Disaster Risk Management for Health Fact Sheets Global Platform - May 2011 Disaster Risk Management for Health SEXUAL AND REPRODUCTIVE HEALTH

Key Points Why is this important?

 Reproductive health is a human right.  Lack of adequate reproductive health services (in-  Sexual and reproductive health (SRH) is a cluding contraception and comprehensive abortion significant public health issue, including in care) and gender based violence including sexual 1 emergencies 1 violence can lead to a range of adverse outcomes:

 A range of adverse outcomes can be pre-  Trauma vented by timely provision of healthcare  Sexually transmitted infections services before and after emergencies.  Possible spread of HIV  Safe pregnancies and childbirth depend on  Unwanted pregnancies and unsafe abortions sufficient numbers of trained healthcare  Maternal and neonatal deaths workers and adequate facilities for providing essential and emergency care.  An estimated 358,000 maternal deaths occur annu- ally. 99% of these occur in the developing world;  Comprehensive, high quality reproductive 4 87% in Sub-Saharan Africa and South Asia. health care requires input from all sectors:

protection, nutrition, education, and commu- 1  In any emergency situation, one in five women of nity services, as well as health. childbearing age is likely to be pregnant.5  Promoting SRH through primary health care at all times, including in emergencies, consists  Countries in conflict or experiencing other forms of of family planning and comprehensive abor- instability often experience the highest rates of ma- tion care, prenatal care, skilled childbirth care; ternal and neonatal mortality. and post-natal care for the mother and baby.  In emergencies, communities are the first re- sponders and can rapidly identify pregnant What are the health risks? women and support them in getting the care Adolescence1 they need.  Adolescents face increased vulnerability to exploita-  The Minimum Initial Service Package (MISP) tion, violence and transactional sex. for Reproductive Health is a coordinated minimum set of priority activities for decreas-  Increase in risk taking behaviour due to: ing morbidity and disability in crisis-affected 1 2 o breakdown of youth-adult partnerships. populations . MISP is a SPHERE standard. o distortion of future perspectives.  Lack of services that are tailored to the needs of, Examples of gender-based violence in and easy to access for adolescents by age group humanitarian settings (e.g. 13 year olds compared with 17 year olds) and Taken from IASC Guidelines on gender-based violence3 gender. “Human relations were laid bare and the strengths and weaknesses in relationships came more sharply into fo- 1 Family planning cus. Thus, socially isolated women became more isolated, domestic violence increased and the core of Disruption to provision of basic contraceptive methods relationships with family, friends and spouses were ex- and lack of availability of emergency contraception posed.” (Based on a field report in the aftermath of an may lead to: Australian flood) o increased risk of unplanned pregnancy. Increase in violence against women was also noted in reports from the Philippines after the Mount Pinatubo o increased risk of unsafe abortion, with further eruption, in Central and North America after Hurricane risk in situations where there is rape and sex- Mitch, and in several countries after the 2004 tsunami. ual violence.

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Further information, contact: WHO - Jonathan Abrahams (e-mail: [email protected])

Maternal and newborn health  Undertaking risk and capacity assessments of popu-  Poor access to skilled care for childbirth, including lations and the health system in relation to SRH. care for obstetric and neonatal complications;  Building resilient health systems and primary care most maternal and neonatal deaths occur around capacities which can continue operating in a disas- the time of labour, childbirth and the immediate ter. postnatal period.6  Identify health workers with midwifery skills and  Maternal and neonatal mortality is higher in de- facilities and estimate the capacity for the provision veloping countries than in developed countries, of basic and comprehensive emergency obstetric largely due to poor access to skilled health care care. workers for childbirth and the difficulties faced in referring for obstetric and neonatal complications.  Undertake population-based health education around the needs of women and babies before, dur-  Disasters put women and their newborns at in- ing and after birth with a particular emphasis on creased risk of morbidity and mortality because of danger signs and when and where to seek care. the sudden loss of support and reduction of ac- cess, compounded in many cases by trauma,  Integrated SRH messages into health sector and malnutrition or disease, and exposure to vio- non-health sector-driven public awareness cam- lence.5 paigns and educational materials about disaster risk management.

Trauma - Gender-based violence (GBV) 1,3,7  Strengthening existing SRH services to absorb  The stress and disruption of emergencies often impacts, adapt, respond to and recover from emer- leads to a rise in sexual violence and domestic gencies, through: coordination; response planning; abuse. training and capacity development – sufficient to im- plement the MISP immediately at the onset of an  GBV affects women and girls most commonly, but emergency. may also affect men and boys as well. The MISP focuses on preventing and managing the o GBV includes: sexual violence; domestic vio- consequences of sexual violence; reducing HIV trans- lence; forced and early marriage; harmful mission; preventing excess maternal and newborn traditional practices such as female genital mu- morbidity and mortality; and planning for comprehensive tilation, honour crimes; and trafficking. RH services, integrated into primary health care as the o GBV has physical and psychological conse- situation permits. quences. o GBV also impacts upon the individual’s social health in terms of stigma, isolation and rejec- References and further reading tion. 1. Inter-agency Field Manual on Reproductive Health in Sexually transmitted infections (STIs)1,,7 and HIV1,7 Humanitarian Settings. Inter-agency Working Group on  STIs may spread more rapidly where there is dis- Reproductive Health in Crises, 2010. 2. Humanitarian Charter and Minimum Standards in Hu- ruption to the community and/or health manitarian Response. The Sphere Project, 2011. infrastructure, such as in emergency situations. 3. Guidelines for Gender-based Violence Interventions in Humanitarian Settings. Inter-agency Standing Committee  Populations (particularly if affected by complex Taskforce on Gender in Humanitarian Assistance, 2005. emergencies) are at greater risk of HIV due to: 4. WHO, UNICEF, UNFPA, The World Bank. Trends in ma- o Reduced access to HIV prevention and treat- ternal mortality 1990–2008: estimates developed by WHO, UNICEF, UNFPA and The World Bank. Geneva: ment services. World Health Organization, 2010. o Disrupted social networks leading to greater http://www.who.int/reproductivehealth/publications/monit exposure to sexual violence and transactional oring/9789241500265/en/index.html sex. 5. “Women are the Fabric: Reproductive Health for Com- o Population movements to areas of higher HIV munities in Crisis”. UNFPA, 2006. prevalence. http://www.unfpa.org/public/publications/pid/1348 6. WHO (2010). Packages of interventions for family plan- ning, safe abortion care, maternal, newborn and child Risk management considerations health www.who.int/making_pregnancy_safer/documents/fch_1 Governments and communities can protect and pro- 0_06/en/index.html mote SRH) through: 7. Prevention and Control of Sexually Transmitted Diseases in Emergencies. PAHO, 2011.  Action across all sectors to ensure that SRH is 8. WHO Sexual and reproductive health. Packages of Inter- included in disaster risk management legislative ventions for family planning, safe abortion care, maternal, frameworks, policies and strategies with necessary newborn and child health. WHO 2010. resources and community participation. http://whqlibdoc.who.int/hq/2010/WHO_FCH_10.06_eng. pdf

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