Photo: Sven Torfinn/Panos/UNFPA
New York – In Afghanistan, where fertility and maternal death rates are among the highest in the world, restricted access to certain conflict areas makes it nearly impossible to deliver contraceptives to woman who would like to have fewer and safer pregnancies. After natural disasters, supply chains are often disrupted. And in Darfur women and young people trying to locate family planning services and information may wind up as survivors of sexual violence or worse: dead.
Although it has been forty years since world leaders proclaimed that people should have the right to plan the spacing and number of their children, hundreds of millions of women, men and young people lack access to family planning services and information. Thus, they are unable to exercise a basic human right.
Henia Dakkak, a technical advisor for reproductive health, including family planning, for UNFPA, theUnited Nations Population Fund, explains why it is so critical to incorporate family planning options into emergency response for vulnerable and conflict-affected populations.
Henia also discusses how a lack in family planning can lead to an increase in infant and maternal mortality, transmission of HIV and other sexually transmitted illnesses, and unsafe and illegal abortions.
Why is providing family planning services and information to crisis-affected populations an important part of humanitarian response?
First of all, family planning is not about stopping couples from having babies but about making sure they are empowered in the decision-making process and are provided with services and information to meet their specific needs. However, many couples are not aware of or have access to reliable family planning methods. So they use traditional methods, such as withdrawal before ejaculation or abstaining from sex during certain periods of ovulation. These methods tend to be much less reliable than modern methods.
When an emergency strikes, it is important to acknowledge that people do not refrain from having sex. Yet, couples may want to refrain from getting pregnant due to instability in environment and loss of housing. But they may lose access to contraceptive devices or supplies in an emergency. Also, pregnancy in an emergency or conflict setting can be dangerous – for both mother and child -- and couples should have family planning options available to them in order to avoid these risks if they choose.
If women are not provided with family planning options during an emergency what are some of the negative outcomes that can occur as a result?
Women in emergencies may be living in tents or huts and may not even have access to health facilities or trained practitioners. Another threat to women and girls in crisis settings is an increase in sexual violence, which can cause unwanted pregnancies. In some countries, women impregnated as a result of rape may be tempted to have an unsafe and illegal abortion. This is because a child born of two different ethnic groups may not be accepted by the community and can experience extreme challenges throughout his/her life span. If a woman does not want to risk having a child as a product of a rape then she should be provided with the option of emergency contraceptives.
How does UNFPA work to ensure individuals are provided with family planning options during and after an emergency?
During an emergency, UNFPA helps individuals and couples gain access to family planning, such as modern contraceptive drugs and supplies. In post-conflict settings, couples are generally ready to begin having children again. So our focus will expand from providing family planning services to promoting the concept of family planning and disseminating information regarding the types of methods available. It is also important that individuals or couples seeking family planning assistance are aware of the pros and cons of each option and of which methods will best meet their individual or family needs. Therefore, UNFPA includes counselling services as part of our humanitarian response.
What are some of the new contraceptive technologies and how do they fit into different life circumstances?
There are many new contraceptive technologies to meet a wide range of individual needs. For example, the copper-bearing intrauterine device (IUD) is a small, flexible plastic that can be inserted into a woman’s uterus and has been proven effective in stopping pregnancy for up to ten years or more. The levonorgestrel intrauterine device (LNG-IUD) is a T-shaped plastic device that is also inserted through the uterus and can provide protection from pregnancy for up to 5 years. These options are available for women wanting to avoid pregnancy on a more long-term basis and both are completely reversible. For women wanting short-term options, there are a variety of spermicides, once-a-month injectibles and diaphrams. There are even specialized pills for women who are lactating.
Another short-term option is the combined patch, which is a small, thin, square of flexible plastic worn on the body that continuously releases 2 hormones—a progestin and an estrogen, like the natural hormones progesterone and estrogen in a woman’s body—directly through the skin into the bloodstream.
The female condom is considered beneficial for women because they can initiate its use and it can be used without seeing a health care provider.
How can a lack of family planning link to an increase in sexually transmitted infections and HIV?
In an emergency situation, many factors can heighten the risk of HIV transmission, such as an increase in sexual violence and exposure to infected blood. Also, the breakdown of information networks and infrastructures can lead to a lack of family planning options, such as condoms. This is why it is important that crisis-affected populations have access to condoms. It is also important to note that both the male and female condom are the only forms of contraception that can be used both as a tool for family planning and also as a way to prevent the transmission of HIV and other sexually transmitted illnesses.
How can a lack in family planning link to an increase in maternal and infant mortality?
Maternal and infant mortality is very high around the world even with all the new modern contraceptives available. In an emergency, the threat of maternal and infant mortality can increase for many reasons, including too-early pregnancy as a result of rape and limited access to health facilities and skilled providers. In any setting, 15 per cent of women will experience life-threatening complications during delivery and 5-7 of this 15 per cent will need a Caesarean section. If women and girls do not have access to health facilities and providers, then the probability of death is very high if they have complications. It is therefore safe to conclude that if women and girls had access to family planning services and were allowed to utilize them there would be fewer unintended pregnancies, and this would reduce the number of mothers and babies dying in the world.
How is UNFPA working to make family planning rights and services available to all populations in the future?
The International Conference on Population and Development (ICPD) helped establish very specific goals to be accomplished by 2015, including the reduction of child and maternal mortality and access to family planning services, information and counselling. However, there is an overwhelming unmet need for family planning options amongst poor and marginalized populations. In some of these communities, child and maternal deaths are actually on the rise.
Working closely with its government counterparts, UNFPA promotes family planning as a way of reducing maternal and infant mortality for providing dual protection from pregnancy and the transmission of HIV and other sexually transmitted infections. We collaborate with partners, national counterparts and societies to promote family planning rights using culturally sensitive and rights-based approaches. We assist in making contraceptives and information available in the language of our target populations and that young people are informed of their rights and family planning options. And we tend to find that when individuals have the information and services available to them they are grateful for the opportunity to have more options to plan their futures.
UNFPA also works to ensure those who are already practicing their right to plan their families have continued access to services, commodities and information.
– reported from New York by Shannon Egan