary hardship in an already dire situation.
* Bright, Campbell and Vivian Cintron. 2014. “A Balanced Response to Basic Human Rights Needs in Crisis Settings.” United Nations Population Fund (UNFPA).
Other posts in this series:
- Children by Choice, not Chance: Bayer’s Contribution to Sustainable Access to Contraceptives, by Klaus Brill, Bayer HealthCare Pharmaceuticals
- The Manufacturer’s Perspective: Stronger Supply Chains and Forecasting for Improved Access and Reproductive Choice, by Maggie Kohn, Merck
- Contraception: Why Access, Choice, and Price Matter, by Victoria Hale, Medicines360
- Rights-Based Family Planning: Importance of Increased Access, by Chastain Fitzgerald, WomanCare Global