Every year, an estimated 60 million people are displaced by natural disasters and armed conflict.

In more recent years, however, the nature of displacement has changed. Periods are either more often (take the case of Southern Mindanao, which is affected by both natural disaster and internal conflict) or protracted (like Syria, for example) stretching both humanitarian aid, funding and basic services which are already scarce.

 In an environment where responding to responding to emergency needs is paramount, the need for reproductive health care services is overshadowed by the urgent need to survive each day.

“The state of women, adolescent sexual reproductive health programs and family planning programs in humanitarian crisis is not exactly good news, but it is important to discuss,” said Sandra Krause Director of Reproductive Health at Women’s Refugee Committee.

According to Krause, 16 million girls between the ages of 15 to 19 give birth every year. Out of that number, an estimated two million are 15 years old. The risk of pregnancy is twice as high for girls ages 15 to 19 in crisis situations.

“In humanitarian settings, the risks are compounded for adolescents because there is increased risk of sexual violence from sexual exploitation and rape,” said Krause.

“Adolescents and women have the same need for sexual reproductive health information and services as they would in non-crisis situations. However, there is a lack of sensitivity to the issue and sexual reproductive health programming is largely absent in humanitarian response.”

Family planning is life-saving intervention

Recognizing that family planning is a life-saving intervention for women and girls in humanitarian crises, the Women’s Refugee Commission and Save the Children in partnership with the United Nations High Commissioner for Refugees (UNHCR) and the United Nations Population Fund (UNFPA) conducted a study to map existing adolescent sexual and reproductive health programs that have been implemented in humanitarian settings since 2009.

The key results of their joint report, Adolescent Sexual and Reproductive Health Programs in Humanitarian Settings: An In-depth Look at Family Planning Services showed that:

• Only 37 programs focused on the sexual reproductive health needs of 10-to 19-year-olds in humanitarian settings since 2009.
• Out of this number, only 21 of these programs offered at least two methods of contraception.
• Of the programs that offered at least two methods of contraception, none were in acute onset emergency settings; so there is a period in wherein women may not receive RH services at all.
• Proposals for adolescent sexual and reproductive health through humanitarian funding streams constituted less than 3.5% of all health proposals per year.
• The majority of these proposals have gone unfunded. Among 2,638 health proposals from more than a hundred appeals, only 37 included some elements of adolescents’ sexual and reproductive health. Among the 37 programs identified, only about a third received any funding; seven programs were fully funded and five were only partially funded.

Best practices: Not just sexual health

Though they were not many, there were some examples of good practices of providing RH services and information, notably Profamilia in Colombia, the Adolescent Reproductive Health Network in Thailand and Straight Talk Foundation in northern Uganda.

According to Krause, there were common factors that contributed to the success of these programs and should be replicated in other humanitarian crisis situations.

“[Among the successful programs] They ensured stakeholders involvement to build trust and secure support. They really paid attention to actually adolescent participation and engagement.”

Targeting of beneficiaries of RH services was done in response to the needs and in an inclusive manner. “The programs were responsive to the different needs of adolescents – those that were in school, those that were not in school, those who are married or not married, very young adolescents and older adolescents. A dedicated and well-qualified clinical staff provided comprehensive sexual and reproductive health services; not just family planning but whole array of services.”

In addition, programs that took on a multi-sectoral approach to programming and addressed prior needs such as literacy, livelihood and income generation had the best results. Some programs went as far as including support for transportation, which can be a challenge for refugees and the internally displaced, in terms of cost.

Essentially, there is an urgent need to scale up adolescents’ sexual and reproductive health programming in humanitarian settings.

Philippines: Maternal health in crisis situations

Teresita Artiaga Elegado, program coordinator of the Family Planning Organization of the Philippines, recalls the aftermath of Typhoon Sendong.

“The Philippines is the world’s third most disaster prone area; we have about 19 typhoons every year and about 6 to 10 of them make landfall,” said Artiaga-Elegado.

When Sendong hit Cagayan de Oro in 2011, it was challenging time for her team; there were massive floods in a region that is not accustomed to typhoons and only recently doing training for minimum initial service package (MISP), a set of priority practices for health care professionals to address RH needs in crisis situations.

“There were 600,000 people affected and 60% were females. Local governments in this region were not among those trained in MISP,” said Artiaga-Elegado.

This was compounded by the fact that in some areas of the Philippines, RH is not a priority by local government in normal situation and became even less of a priority during humanitarian emergencies.

“We could not distribute contraceptives in evacuation centers [during Sendong] because the local government was pro-life. RH Kits provided to the city government not utilized. In our rape kits, emergency contraception was taken out,” explained Artiaga-Elegado.

The teams on the ground made the most of out of the situation and formed

RH Working Group activated at the national and regional levels across different sectors. The DOH, OB-GYNS and midwives were activated as mobile MISP teams.

An immediate prelisting of pregnant and lactating women and a mapping of functional birthing facilities were done.  RH medical missions were launched and referral systems were set up and mobile MISP teams were deployed to remote villages. Information campaigns were driven mostly by both word-of-mouth. However, in post-analysis reports of the response during Sendong, these efforts were not recognized.

“In the government reports, our RH services were not reported. There was no importance placed on the issue or our efforts to address it,” Artiaga-Elegado said.

“Maternal mortality is not a direct result of conflict and crisis, but rather absence of health care. Often,  MMR (maternal mortality ratio) is already high even prior to destabilizing event; conflict and crisis exacerbate the situation. The majority of countries with the highest maternal mortality ratios and newborn mortality rates are crisis-affected. Family planning is a life-saving intervention [for women and young girls] in humanitarian settings. We need to scale up these efforts,” said Catrin Shulte of Médecins Sans Frontières (MSF or Doctors Without Borders). – Rappler.com