During a crisis, the need for reproductive health services in humanitarian settings doesn’t go away. In fact, it increases significantly. Stories featured in this post are first-person accounts from those who have lived and worked in humanitarian settings.
Worldwide, more people are on the move than ever before. By the end of 2018, there were approximately 70.8 million people who were forcibly displaced, and it is estimated that 136 million people were in need of humanitarian assistance globally. About half of all refugee, internally displaced, and stateless populations are women and girls. Those in humanitarian settings and those who are forcibly displaced are at an increased risk for many health concerns, including those related to reproductive health.
During a humanitarian crisis, the need for reproductive health care doesn’t go away. In fact, it increases significantly. Women and girls are more likely to experience interrupted contraceptive access—especially with methods that require frequent resupply, such as pills— as commodities and trained health professionals become scarcer and infrastructures to deliver contraceptives shut down.
Women and girls are also more likely to be victims of sexual violence during a humanitarian crisis. Sexual and gender-based violence is used as a tactic of war in many conflicts. And leaving doesn’t guarantee safety: Women and girls often face the risk of sexual and gender-based violence along their journeys and once they reach their destinations.
Furthermore, women are less likely to have access to reliable nutrition, often lack access to antenatal care, and are more likely to deliver prematurely. Coupled with the fact that emergency obstetric care and clean equipped delivery rooms are almost non-existent, being pregnant becomes increasingly dangerous.
The integration of reproductive health care into humanitarian settings has made significant strides in the last few decades, including the inclusion of reproductive health services into the Sphere Project’s Humanitarian Charter and Minimum Standards in Humanitarian Response, which sets global benchmarks to guide responders.
Furthermore, reproductive health needs are also addressed in the Minimum Initial Service Package developed by the Inter-Agency Working Group on Reproductive Health in Crises (IAWG). In 2018, the IAWG released an updated version of the Inter-Agency Field Manual on Reproductive Health in Humanitarian Settings.
However, despite the establishment of standards for reproductive health provision in humanitarian settings and efforts by organizations working in these settings, gaps still remain. Barriers to implementation are not unique to reproductive health. Funding for humanitarian aid continues to lag behind need year after year, with impacts on all aspects of health. Systemic and cultural aspects also impact implementation. Significantly, many interventions fail to reach the most vulnerable—adolescents, people with disabilities, LGTBI individuals, and sex workers.
With many conflicts lasting not years but decades, many humanitarian organizations are reframing their programs to encompass more long-term planning and service delivery, not just emergency response. It is not uncommon for women or girls to live 20 years in a humanitarian setting. That could mean almost their entire reproductive age. Their fertility preferences do not stay static during this time—which means their reproductive needs are not only important, but essential.
Fundamentally, responders must prioritize reproductive health within humanitarian assistance, instead of being put second. This includes incorporating reproductive health in long-term preparedness planning, providing key reproductive and maternal health supplies in all preparedness kits, and strengthening systems to deliver reproductive care during times of crisis. It also includes a focus on related issues such as preventing gender-based violence and providing psychosocial and mental health support services. Furthermore, and perhaps most importantly, reproductive health care must be responsive to the changing needs and desires of women and girls.