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Contraceptive Services in Humanitarian Settings and in the Humanitarian-Development Nexus: Summary of Gaps and Recommendations from a State-of-the-Field Landscaping Assessment (March 2021)

Evaluation and Lessons Learned
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The Women’s Refugee Commission (WRC) completed a landscaping assessment from 2018–2020 to evaluate and build the evidence base on barriers, opportunities, and effective strategies to provide contraceptive services to women and girls affected by crises. The assessment included a literature review, a global contraceptive programming survey, case studies in three humanitarian settings, and two sets of key informant interviews (KIIs). The second set of KIIs was conducted after the COVID-19 pandemic began and aimed specifically to understand the effects of COVID-19 on contraceptive services. All other assessment components were completed before the start of the pandemic.

The findings revealed several primary gaps that hinder access to contraceptive programming in humanitarian settings. Based on the findings, key overarching recommendations for governments, donors, and implementing agencies across the humanitarian-development continuum include:

  • Continue building awareness that contraception is part of the package of essential health services in humanitarian settings: Conduct ongoing advocacy and mobilization with governments, donors, and other partners to prioritize sexual and reproductive health (SRH), including contraception, within humanitarian preparedness, response, and recovery, and to improve understanding that contraception is a lifesaving health service and the standard of care that must be made available in all crises.

  • Improve provision of the full range of contraceptive methods, particularly long-acting reversible contraception (LARCs) and emergency contraception (EC): Implement task-sharing policies, remove policy restrictions on EC and LARCs, and make EC available in a wide range of outlets; increase providers’ knowledge of EC and LARCs, including LARC insertion and removal, and provide training on rights-based contraceptive counseling that emphasizes client choice and informed decision-making; and build awareness of EC and LARCs among populations affected by crises.

  • Increase access to contraceptive services for adolescents and members of other marginalized populations: Engage adolescents, persons living with disabilities, and members of other marginalized populations, including local organizations led by these groups, in contraceptive programming from preparedness to response to recovery; employ alternative service delivery modalities to reach adolescents and members of other marginalized populations; and address stigma through community sensitization and values clarification activities.

  • Improve contraceptive commodity availability: Engage staff with pharmaceutical supply chain management skills during emergency preparedness, response, and recovery; integrate emergency preparedness into investments in strengthening SRH supply chains during stable times, including training on management of contraceptive commodities in emergencies; and invest in strengthening SRH supply chains after an acute emergency to transition to a more stable supply chain.

  • Strengthen data collection and use for contraceptive service delivery: Train health facility staff on contraceptive data collection, analysis, and use, and budget adequately for data collection activities; standardize and streamline contraceptive indicators and data collection tools used in humanitarian settings; and build the evidence base on effective strategies to deliver contraceptive services across the emergency programming cycle.

  • Invest in preparedness for contraceptive service delivery: Integrate contraception in emergency preparedness and disaster risk management policies and budgets; strengthen capacity of governments and partners across the humanitarian-development continuum to engage in preparedness and response; and advocate for preparedness to become a routine component of governments’ and development agencies’ SRH programming and coordination during stable times.

  • Localize contraceptive service delivery in crisis-affected settings: Support and strengthen local partners, from governments to community-based organizations, to lead contraceptive service delivery from preparedness to response to recovery; provide flexible, long-term direct funding to local SRH organizations and government agencies; and address barriers in the international aid architecture that impede participation of local SRH stakeholders.

  • Extend and institutionalize mechanisms that have been instituted during COVID-19 to improve contraceptive availability and access, including multi-month provision of short-acting methods, telemedicine and digital protocols, task-shifting and sharing, community-based provision of methods, integration of contraception in primary health activities, and self-care methods including self-injection of subcutaneous injectables.

A complete list of recommendations can be found at the end of each section.