Reproductive health programming
- United Nations Security Council Resolution 1889 states the need to ensure women and girls’ access to sexual and reproductive health services and to improve reproductive rights to achieve positive socio-economic conditions in post-conflict situations (IAWG-RHC as cited by RHRC website: General Reproductive Health: Key Messages.
- Reproductive health is a cross-cutting issue and in order to provide effective services a multi-sectoral integrated approach must be put in place. The planning and delivery of reproductive health services should include actors from various sectors including protection, health, nutrition, education and community service (Inter-agency Working Group on Reproductive Health in Crises, 2010).
- In the acute stage of a humanitarian emergency reproductive health services are often limited or non-existent (Raise Initiative, 2007), and reproductive health services are not often seen as a priority. These factors along with security restrictions and lack of access can make reproductive health programming a challenge.
- The lack of sufficient reproductive health services during the acute stage of a humanitarian emergency can have serious health implications for women and girls, including the following:
- Unplanned pregnancy due to lack of family planning and lack of emergency contraception following rape.
- Disease, disability and severe medical conditions (such as fistula) due to unwanted pregnancy, obstetric complications and lack of emergency obstetric care.
- Life-threatening complications from unsafe abortions.
- Risk of HIV infection and reproductive disorders.
- Increased vulnerability to violence against women and girls (adapted from IWAG-RHC, 2010 & Raise Initiative, 2007).
- It is important that women and girls receive basic reproductive health services during the acute stage of a humanitarian emergency in order to ensure that their basic health needs are met and in order prevent reproductive health related morbidity and mortality. As such, a Minimum Initial Service Package (MISP) should be available.
- When implementing reproductive health programs in conflict or post-conflict settings it is important to apply the following principles (adapted from IWAG-RHC, 2010):
- In order for reproductive health services to be effective and efficient it is important to ensure information sharing, compromise and collaborative action amongst all actors and relevant stakeholders.
- Furthermore, at the onset of the emergency, an agency to lead reproductive health within the health cluster (or relevant health coordination mechanism) should be identified by the coordination lead.
2. Quality of care
- Reproductive health services should be complete and accessible and discrimination free.
- Communication tools (such as community-wide or targeted information campaigns) should be used to ensure that vulnerable populations and communities receive the information they need, when then need it, in a comprehensible way that allows them to make practical decisions.
4. Community Participation
- To assure the appropriateness, acceptability and sustainability of all reproductive health activities and programs, key stakeholders from the community must be involved in all aspects of the programme cycle including assessment, design, implementation, and the monitoring and evaluation.
5. Technical and managerial capacity-building
- Technical and managerial capacity within local, national, regional and international organizations should be supported and built in order to improve the coverage, quality and sustainability of reproductive health services.
- Health care providers and organizations responsible for reproductive health programs should be held accountable to set standards and principles. Relevant standards and principles should include fiscal responsibility, humanitarian principles, professional standards, local and international laws and the principles.
7. Human rights
- Reproductive health programs should apply a rights-based approach and health service providers should be familiar with international, regional and national (as well as customary) laws and treaties which effect human rights in the country they are working in.
- Reproductive health programs should include advocacy components to ensure that laws, policies, practices and social norms enable women and girls to enjoy their right to reproductive health.
Example: An organization in Sierra Leone called the Women in Crisis Movement (WICM), supported by the UNFPA, developed a post-conflict comprehensive programme called “Empowering Adolescents and Young Girls Affected by the War through Reproductive Health Services, HIV/AIDS Prevention and Reintegration Opportunities.” The project targets 2,300 women and girls between the ages of 15 and 38 who have suffered abduction, abuse, exploitation and other forms of violence at the hands of warring factions; many of them have resorted to commercial sex work as a means of survival both during and after the war. Besides empowering young women through economic opportunities as alternatives to commercial sex work, the project offers sexual and reproductive health services. The project activities specific to the health sector include:
- Free medical care to all the participants and to host communities through six satellite mother-and-child health clinics with voluntary mass treatment of sexually transmitted infections and regular family planning and child-care programs;
- Adult literacy classes for the women and their partners with a component developed by UNFPA on reproductive health, family planning, prevention of HIV infection, nutrition, sanitation, personal hygiene, sexually transmitted infections; and Occupational options;
- Free condom supplies;
- Counseling and psychosocial support, which has been extended to more than 800 girls and young women.
Since the inception of the project, knowledge about HIV and other STIs have increased, condom use has increased, and the prevalence of HIV has declined. Women have also been granted a new right to inherit property when their husbands die.
For comprehensive information and additional tools on Reproductive Health in conflict and post-conflict humanitarian settings see the Reproductive Health Response in Crises (RHRC) Consortium website.
Inter-agency Field Manual on Reproductive Health in Humanitarian Settings (Inter-agency Working Group on Reproductive Health in Crises. 2010). Available in English.
Adolescent Sexual and Reproductive Health Toolkit for Humanitarian Settings (UNFPA and Save the Children, 2009). Available in English. This Toolkit is intended to guide humanitarian programme managers and healthcare providers to ensure that sexual and reproductive health interventions put into place both during and after a crisis are responsive to the unique needs of adolescents. It provides user-friendly tools for assessing the impact of a crisis on adolescents, implementing an adolescent-friendly Minimum Initial Service Package , and ensuring that adolescents can participate in the development and implementation of humanitarian programmes. Other tools are specifically designed for healthcare providers to help them be more effective in providing and tracking services for adolescents at the clinic and community levels.
Inter-Agency Reproductive Health Kits for Crisis Situations (Fourth edition) (Inter-Agency Working Group (IAWG) on Reproductive Health in Crises, 2008). The essential drugs, equipment and supplies to implement the MISP have been assembled into a set of specially designed prepackaged kits, the Inter-Agency Reproductive Health Kits. The kits complement the objectives laid out in Reproductive Health in Humanitarian Settings: An Inter-agency Field Manual. The resource is also available in French and Spanish.
Ensuring Privacy and Confidentiality in Reproductive Health Services: A Training Module and Guide for Service Providers (PATH and Global Health Council, 2003). This manual contains tools, resources and guidelines on the role of health care workers in addressing violence; guidance to help health workers and managers set up programs; and tools for assessment, monitoring and evaluation and screening. Available in English.