Organization: Women's Commission for Refugee Women and Children
Contact: Megan McKenna
Abstract: For years, reproductive health care was nearly nonexistent in refugee settings and a neglected part of humanitarian assistance.
For refugee and internally displaced women and adolescents, pregnancy is in many cases a life-threatening condition; in fact, it's a leading cause of death in emergencies along with birthing complications, according to the United Nations Population Fund. For years, however, reproductive health care was nearly nonexistent in refugee settings and a neglected part of humanitarian assistance. Numerous nongovernmental organizations (NGOs) over the last several years have been working to address this grievous gap and their hard work is beginning to pay off; reproductive health care is slowly becoming a priority in emergency situations. "There's a growing understanding that reproductive health care is a vital component of overall care during crises," says Julia Matthews, Reproductive Heath Program Manager at the Women's Commission for Refugee Women and Children. "Without it, many urgent health needs of women remain unaddressed and thousands die preventable deaths." More than 500,000 women die every year in pregnancy or childbirth; ninety-nine percent of these deaths occur in developing countries. Refugee women and adolescents are particularly vulnerable to poor reproductive health because of the precarious conditions in which they live. Their poverty, powerlessness and lack of access to information leads to higher rates of unsafe sexual practices, unwanted pregnancies and dangerous abortions. It also heightens their vulnerability to sexually transmitted infections, including HIV/AIDS. Starting in the mid-1990s, nongovernmental organizations and U.N. agencies began to push for the inclusion of reproductive health care as part of routine humanitarian response to emergencies. The need was stark in conflict situations, where the lack of services was often life threatening, particularly for refugees and the internally displaced. One of the most significant achievements towards promoting reproductive health care in emergencies was the creation of basic standards and actions to take at the outset of a humanitarian crisis to address reproductive health needs, and a kit of supplies to help carry them out. The Minimum Initial Services Package (MISP) outlines steps that must be undertaken by trained staff in a humanitarian crisis to provide ante- and postnatal care, ensure clean delivery practices, reduce the threat of HIV transmission, prevent sexual violence and mitigate the consequences when it occurs. Sexual violence is often linked to forced population movement and proximity to military personnel. In addition to these activities, the MISP includes clean birthing kits, condoms and drugs to treat sexually transmitted infections. With the increasing use of rape as a tool of war, emergency contraception is being recognized as an important part of reproductive health services in conflict situations. The need is clear; in Rwanda during the 1994 genocide, for example, the vast majority of Tutsi women were likely exposed to some form of gender violence; of those, it is estimated that a quarter to a half million survived rape. Gender-based violence (GBV) as a whole, including rape, is becoming acknowledged as a vital concern amid refugee populations. A recent study on the prevalence of GBV amid refugees and the internally displaced - one of the first of its kind -- found that although GBV is part of virtually all conflicts today, little is being done to protect its most vulnerable victims. The report, If Not Now, When? Addressing Gender-based Violence in Refugee, Internally Displaced, and Post-Conflict Settings, A Global Overview, by the Reproductive Health for Refugees Consortium, outlines the gaps and recommends ways to address them. The Women's Commission for Refugee Women and Children has been one of many NGOs that have contributed to the momentum in support of reproductive health for refugees and helped drive it to the forefront of humanitarian assistance. Among the programs that the Women's Commission supports are those at the Mae Tao Clinic on the Thai/Burma border. The clinic provides refugees and the internally displaced with a wide range of reproductive health services (see related article). Association Najdeh, a Lebanese NGO, is another Women's Commission-supported NGO. It provides a variety of reproductive health services for Palestinian refugees living in and around refugee camps in Lebanon, as well as reproductive health education on issues including family planning, maternal care, STI/HIV prevention and domestic violence. "Although a great deal has been accomplished over the last several years, reproductive health care remains an acute need for the millions caught in crisis around the world, particularly refugees and the internally displaced," says Matthews. "Until it becomes a routine part of all emergency response, the lives of hundreds of thousands of displaced women and adolescents will hang in the balance."