The ICPD+5 review process
Rennes, France, 3 November 1998–An international meeting on providing reproductive health services to crisis victims opened with presentations on sexual violence, emergency contraception and adolescents’ needs. Experts from relief organizations are sharing experiences in meeting the reproductive health needs of people displaced by war and disaster, including pregnant women and victims of rape, throughout the world.
The three-day gathering here is being organized by the United Nations Population Fund (UNFPA) and hosted by the Ecole Nationale de la Santé Publique (ENSP). The school’s Director, Dr. Pascal Chevit, opened the meeting. He welcomed participants and pointed out that ENSP has collaborated with several of the agencies represented here--including the Office of the United Nations High Commissioner for Refugees, UNFPA and the International Planned Parenthood Federation--in reproductive health service training, research and communications activities.
Alphonse MacDonald, Director of UNFPA’s office in Geneva, spoke on behalf of the Fund’s Director, Dr. Nafis Sadik. Women and girls suffer the most in crisis situations because of social inequity, he said. The breakdown of communities’ social structures often leads to widespread sexual violence, and in several recent conflicts, rape has been used as an instrument of terror.
UNFPA is cooperating with a number of other agencies represented at this meeting to provide reproductive health services to refugees, he noted. Providing services requires equipment and supplies, properly trained staff and adequate funding.
In response to sexual violence, he added, service providers need to help refugees psychologically and socially as well as medically. "Especially valuable is post-coital contraception, which should be made available to women who wish to prevent an unwanted pregnancy. It is both our duty and our responsibility to ensure that individuals in crisis situations have the same rights and choices as people everywhere."
Mr. MacDonald also noted that UNFPA’s long-term goal is to link relief operations to post-crisis development.
Today’s plenary session included three panel discussions, on reproductive health minimum services in emergencies, sexual violence and adolescent reproductive health needs.
In the first panel, Dr. Michael Tailhades of the International Federation of Red Cross and Red Crescent Societies (IFRC) described his organization’s efforts to provide a comprehensive package of reproductive health education and services to refugees in western Tanzania, starting in 1996. "A vital part of the strategy was to offer care, including care for adolescents and post-coital contraception, for victims of rape and counselling for rape victims," he said. Another aspect of the programme, organized in cooperation with UNFPA and United Nations High Commissioner for Refugees (UNHCR), was the provision of a clean delivery kit to every pregnant woman returning home from the camps.
One lesson learned from this experience, he noted, is that reproductive health problems are most acute during the initial phase of organizing refugee camps, and must be addressed as soon as shelter, food, water and sanitation have been provided. Health workers from all organizations involved in relief efforts need to be trained to address reproductive health needs, and coordination among agencies is critical, he added.
Batya Elul of the Population Council and Dr. Ali Kubba of Lambeth Healthcare Trust in London spoke about emergency contraception. Ms. Elul discussed three available methods of "contraceptive first-aid": two different regimens of pills--either pre-packaged or put together using the contents of oral contraceptive packets--and the emergency insertion of a copper-T intrauterine device. The first two methods have been used for some time in the United Kingdom, Scandinavia and China, and their use is increasing in a number of other countries; these methods can be offered anywhere oral contraceptives are available, and are effective up to 72 hours after unprotected sex. The third method can be used after 72 hours, but there is a risk of infection, so a trained provider must perform it.
"For the record, she stressed, emergency contraception is not abortion. It will not interrupt an established pregnancy."
Dr. Kubba elaborated on the clinical guidelines for post-coital contraception, which he called safe, simple, inexpensive and economical.
To respond to widespread sexual violence against refugees--including rape, domestic violence and forced marriage--Kate Burns of UNHCR emphasized the need for prevention, community action and survivor support.
Sexual violence is the ultimate act of humiliation, said Philippe Lecorps of ENSP. This has policy implications: refugee camps should be organized to serve victims. The role of security forces should be to help refugees, not control them. Efforts need to be made to help rape survivors become whole again. And camps should serve as a collective memory, so the international community will recognize the magnitude of the problem of sexual violence.
Dr. Gill Mezey, a forensic psychiatrist at St. George’s Hospital Medical School in London, said that reproductive health providers need to be concerned with women’s mental health. Women who have been raped are subject to depression, anxiety, substance abuse and post-traumatic stress disorder. Early intervention--getting women to talk about their experience--can help to restore their sense of power, dignity and control and to alleviate long-term trauma, she said.
But "until a woman feels safe, you can’t really think about treatment", she added.
On the topic of adolescent reproductive health, Dr. Adepoju Olukoya of the World Health Organization noted that crisis situations expose adolescents to sexual violence, but there are still very few reproductive health services aimed at young people. Cynthia Waszak of Family Health International spoke about the UNFPA-funded HARP project. Working in Zambia, Uganda and Egypt in collaboration with the Association of Girl Guides and Girl Scouts, the project teaches young girls about their bodies and nutrition, and older girls about reproductive health, including family planning and sexually transmitted diseases (STDs).
"It is important to think of adolescence not as a problem to be solved, but as a resource to be developed and empowered," she stated.
Ms. Joyce Ringu of the National Council of Churches of Kenya talked about conditions in the Kakuma refugee camp in north-west Kenya. Most of the refugees are Sudanese, but the camp also houses Somalis and seven other nationalities. One third are young people, who are at risk of drug addiction unwanted pregnancy, abortion, forced marriage, prostitution and STDs including HIV/AIDS. Her organization has worked to educate adolescents through cultural activities and sports, and also provides peer counselling.
The Technical Meeting on Reproductive Health Services in Crisis Situations is part of "ICPD+5", a series of conferences and workshops to review progress towards the goals of the 1994 International Conference on Population and Development (ICPD) in Cairo. The ICPD called for comprehensive reproductive health care for all, including displaced persons. The review will culminate in an international forum in The Hague from 8-12 February 1999, and a 30 June-2 July 1999 special session of the United Nations General Assembly.