Reproductive Health for Communities in Crisis
One of the most significant achievements since the
ICPD has been greatly increased attention to the
reproductive health needs of populations made
vulnerable by armed conflict or natural disaster.
A decade ago, humanitarian assistance for populations
affected by complex emergencies was generally
limited to food, water and sanitation, shelter and
protection, and basic health care. More deaths occur
worldwide from preventable complications of pregnancy
and childbirth than from starvation, but basic
materials for safe delivery and emergency obstetric
care were rarely included in emergency assistance.
The risk of unwanted pregnancy and sexually
transmitted infection increases dramatically in
displacement camps, but few humanitarian actors
in these settings were providing family planning
services, post-rape treatment and counselling, or
This began to change at the ICPD in 1994, where
the Programme of Action specifically addressed the
reproductive health needs of displaced persons, and
refugee women were invited to speak about their
reproductive health needs on an international stage
for the first time.
|REPRODUCTIVE HEALTH FOR DISPLACED PERSONS|
Migrants and displaced persons in many parts of the world have limited access to reproductive health care
and may face specific serious threats to their reproductive health and rights. Services must be particularly sensitive to the needs of individual women and adolescents and responsive to their often powerless situation, with particular attention to those who are victims of sexual violence.
|—ICPD Programme of Action, para. 7.11
In the mid-1990s, UNFPA, the Office of the United
Nations High Commissioner for Refugees (UNHCR),
WHO and other partners collaborated in the creation
of a comprehensive Inter-agency Field Manual for
Reproductive Health in Refugee Settings,1 and agreed on a
set of minimum standards for care.
UNFPA has assembled the material resources needed
in emergency situations into reproductive health kits,
made up of 12 sub-kits including supplies for clean and
safe delivery, management of obstetric complications,
prevention and management of STIs including HIV/AIDS,
and family planning. Since 1996, agencies, organizations
and governments have ordered and deployed
the kits in more than 50 countries and territories.
RIGHTS APPLY IN EMERGENCIES AS NEEDS ESCALATE.
Women of reproductive age are about 25 per cent of
the tens of millions of refugees and persons internally
displaced by war, famine, persecution or natural
disaster. One in five of these women is likely to be
pregnant. Neglecting reproductive health in emergencies
has serious consequences, including unwanted
pregnancies, preventable maternal and infant deaths,
and the spread of STIs including HIV/AIDS.
The ICPD affirmed that the right to reproductive
health applies to all people at all times. Effective
reproductive health programmes safeguard human
rights such as the right to health, to freely decide the
number and spacing of children, to information and
education, and to freedom from sexual violence and
Pregnancy and childbirth can be dangerous for
women in the best of circumstances. Conflicts or
natural disasters put pregnant women at even greater
risk because of the sudden loss of medical support,
compounded in many cases by trauma, malnutrition
or disease or exposure to violence.
When a powerful earthquake struck Bam, Iran, in
December 2003, more than 85 per cent of the affected
area’s health infrastructure and more than half of its
health care personnel were lost in less than a minute.
The trauma of the catastrophe caused many pregnant
women to deliver prematurely or to miscarry.
When recent fighting in Sudan forced more than
100,000 refugees to flee to Chad, pregnant women had
to give birth on the roadside and in the middle of the
desert. The lack of even the most basic items for safe,
clean delivery—soap, a clean razor blade for cutting
the umbilical cord, and plastic sheeting to lay on the
ground—condemned many women to fatal infections,
leaving their children motherless and at risk.(2)
A 2002 study found that complications of pregnancy
and childbirth were the leading cause of death
among women of childbearing age in war-ravaged
Afghanistan. Only 7 per cent of Afghan women who
died during childbirth were attended by a skilled
health care worker.
As in more stable settings, almost all women who
develop pregnancy-related complications can be saved
from death and disability if they receive treatment in
time. Within 72 hours of the earthquake in Bam,
UNFPA helped the Iranian Ministry of Health and
Medical Education to procure supplies so pregnant
women could deliver safely at home, and to establish
temporary emergency obstetric care facilities. In Chad
and in other refugee sites, UNFPA works with local
partners to establish prenatal support and a referral
system for obstetric emergencies. In Afghanistan, UNFPA responded with emergency supplies and equipment
during the acute phase of the crisis, and has
contributed to longer-term development as well,
rehabilitating a maternal hospital and training
health care workers, among other activities.
A recent global evaluation by the Inter-Agency
Working Group on Reproductive Health in Refugee
Settings found that most refugee sites now offer at
least some combination of prenatal care, assisted
child delivery, management of obstetric emergencies,
and newborn and post-partum care. Maternal mortality
ratios in refugee camps in Kenya, Pakistan and
the United Republic of Tanzania have been found to
be lower than in the host country overall or in the
refugees’ home countries. While some components
of maternal health care—particularly emergency
obstetric support—still require a great deal of
strengthening, a good start has been made
THE IMPACT OF CONFLICT ON WOMEN AND GIRLS
In addition to the general effects of violence and lack of health care:
- Women are uniquely vulnerable to vitamin and iron deficiencies—particularly anaemia, which can be fatal for pregnant women and their babies.
- Women suffer a range of reproductive health problems, from not having sanitary supplies for menstruation to lifethreatening complications related to pregnancy.
- The stress and disruption of war often lead to a rise in gender-based and sexual violence.
- Women are primarily responsible for caring for those made vulnerable by war—children, the sick and the elderly.
- Women’s vulnerability is further increased by the loss of men and boys, disruptions of the social structure, and other conflict factors.