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Denial of Sexual and Reproductive Health Care: A Man-Made Emergency

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By Stephanie Johanssen, Senior Advocacy Officer and UN Representative, Women's Refugee Commission

“Even When You Are Afraid, You Stay,” said a 2017 study exploring the role of nurses and their ability to continue routine and emergency maternity services during the time of the Ebola virus epidemic in Sierra Leone. Among its findings was that while services continued, the fear of Ebola and mistrust kept women from accessing care at a health facility. Even for those who did visit a health facility, an increase in maternal mortality was observed.

Some governments are choosing to ignore the lessons learned during the Ebola crisis. In a recent letter to the United Nations (UN) Secretary-General, the Acting Administrator of USAID asked the UN to remove references to sexual and reproductive health and its derivatives from the UN’s COVID-19 Global Humanitarian Response Plan.

This sends a dangerous signal with far-reaching consequences for women and girls in humanitarian settings. Their health and lives depend on the ability of aid organizations to provide impartial and comprehensive services. Inserting politics and singling out certain health services and care runs contrary to the humanitarian mandate to save lives and alleviate suffering.

Ensuring the rights and needs of women and girls are met from the very onset of an emergency has been neglected for far too long. The Women's Refugee Commission’s (WRC’s) 1994 landmark report “Refugee Women and Reproductive Health Care: Reassessing Priorities” found that in the majority of refugee settings, comprehensive reproductive health services were not provided.

Twenty-five years after the Beijing Declaration, which imagined a world where each woman and girl could exercise her freedom and choices, and 20 years after the adoption of UN Security Council Resolution 1325 on women, peace, and security, our patience is running thin. We cannot let COVID-19 serve as an excuse to turn back the clock on women and girls.

Every day, more than 500 women and girls in countries with emergency settings die during pregnancy and childbirth, mostly due to the absence of skilled birth attendants or lack of emergency obstetric procedures, as well as from complications of unsafe abortions. These deaths are entirely preventable and are the result of patriarchal policies and decisions that continue to treat women’s and girls’ reproductive care as optional.

The Inter-Agency Working Group on Reproductive Health in Crises, a unique coalition assembling humanitarian organizations, UN agencies, and civil society groups, hosted by WRC, developed the Minimum Initial Service Package (MISP) on sexual and reproductive health. In response to the letter by USAID, the IAWG stated: “The evidence is clear, the de-prioritization of SRH services during previous epidemics has led to stark increases in preventable suffering and death amongst girls and women in humanitarian settings.”

A recent study by WRC in Northeast Nigeria focusing specifically on family planning is a stark reminder of the urgency of providing comprehensive sexual and reproductive health care. WRC interviewed community members who stated that the Boko Haram insurgency increased their demand for contraceptives, yet they faced significant barriers to accessing these services. The consequences are high; the study notes that Nigeria has one of the highest maternal mortality ratios in the world at 814 deaths per 100,000 live births.

The COVID-19 crisis, which is already claiming lives and exacerbating existing inequalities, should prompt governments to promote access to life-saving health services, not exploit the pandemic to curtail them. This includes access to contraception, intrapartum care for all births, emergency obstetric and newborn care, safe abortion care, clinical care for rape survivors, and prevention and treatment for HIV and other sexually transmitted infections.

Governments and humanitarian actors have a choice: Continue to risk the lives and health of women and girls or learn from the lessons of Ebola by ensuring that one emergency doesn’t lead to another.