Too often neglected--safe abortion care in crisis settings

Monday, June 20, 2016

women refugees

World Refugee Day, observed on June 20 each year, was established by the United Nations more than 15 years ago to call attention to the plight of millions of people worldwide who live in refugee camps and other crisis settings, driven from their homes by conflict, natural disaster and other violent events.

For women and girls in these settings, the need to control their reproductive lives is crucial, but the harsh reality is that they often lack consistent access to contraception and are at heightened risk of sexual violence, including rape as a weapon of war. Reproductive health services, including safe abortion care, are often given little attention during acute, or even protracted, emergencies, as health workers struggle to prioritize countless needs. Yet, the effects of this neglect are lifelong. Women living in crisis settings—including young women and adolescents—are particularly vulnerable to unwanted pregnancy and potentially unsafe abortions.

As a member of the Inter-Agency Working Group (IAWG) on Reproductive Health in Crises, Ipas has been involved in efforts for many years to advance the sexual and reproductive health of people affected by crises. Today, as the number of people living in crisis settings continues to swell and the average length of their stay in refugee camps lengthens, Ipas and our global partners are stepping up efforts to ensure that safe abortion care is integrated into humanitarian response programs.

Tamara Fetters, Ipas senior research and evaluation advisor, and Tracy DiTucci, Ipas special projects advisor, recently fielded questions about Ipas’s work in this area.

Why is the issue of abortion care in crisis settings so often neglected?

DiTucci: Despite gains made over the past 10 years to expand access to reproductive health services in crises, women’s access to safe abortion care in crises remains limited to non-existent. A study recently published in the journal Conflict and Health sheds some light on why, with four main reasons suggested: a widespread belief within the humanitarian community that there is no need; that “abortion is too complicated to provide in crises”; that “donors don’t fund abortion services”; and that abortion is illegal. These reasons are largely based on false assumptions, and underscore the harmful role that misinformation about abortion plays in restricting women’s access to this lifesaving and life-sustaining care in crises.

Where does the international aid community stand on the issue? What barriers to abortion care do you see? Is there resistance?

DiTucci: Historically, sexual and reproductive health has been overlooked and undervalued within the international aid community due to competing needs and limited resources, among other reasons. A 1994 report produced by the Women’s Refugee Commission helped to change that, and served as a landmark for putting women’s reproductive needs and rights in crises on the global conscience. While there has been growing awareness and increased investments in reproductive health in crises more broadly since the 1994 report, safe abortion care largely remained on the sidelines.

But times are changing. Several donors, coalitions, organizations and advocates are raising the international aid community’s awareness on the dire consequences of continuing to neglect sexual and reproductive health in crises, including the right to safe abortion care. In September 2015, the European Parliament changed its policy to affirm that female war rape victims must be provided abortions as part of their right to non-discriminatory medical care under the Geneva conventions, irrespective of a country’s abortion law. At the World Humanitarian Summit, several key advocates spoke up on this issue and urged others to commit to fully recognizing and responding to women’s right to safe abortion care.

The technical capacity and approaches are in place to address these issues – it is up to the humanitarian community to tap into them to ensure that women affected by crisis no longer need to suffer because they lack reproductive health options that include safe abortion care.

Ipas staff recently were in Jordan for a Research for Health in Humanitarian Crises (R2HC) forum and, in Turkey, met with some of the attendees at the World Humanitarian Summit (WHS). Why was it important to have a presence at these gatherings?

Fetters: As a researcher, my primary interest is closing the evidence gap that contributes to the lack of prioritization of sexual and reproductive healthcare, including abortion services, in humanitarian settings.  Unsafe abortion is a silent killer: Women may suffer the short or long-term consequences of abortion-related morbidity; families may lose wives, sisters and mothers, while stigma and shame about abortion keeps them quiet. The WHS was important for many reasons; for me it was particularly important that more than 60 scholars spoke up and restated their commitment to generate stronger and more collaborative evidence in crisis settings. I believe that Ipas has a role to play in contributing to better research on sexual and reproductive health, and particularly unsafe abortion, in crisis settings. The meeting in Jordan was to bring academics, practitioners and humanitarian aid workers together and to begin to create the space and the linkages to develop a more rigorous and realistic research agenda in humanitarian settings. 

What is Ipas doing to increase access to abortion care for women in crisis settings?

DiTucci: Our work with IAWG has focused on building the capacity of health-care workers to provide reproductive health services in crisis settings. At IAWG’s annual meeting (9-11 March 2016), held in Dakar, Senegal, abortion care was a part of core meeting topics for the first time ever. Ipas staff and partners led several panels and plenary presentations and co-developed a “Safe Abortion Care Champions” workshop which explored myths and misconceptions about abortion. In addition, Ipas, as part of IAWG’s Training Partnership Initiative, supported a two-day training session held in advance of the meeting which included a manual vacuum aspiration (MVA) refresher training for humanitarian field staff based in Africa and Asia.

Fetters:  We hope to continue with our global advocacy efforts and are working to introduce more international field activities that focus on breaking down the barriers to care, such as negative attitudes and confusion about the legality of abortion, in organizations working in crisis settings.