This year marks the 20th anniversary of the International Conference on Population and Development in Cairo, where the international community first recognized reproductive health as a human right for all women, including those displaced by conflict and disaster. World leaders gathered at a United Nations General Assembly Special Session this week to review the progress that has been made since Cairo and will be unveiling a new plan of action to meet the critical development challenges facing the world beyond 2014.
While it is encouraging to see sexual and reproductive health (SRH) gaining attention on the international stage, there is still considerable work to be done to ensure all women everywhere have access to these life-saving services. Across the globe, war, natural disasters, and disease are destroying vital health infrastructures, leaving people dependent on crucial humanitarian assistance. However, in these tumultuous times, the needs of women and girls are often forgotten. For refugee and internally displaced women, their fight for survival extends beyond the conflict, violence and environmental devastation in their homelands and the long, unpredictable journeys to safer lands of refuge. In humanitarian emergencies, the lack of accessible and quality sexual and reproductive health care is the “second front” that women have to face. In these dire situations, health systems are often fractured or non-existent, placing women and girls at unfathomable risk of disease, debilitation, and death.
The reality is women’s lives don’t stop during conflict. Women continue to be sexually active, become pregnant, and experience complications, whether displaced or not. In displaced populations, roughly 4% of the population will become pregnant. Of those pregnancies, 15% will suffer life-threatening complications before, during, or after childbirth. Without access to life-saving SRH services, many women are unable to survive their pregnancy or become severely disabled with the development of obstetric fistulas. What is possibly the most tragic about maternal death is that the five leading causes (hemorrhage, obstructed labour, infections, eclampsyia and unsafe abortions) are mostly treatable or preventable. Unsafe abortion alone accounts for 25-50% of maternal deaths for refugee women worldwide. Where abortion is illegal or abortion services are not adequately provided, many women have to revert to drastic methods such as inserting sharp objects into the uterus, drinking poison and beating the pelvis.
The fact that SRH for displaced women did not garner attention on the international stage until the mid-1990s and still remains devastatingly underfunded in some areas is not only a denial of women’s rights but also an affront to humanity. SRH is not only about improving access to family planning to reduce unwanted pregnancies and stop the spread of HIV infections. It also encompasses services for sexual and gender based violence, comprehensive emergency obstetric care, and abortion and post-abortion care. In recent years, the majority of international aid has targeted HIV/AIDS and sexual and gender based violence efforts. While these are critical aspects of SRH and have saved countless lives, women are continuing to die because they are unable to have a safe and wanted pregnancy or abortion. Of course, it is not only the life of the mother that is in jeopardy during pregnancy and childbirth. If a mother dies in childbirth, her child is 10 times more likely to die within the first two years.
Despite this grim scenario, there are viable interventions available for the international community to meet the needs and respect the rights of displaced women. The Minimal Initial Service Package (MISP) is a set of priority SRH services and resources to be implemented at the onset of a humanitarian emergency or disaster, including planning for comprehensive services once the crisis stabilizes. MISP targets key interventions to coordinate SRH planning and service provision, prevent sexual and gender based violence, reduce HIV transmission, prevent maternal and newborn death and disability, and establish comprehensive SRH services for the long-term. If implemented in a timely and effective way, MISP has the potential to significantly reduce maternal death and disease among displaced women.
All too often we consider humanitarian aid to be comprised solely of food, water, and shelter. However, for women and girls, sexual and reproductive health care is just as essential to their survival. Challenges remain in the funding and delivery of these life-saving services, but strategies for overcoming these are available. Ensuring comprehensive sexual and reproductive health care is available at the onset of every humanitarian emergency will not only save lives, but will contribute to reducing systemic gender inequalities. Sexual and reproductive rights are human rights. The time to act is now.
Katie Durvin is a TD Fellow in Migration in Diaspora Studies and MA Candidate at the Norman Paterson School of International Affairs (NPSIA) specializing in Development Projects and Planning. Her main research interests lie in the relationship between gender, development and conflict in humanitarian emergencies and is particularly interested in reproductive healthcare access for displaced women and girls
Featured photos provided by Katie Durvin; graph by UNHCR – Global Report 2013.