Ensuring Access to Sexual and Reproductive Health in Humanitarian Settings

Humanitarian crises disrupt basic services, making it difficult for people to access basic care, including sexual and reproductive health (SRH) services. Given this is an urgent priority in the Asia region, in particular due to the elevated risk of natural disasters, Knowledge SUCCESS hosted a webinar on September 5 to explore SRH in times of crises. Speakers shared their implementation experiences in crisis settings, including how organizations address persistent challenges and corresponding good practices and lessons. The webinar attracted 614 registrants, with nearly 150 people attending live. 

Go to full webinar recording here, or click on the links below to go to specific segments.

Background: Ensuring Access to SRH during Emergencies

Webinar moderator, Pranab Rajbhandari (Regional KM Advisor for Knowledge SUCCESS), gave an overview of the current challenges in ensuring people have access to SRH services in emergencies such as natural disasters, violence, conflict, and pandemics, focused on the Asia region. He also provided some context on the availability of the Minimum Initial Service Package (MISP), developed by the Interagency Working Group on Reproductive Health in Crises, as a set of priority SRH activities to be implemented at the onset of an emergency. The MISP is the gold standard in SRH service provision during times of emergency.

Lightning Talks

The speakers, who work extensively in emergency preparedness and responsiveness, shared short presentations on how their organizations supported displaced communities and some of their successful approaches as well as lessons.

Javaria Nisar, Advocacy and Communication Officer, Forum for Women Development & Research – White Ribbon Alliance, Pakistan

Javaria Nisar highlighted the 2022 flood crisis in Pakistan, which displaced 1.6 million women of reproductive age, including 130,000 pregnant women in urgent need of essential health services, where they launched a campaign called Reproductive Health in a Post-Flood Pakistan: Listening & Learning from Women in Disaster. The initiative aimed to address SRH needs by amplifying the voices of women and healthcare providers and generating localized evidence to inform policy makers and engage decision-makers to improve disaster preparedness. More than 2,500 women and 250 healthcare providers from local communities in five districts were consulted, and they indicated their top needs were: (1) food and nutrition, (2) better family planning services and water, and (3) sanitation and hygiene services, among others.

Najib Samim, CEO, Afghan Family Guidance Association (AFGA), Afghanistan

Najib Samin set the context for the provision of SRH services in Afghanistan in the face of significant challenges due to prolonged conflict and natural disasters/acute crises. He shared some of the best practices employed by AFGA during emergency or crisis development, which include the deployment of emergency response teams to conduct needs assessment, ground reporting, and response planning. 

He added that over the past 2.5 years, during multiple crises, that included flash floods and several earthquakes, 809,953 SRH services were provided to 296,747 affected populations. He shared several key lessons:

• Ensure male and community leaders’ engagement.
• Develop and establish community midwives for community-based SRH service delivery (from local communities) that is backed up with specialists as first-line referrals. 
• Involve local peers/volunteers from the affected population among the response team to provide scale of reach and ensure the safety of their response teams with community participation.

Dr. Pravin Shakya, Executive Director, Family Planning Association of Nepal (FPAN), Nepal

Dr. Pravin Shakya provided an overview of FPAN’s experience in supporting SRH needs of displaced communities in Nepal due to floods, landslides, earthquakes, and fires. He shared context on how a major earthquake in 2015 led to greater awareness of the need to provide SRH services to the affected population. The recent pandemic also stressed the importance of equipping the government, communities, and development partners with disaster prevention, preparedness, and resilience skills. He addressed how they systematically incorporated SRH service provision into emergency preparedness efforts, and shared some key lessons including the need for: 

• Preparedness activities including trainings, simulation exercises, and post-crisis capacity strengthening involving government and partner service providers
• Localized humanitarian response, engaging local authorities and partners as well as community mobilization 
• Mobile medical teams that stay on-site for 10-12 days, followed by a 5-day break to ensure greater access to remote areas
• Peers from affected populations to help sustain SRH demand post-crisis 

Discussion and Q&A

Some key takeaways from the discussion with the speakers: 

• When asked about supply chain disruption during conflicts, disaster, and war, Najib Samim explained that AFGA has established regional warehouses stocked with medicine, medical equipment, and winterization kits, obtained from UNFPA, to respond to urgent crises. Their emergency response teams also make a huge difference in reaching crisis locations quickly in order to report on casualties and assess and discern what appropriate response is needed. 
• While it was noted that women are not allowed to work in Afghanistan, they are allowed in healthcare and education. Najib Samim shared that AFGA has 300 women employed as doctors and midwives to provide services to the 12 provinces that they work in.
• When asked if the Ask-Listen-Act approach influenced local action and policy change, Javaria Nisar clarified that the approach acted as a platform to hear from affected women and healthcare providers. The White Ribbon Alliance in Pakistan was able to find solutions for 50-60% of issues identified at the local level. Local evidence allowed for real-time action. In terms of broader reform, their concerns were recorded at the provincial and national levels in a timely manner. The campaign aimed for the ‘listening’ session to be a key accountability mechanism. They facilitated open dialogue between the affected women and government officials, which led to their issues being incorporated in the FP2030 roadmap in Pakistan. 
• Responding to a question about extending SRH services for women living with HIV in Nepal, Dr. Pravin Shakya said FPAN usually mobilizes local communities (i.e., peer educators) and frontline workers to engage people living with HIV to offer services. He also shared that they now had sustainable capacity with trained service providers ready to support SRH services. This was not always the case, as previous programs were ad-hoc and implemented over several months. 
• When asked how the White Ribbon Alliance approached gender-based violence (GBV) and if they used a checklist for assessment, Javaria Nisar said they sought to create a safe space for women to share their experiences. The questions and responses of these women’s experiences with GBV were off the record and conducted in a safe, discreet manner. 

The webinar highlighted crucial insights from the speakers who generously shared their experiences and described lessons and good practices for future planning purposes including:

• Disaster preparedness with well-trained individuals and medical stock
• Clear coordination before and during a crisis to ensure swift response
• Local community engagement to ensure seamless cooperation and prompt access to affected populations in remote areas