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Skip to 0 minutes and 12 seconds SPEAKER 1: So when we talk about sexual and reproductive health, we’re talking about access to family planning, and to emergency contraception, to safe abortion care, where that’s legal, and to post-abortion care, to care of women during pregnancy, labour, and the post-natal period, care for their babies, neonatal care, and to care for STIs and prevention of STIs and HIV. We know that mothers, adolescents, and babies living in humanitarian settings and crises are more vulnerable and at risk of deaths and of disability related to their inability to access care. The 2016 Lancet Maternal Series, for example, showed that the highest burden of maternal mortality was clustered in among those countries where which shouldn’t call– which are fragile states.

Skip to 1 minute and 12 seconds Over half of all maternal and newborn deaths occur in around 50 countries, which are categorised as fragile states, which are also more susceptible to armed conflicts and natural disasters. Delivering health care and ensuring sexual and reproductive health rights in humanitarian crises is very challenging because of the environment.

Skip to 1 minute and 35 seconds There’s often– humanitarian agencies are often working in unsafe and insecure situations. So they have to be concerned about the safety of their own staff. Makes it difficult for women to access health services and to maintain logistics chains and supply chains to equip house posts. There are often severe constraints to human resources and to finances. And then, there’s often poorer governance or a lack of governance, of political will. Infrastructure is often damaged or inadequate. And it’s often compounded by the complexities in the political system, which can include where governing bodies can be reluctant to institute sexual reproductive health. They have competing priorities.

Skip to 2 minutes and 29 seconds Enabling sexual and reproductive health rights it’s also very challenging in situations where there are dominant and negative interpretations of the role of women and women’s issues. And those values can often be held onto even more tightly at times of conflicts and uncertainty, which make it even harder to operationalise sexual and reproductive health rights. So in humanitarian crises, there’s a set of guidelines called the Minimum Initial Service Package, MISP. And this specifies a series of critical actions required to respond to sexual and reproductive health needs at the onset of a humanitarian crisis. So the goal of the MISP is to save lives by implementing these priority emergency interventions for sexual and reproductive health.

Skip to 3 minutes and 22 seconds The MISP was developed by the Interagency Working Group on Reproductive Health in Crisis, which was led by the World Health Organisation, UNFPA, and UNICEF. The MISP is not just a set of supplies. It’s also a set of activities that guide international standards and should be led and coordinated by trained professionals. So there are five objectives of the MISP. Firstly, is to nominate a coordinating agency to lead the interventions and activities related to sexual and reproductive health. And secondly, to prevent sexual violence and manage the consequences of it. Thirdly, to prevent the transmission of HIV. Fourthly, to prevent maternal and newborn mortality and disability. And finally, to work towards implementing more comprehensive sexual and reproductive health care when the situation allows.

Skip to 4 minutes and 23 seconds There are several standards and guidelines that can support the implementation of sexual and reproductive health rights in humanitarian crises. One of those is the Interagency Field Manual on Reproductive Health in Humanitarian Settings. And that’s sort of the results of a collaborative consultative process led by the United Nations and includes around 100 members from other agencies, including government organisations and non-governmental organisations as well. There are several standards that exist that provide a framework to implementing the MISP and they’re available online. And there are also guidelines that UNFPA have developed again with other members from the wider collaboration that address standards for prevention and response to sexual and gender based violence.

How is sexual and reproductive health affected by crises?

Sexual and reproductive health is an often neglected topic in humanitarian crises, but in recent years humanitarian organisations and donors have increased their focus on such healthcare in emergency settings.

In the video, Sara Nam explores the difficulties around implementation, emphasising differences in gender roles and use of the minimum initial service package (MISP), and its five objectives.

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Improving the Health of Women, Children and Adolescents: from Evidence to Action

London School of Hygiene & Tropical Medicine