Reproductive Health for Communities in Crisis

	Safe Motherhood
	Family Planning
	Sexual and Gender-based Violence
	HIV/AIDS and Other STIs
	Adolescent Reproductive Health
	Gains and Gaps

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 even condoms.

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.

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 coercion.

Safe Motherhood

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 since 1994.

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