Sexual and reproductive health and rights (SRHR) in humanitarian crises
Volume 26 Number 51, October 2017
Today, an estimated 26 million women and girls of reproductive age are living in emergency situations around the world, all of whom require access to sexual and reproductive health services. Amidst the complex and varied contexts of humanitarian settings, access to services such as family planning, abortion, and emergency obstetric care, can too easily be compromised or denied. Policy barriers, failed health systems, a lack of effective interventions, and other socio-cultural and economic factors may all contribute to inadequate realization of sexual and reproductive rights in such settings.
Although many sexual and reproductive health services have become more available in humanitarian contexts over the last decade, a recent systematic review in the BMJ notes that there remains a concerning lack of data regarding the effectiveness of SRHR interventions across the various stages of humanitarian crises, along with “evidence of high unmet needs and insufficient investments for sexual and reproductive health services during humanitarian crises.” Further, the majority of humanitarian crises occur in low- and middle-income countries, often where the infrastructure and capacity to effectively respond are weakest.
This thematic issue of RHM continues a dialogue we first engaged with in our May 2008 thematic issue on SRHR in conflict and crisis situations. Through this new issue, we intend to contribute to the growing global conversation, commitments, and momentum regarding SRHR in humanitarian settings by taking stock of progress (or regressions) in this area, building the evidence base, and widening the discussion to include marginalized and under-represented voices. We are also broadening the scope of the conversation, moving beyond situations of acute conflict and crisis to consider SRHR within a wider context of humanitarian settings, along with different phases of a crisis or recovery process. Guided by the Sphere Standards for humanitarian responses, we consider humanitarian action to take place within and across a range of contexts and situations, “including natural disasters, conflict, slow- and rapid-onset events, rural and urban environments, and complex political emergencies in all countries.” Accordingly, this issue aims to generate and disseminate new evidence and insights across the following thematic areas:
- Heightened Risk and Vulnerability
Women and girls caught in humanitarian crises, or living in protracted humanitarian settings such as refugee or internally displaced people (IDP) camps, experience insecurity, displacement, the breakdown of tradition social support structures, and often increased levels of impoverishment, leading to heightened and differential SRHR risks compared with those living in more stable settings. For many, the availability of services such as comprehensive family planning, emergency contraception, and safe abortion is still limited. Women often experience limited or no access to antenatal care and emergency obstetric care, and are more at risk of gender-based violence, child marriages, vulnerability to smuggling or trafficking, and interruption or discontinuation of anti-retroviral medications. Further, there are unique SRHR needs and concerns for those at the intersection of multiple vulnerabilities, which, along with women, includes people living with disabilities or illness, LGBTI people, the elderly, and children, particularly unaccompanied or separated children in situations of both acute and protracted crisis. There is an urgent need to investigate and understand both the causes and consequences of these differential risks.
- Interventions and Responses
The development of effective interventions and responses requires us to probe what might be feasible in such settings, what is most needed, and what is appropriate for the different populations in humanitarian crises. There is also a pressing need to build an evidence-based understanding of what interventions are proving most effective within humanitarian settings, and what factors support or impede the effectiveness of different interventions. The complex and often rapidly shifting contexts of humanitarian settings can present multiple obstacles and barriers for those attempting to access sexual and reproductive health services, and for those attempting to provide them. Such barriers can include, amongst others, language differences, logistical barriers, inadequate health systems, gaps in service delivery, education and literacy levels, and cultural differences. Women may also face stereotypes or prejudice from aid workers or health practitioners related to their sexual and reproductive needs and desires.
- Legal and Policy Issues
Legal and policy barriers represent another important concern. These barriers may impact SRHR in different ways, depending on the specific setting and context. Some services, such as maternal healthcare, may be less controversial and more widely supported and available than others, such as safe abortion, contraception, and condoms. On the other hand, for some groups such as refugees, asylum seekers and irregular migrants, access to care and the provision of services in host communities may be deeply politicized, and linked to emotive questions of citizenship, identity, deservingness and belonging. SRHR actors and advocates also face significant challenges in ensuring the integration and implementation of SRHR into humanitarian policies and responses, particularly as SRHR and gender considerations have, in previous years, largely been assumed to fall within the ambit of development, rather than humanitarian interventions. Working towards the realization of SRHR in humanitarian settings will require uncovering legal and policy barriers, as well as the showcasing of policies and laws that support the realization of these rights amongst affected populations. It will also require a search for new and innovative ways to improve the coordination of interventions and programmes, and to integrate SRHR into the existing work of governments, international organizations, NGOs, and other humanitarian and development actors.
Call for Papers – What and When?
For this issue of RHM, we invite articles that offer new insights and evidence to contribute to the global knowledge base regarding SRHR in humanitarian crises, particularly in relation to the themes outlined above. We welcome analytical pieces, critical perspectives, and policy and human rights analyses that interrogate these issues, and we encourage original research articles, along with commentaries and viewpoints. Further, we invite critical reflections regarding the methodological and ethical challenges of conducting SRHR research in humanitarian settings. We also encourage the submission of narratives from individuals with relevant first-hand experiences, as well as contributions from affected countries and from activists and actors working in this field.
Other potential topics include:
- What are the individual experiences of people in humanitarian settings, in accessing SRHR, both practical (in terms of services) and relational? How are these experiences shaped and mediated by intersecting factors such as race, religion, socio-economic status, sexual orientation, educational level, gender identity, disability or age?
- How do SRHR needs, responses and delivery mechanisms shift throughout and across the different stages and contexts of humanitarian crises? How do, or should, responses vary, in relation to the nature and duration of the crises?
- What are the impacts of living in situations of conflict and crises, or in protracted humanitarian settings, on the various ways in which familial relationships and intimacy find expression?
- How can policy makers and practitioners working across the development and humanitarian sectors improve coordination and collaboration for the effective delivery of SRH services and the protection of rights in the context of humanitarian crises?
- What approaches to SRHR advocacy have been most effective in humanitarian contexts? What factors have contributed to the successes and shortcomings of such advocacy efforts?
- How can SRHR advocates and actors continue to build on recent international momentum and commitments around SRHR in humanitarian settings, such as those made at the World Humanitarian Summit (May 2016) and in the New York Declaration for Refugees and Migrants (September 2016)?
 Warren, E., Post, N., Hossain, M., Blanchet, K., & Roberts, B. Systematic review of the evidence on the effectiveness of sexual and reproductive health interventions in humanitarian crises. BMJ open 2015; 5(12), p1.
 The Sphere Project. The Sphere Project: Humanitarian Charter and Minimum Standards in Humanitarian Response. Northampton, UK: Belmont Press Ltd/The Sphere Project, p9.
 Askew, I; Khosla, R; Daniels, U; Krause, S; Lofthouse, C; Say L; Gilmore, K; and S. Zeid. Sexual and Reproductive Health and Rights in Emergencies. Bulletin of the World Health Organization 2016; 94:311.
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