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Pregnancies Don’t Wait for Emergencies to End

Cléo Fatoorehchi

UNITED NATIONS, Mar 2 2011 (IPS) - When disaster strikes, the initial humanitarian response tends to focus on basic commodities like food and shelter. But as the crisis or conflict drags on, other critical needs often go unmet – such as prenatal care for pregnant women, and emergency contraception for victims of sexual assault.

To close this gap, the U.N. Population Fund (UNFPA) and Women’s Refugee Commission (WRC) – part of the International Rescue Committee (IRC) – have launched a newly updated Inter-Agency Field Manual on Reproductive Health in Humanitarian Settings.

The Field Manual targets health officials and providers, such as doctors, nurses and midwives, as well as policymakers and donors. In addition to maternal and newborn health and family planning, it also addresses gender-based violence and sexually transmitted infections.

“When there is a breakdown in civil society… sexual assaults and violence go way up and people have pregnancies and exposure to HIV,” Sandra Krause, reproductive health programme director for WRC, told IPS on the sidelines of the U.N. Commission on the Status of Women this week.

“So it’s really critical to be able to give women access to emergency contraception and post-exposure prophylaxis to prevent HIV,” she said.

A rise of violence against women has been documented not only in armed conflicts but following natural disasters as well, such as this year’s floods in Australia, the 2004 tsunami in Southeast Asia, Hurricane Mitch in Central America 1998, and the 1991 Mount Pinatubo eruption in the Philippines.

The disastrous Jan. 12, 2010 earthquake in Haiti, which affected over three million people, was “a tipping point, with people in the field recognising there was this priority for reproductive health services,” said Krause.

The Field Manual “outlines what needs to be done in the early days and weeks”, but it also provides guidance for comprehensive reproductive health services to be settled in the longer term, Krause explained.

“Reproductive health is critically important for spacing pregnancies because a lot of women and girls don’t want to be pregnant during an emergency like the tsunami,” she said, “so we will always see a demand for family planning services.”

The need for reproductive health services is especially critical since “15 percent of pregnant women will experience some type of unexpected complication with the pregnancy and will require care or die,” she added.

The Inter-Agency Working Group on Reproductive Health in Crises was founded in 1995, pulling together more than 30 groups, from U.N. agencies to NGOs to academia. It published its first Field Manual in 1999, creating the Minimum Initial Service Package (MISP) to ensure reproductive health in post-conflict or disaster-affected situations didn’t fall through the cracks.

But when WRC did a field assessment some years later, it discovered that most humanitarian workers were unaware of the MISP and did not use it on the ground.

For the latest edition, input was sought from every sector, because “if people … invested in it and know what’s in it, they’re going to use it,” Krause told IPS – what she calls “shared ownership”.

WRC also developed a distance-learning module, available in many languages. The online programme explains, in three or four hours, what the priority activities should be.

“Each chapter has a final online post-assessment and people using it can get a certificate. About 4,000 people have completed the online distance-learning module,” said Krause.

Ashley Wolfington, a reproductive health specialist at IRC, stresses the need for family planning among youth, with girls under 19 years old experiencing double the risk of complications during pregnancy than older women.

Krause also pointed out that, “Women and girls play a tremendous role (in recovery)… and if they’re sick or unable to take care of their families and communities, that’s a problem.”

“Women who are not suffering from complications from unsafe abortions or miscarriages of the consequences of rape or HIV transmissions are much more likely to be able to take care of their families and contribute to building their communities,” she said.

The next step is empowering women themselves to think ahead in terms of what they can do to protect themselves and communicate with one another in the event of an outbreak of war and violence.

As part of a global launch, the Field Manual has already been presented in Santo Domingo in May 2010, in Bangkok in September 2010 and then in Geneva. The event at the United Nations Monday was the first U.S.-based launch.