Reproductive Health for Communities in Crisis
Family planning is often considered to be of secondary
concern in an emergency or post-conflict setting.
But in a war-torn country like Angola or Sierra Leone,
where adequate prenatal care, assisted delivery and
emergency obstetric care are not available, as many as one in nine women will die as a result of pregnancy
or childbirth over the course of their lives. For
women in crisis settings, an unplanned pregnancy
can be fatal.
Neglecting family planning can have other serious
consequences, including unsafe abortions resulting
from unwanted pregnancies, pregnancies spaced too
closely together, dangerous pregnancies in women
who are too old or too young, and the transmission
of STIs including HIV/AIDS.
Maintaining a steady supply of contraceptives can
be a major challenge in an emergency. Transportation
routes may be cut off, distribution networks dissolved
and health facilities destroyed. Existing supplies may
fall far short of demand when large numbers of
people move into a new location.
Although many women in these settings choose
to become pregnant, large numbers who would prefer
not to face the difficulties of pregnancy, childbirth or
having a baby in a displacement camp have no choice
because of lack of access to condoms or other methods
Even where services and supplies are available, a
number of factors can impede their use. A 2001 assessment
by the Women’s Commission for Refugee Women
and Children found that many Angolan refugees in
Zambia were reluctant to use family planning methods,
despite their availability. The barriers identified
included: resistance by husbands; religious and community
beliefs that women should have as many
children as they can have; lack of community-based
distribution programmes; and the difficulty women
have in persuading their partners to use condoms.
To promote acceptance of family planning methods,
the commission recommended a communications
campaign targeting men and the ongoing training
of peer educators and community workers.(3)
In emergency settings around the world, UNFPA
has supplied free condoms as the first step towards
restoring family planning services. When the security
situation permits, the Fund conducts rapid assessments
to identify family planning needs, and often is able to
provide relevant background information on the population,
including family planning method preferences.
When planning medium- and longer-term programmes,
UNFPA and its partners endeavour to involve women, men and adolescents from the affected populations, to
help ensure appropriate, culturally sensitive and
effective family planning services.