The crisis of reproductive care in humanitarian settings
An estimated 26 million women and girls of reproductive age live in refugee camps and other crisis settings around the world. They experience increased levels of exploitation, sexual violence and transactional sex, which can lead to unwanted pregnancy. But their access to contraception, safe abortion care and other reproductive health services is often minimal or nonexistent.
Much of the problem stems not from a lack of technical ability, but from a lack of political will by governments to ensure that women and girls have access to the care they need, says Rajat Khosla, Human Rights Advisor for the World Health Organization’s Department of Reproductive Health Research: “Médecins Sans Frontières, Ipas and others are coming up with strategies of how to actually provide safe abortion services in humanitarian settings. So the conversation is no longer whether we should be providing these services, but how we should be providing these services.”
Khosla was one of several global experts who met recently in conjunction with the 61st annual session of the United Nations’ Commission on the Status of Women to discuss sexual and reproductive health and rights in humanitarian settings. These experts say contraception and safe abortion care need to be prioritized in humanitarian work and worry that the “Global Gag Rule” recently reinstated by U.S. President Trump will create even more barriers to women’s ability to access reproductive care.
The meeting—convened by Reproductive Health Matters, the International Rescue Committee, the World Health Organization, the Women’s Refugee Commission, Columbia University and Ipas—looked at policy, service-delivery and social and cultural barriers to sexual and reproductive health services in humanitarian settings.
“Unsafe abortion is a problem for women globally,” says Hauwa Shekarau, who leads Ipas’s work in Nigeria. “However, women in humanitarian and fragile settings are even more vulnerable and are systematically denied reproductive care or information. We need to stand up, begin action and ensure that these women are provided the assistance they need. Can we do that? I think we can.”
With the total number of people living in crisis settings now upwards of 65 million and increasing, the need to address this issue is urgent, says Khosla. “Why is it that we aren’t providing this care? Why are these settings so ill-equipped to provide access to lifesaving care and commodities that are so needed?”
‘This picture is real. It’s not just on paper’
In Nigeria alone, the humanitarian crisis is massive, with millions in need of assistance, according to Shekarau. “This picture is real. It’s not just on paper. There is widespread displacement, violations of international human rights law, and a growing crisis—all provoked by Boko Haram.” Women and girls living in this crisis are finding themselves in settings where they expect to be protected but end up being sexually violated and abandoned without any reproductive care.
“What is very clear,” she adds, “is that reproductive health care is missing, not just in Nigeria, but in all the humanitarian assistance that is going on in crisis situations around the world. It’s time for the world to open its eyes to this problem.”
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