Sexual and Reproductive Health Care in Humanitarian Crises
Handa Center Research Fellow Sarah Chynoweth co-authored a correspondence in The Lancet titled, “Implementing sexual and reproductive health care in humanitarian crises.”
The correspondence states:
We applaud the call made by Karl Blanchet and colleagues (Nov 18, 2017, p 2287)1 for more systematic and rigorous research on health interventions in humanitarian settings. However, we wish to highlight a key concern that the authors did not directly address in their paper: humanitarian health actors' insufficient application of existing evidence, particularly with regard to sexual and reproductive health.
Although good quality research on humanitarian health interventions is indeed scarce, some evidence does exist. Three examples illustrate this point. First, the provision of long-acting reversible contraceptives is feasible in humanitarian crises, and evidence shows that when good quality contraceptive services (including these long-acting contraceptives) are offered in such settings, women will use them.2, 3, 4 Yet humanitarian health providers often only offer short-acting methods or none at all.5, 6 Second, death in the neonatal period—the first 28 days of life—is the main cause of mortality for children under 5 years of age, and countries affected by conflict and instability suffer the highest neonatal mortality.7, 8 There are cost-effective, evidence-based interventions that can be delivered at the lowest health-care level; however, these interventions are rarely available in crisis settings.9 Third, we know that women and men are targeted for sexual violence in many conflict settings,10 with an estimated one in five women in complex emergencies having suffered sexual violence.11 Clinical management of rape is a minimum standard in the delivery of humanitarian health services, as set forth in guidance from the Inter-Agency Standing Committee12 and WHO.13Nevertheless, implementation of this life-saving care remains on an ad-hoc basis,5 even in settings where ample evidence exists that sexual violence is widespread, such as in the eastern Democratic Republic of the Congo.6
Further research and innovation relating to health in humanitarian crises are needed; however, research and innovation alone are insufficient to meet the health needs of crisis-affected populations. It is important that humanitarian actors apply existing evidence to reduce preventable mortality and morbidity, and to promote wellbeing. During humanitarian crises, donors, aid agencies, and ministries of health should prioritise and reinforce the application of the highest standard of health care, including for sexual and reproductive health. We already know that these interventions save lives and are feasible in humanitarian settings—now we must systematically use this evidence.