Coping with Crises: How
Providers Can Meet Reproductive
Health Needs in Crisis Situations
Series J, Number 53
Millions Need Care in Crises
• Every year natural disasters and conflicts kill
and displace millions of people.
• Conventionally, humanitarian and relief
workers have focused on providing basic
• Reproductive health care is a serious public
health issue in crises that deserves more
• Crises Pose Major Challenges for Reproductive Health
– Range of reproductive health care needed
– Providers face unique challenges
– International Response
• Reproductive Health Care Providers Can Help
– Joining the Inter-Agency Working Group
– Disaster preparedness
– Following guides to crisis care
– Building links
– Focusing on refugees not in camps
– What to do first in a crisis
– After the crisis
Crises Pose Major
Range of Reproductive
Health Care Needed
• Safe motherhood
• Protection and response to sexual and
• Prevention and treatment of STIs including
• Family planning
• Adolescent reproductive health
• In crisis situations 15% of pregnant women
suffer life-threatening complications of
pregnancy and delivery.
• Maternal complications are riskier for women
in crisis situations.
• Better care could prevent most maternal
– Study of Afghan refugees in Pakistan found that, compared
with women who died of other causes, those who died of
maternal causes faced greater barriers to health care.
Sexual and Gender-based
• Armed conflict leads to widespread sexual
and gender-based violence (SGBV).
– Occurs during all phases of conflicts
• Most often women and girls, but men and
boys also affected.
• SGBV increases with loss of security, trauma,
ethnic tensions and breakdown of society.
• Domestic violence also increases.
– East Timor: Half of women reported abuse by intimate
partners, both during the crisis and afterwards.
Health Care Providers Can
Help Reduce Violence
• Caring for Survivors: • Preventing Violence in
– Ask a client about abuse. Camps:
– Providers should be alert – Work with camp
to physical injuries, management.
health conditions, and – Work with refugee health
clients’ behavior that care providers.
indicates trauma. – Advocate leadership by
– Provide appropriate care. women.
– Document the woman’s – Work with security
– Support women’s self- – Involve the community.
HIV/AIDS and Other STIs
• Coupled with crisis situations, HIV and other
STIs can spread rapidly.
• Poverty, powerlessness, food insecurity, and
displacement make refugees more
– In Liberia, HIV prevalence was estimate at 8%. STI
screenings after the war showed 93% of male combatants
and 83% of female combatants had at least one STI.
• Family planning is in as much demand during
a crisis as it was beforehand.
• Refugees have far less access because
services and supplies are disrupted.
• Results are unintended pregnancies and
rising abortion rates.
• Women relying on contraceptive methods
may have to discontinue abruptly.
• Adolescents, especially girls are at risk of
forced sex and sexual coercion in exchange
for food, shelter and protection.
• Unsafe sex and risk-taking among youth
increase in crisis.
– In a refugee camp in Kenya, despite availability of free
condoms 70% of young men and women had unplanned sex
Health Care Providers Face
• Crises disrupt services
• Crises overwhelm health systems
• Crises come on top of existing problems
• Conflicts and natural disasters create
different problems for providers
• Reproductive health care for refugees has
improved, but gaps remain.
• In the last 20 years the international
community has paid increasing attention to
the reproductive health needs of refugees.
• Relief agencies and local agencies working
together can avoid duplication of services and
International Relief Agencies
Provide Reproductive Health
• RHRC Consortium
• The Inter-Agency Working Group on Reproductive
Health in Refugee Situations (IAWG)
• UNICEF, UNFPA, and UNRWA
• The International Medical Corps (IMC)
• Refugees International (RI)
• US Government Agencies
Not Enough Funding
• Relief agencies often cannot provide
complete reproductive health care for
refugees due to lack of funds.
• United States and European Union, provide
most of the funding.
• Since 2000, funding for reproductive health
care has declined as donor priorities have
Care Providers Can
Join the Inter-Agency Working
• Inter-Agency Working Group on Reproductive Health
in Refugee Situations (IAWG) seeks to improve
interagency collaboration and reproductive care for
those in crisis situations.
• Providers can join IAWG electronic mailing list to
receive updates on reproductive health care in crisis.
• Providers can join or start a national, district, or local
interagency working group that can serve as a focal
point to collaborate with relief agencies.
– For further information, contact Nadine Cornier at UNHCR
• If local communities and NGOs are trained
and prepared for disasters, a quicker
response can be mounted.
• International organizations offer disaster
preparedness training courses.
– Health Emergencies in Large Populations (H.E.L.P.) course
offered by International Committee of the Red Cross (ICRC).
– Public Health in Complex Emergencies course offered by
International Rescue Committee (IRC).
– In addition, numerous training tools specifically address
reproductive health in conflict situations.
Pay Attention to Logistics
• Crisis situations present special logistical challenges.
• Any reproductive health program can design and use
a basic logistics management information system.
– Contraceptive Logistics Guidelines for Refugee
Settings (DELIVER) outlines basic principles of
-calculating contraceptive needs
-calculating average monthly consumption
-how to store contraceptives.
Create a Skills Roster
• Providers need to quickly identify people with
• Many refugees have training in health care,
but their skills can be used in a relief effort
only if they are known.
• Without a skills roster, expertise can go
– In Tanzanian camps after the Rwandan genocide, some
providers knew how to insert and remove implants, but relief
workers did not know about provider skills. Women who
needed these services did not have access.
Establish a Relationship with
the News Media
• Governments and humanitarian agencies
should have a plan of working with news
• Media can provide survivors with critical
• News media are often the first to define an
event as an emergency and raise public
awareness and concern.
Working with the News Media
• Find ways to help the media report the news
by providing them with accurate facts.
• Respect media deadlines.
• Always be truthful and factual.
• Use language that is clear, concise, and easy
Follow Guides to Crisis Care
• The Inter-Agency Field Manual is a key tool.
• Use the Minimum Initial Service Package
– Applies to both conflict and natural disasters.
– A series of activities and supplies designed to deal with
reproductive health issues in crisis situations.
– Intended for the acute phase of a crisis.
– Can be implemented immediately without a needs
• Coordination between relief organizations
and local health systems can combine the
experience/expertise of relief workers and
local health care providers.
• Local providers can take the first step and
offer their services.
• Local agencies may receive funding,
supplies, and equipment from UN and other
Focus on Refugees Not in
• International relief organizations and NGOs
can work with local reproductive health care
providers to offer care for refugees who are
not in camps.
• Refugees living in host communities often
receive less health care.
• Health care providers who are able to
continue serving their regular clients may be
able to incorporate refugees into their
What To Do First in a Crisis
• Approach someone working • If there are many displaced
for a UN organization and ask people, talk to relief workers
which organizations and/or organizing shelter, water,
individuals are coordinating latrines and food.
RH care or the MISP.
• Offer your services and • If you know how to set up
provide your qualifications. water pumps and latrines let
• If your clinic/hospital has the them know.
skills or equipment to provide • Work with those distributing
any component of the MISP, food rations to make sure
start immediately. women are equally
• Ask for supplies from relief represented.
organizations. Also ask that • Make sure sanitary supplies
they include your clinic in
distribution of supplies. as well as clean delivery kits
• Go to reproductive health are distributed with food
care coordination meetings rations.
After the Crisis: From Disaster
• Even after conflicts or natural disasters end,
suffering often continues.
• People need continued support to help
rebuild their lives.
• During the transition to post-emergency relief
and recovery, humanitarian providers can
cooperate with other local providers and
coordinate activities that focus on
• Slide 1:Sandra Krause, Women’s Commission for Refugee Women and
• Slide 3: EC/ECHO, New Delhi/Alam Aftab
• Slide 15: CCP, Courtesy of Photoshare
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