By Marcy Hersh, Women Deliver | Thomson Reuters Foundation | 2 October 2018
We must advocate harder than ever before to show that sexual and reproductive health services in emergencies are needed and long overdue
"We don’t need reproductive health services here," a government official told me at the Greece-Macedonia border in the fall of 2015 – then the epicenter of the European refugee crisis. Around us, tens of thousands of people had arrived, and were still arriving, to seek safe passage into Europe.
I had just told the official about one woman I met who went into labor on the side of the road the previous night. There were no skilled birth attendants, clean delivery kits, or emergency obstetricians to help her at the border, so she was taken to a hospital much further away. I told him it was unacceptable that these reproductive health services weren’t available where and when she needed them most – but the official reiterated that they just weren’t a priority.
As a long-time advocate for girls and women in emergencies, I wasn’t surprised – yet still infuriated – by the unacceptable dismissal of sexual and reproductive health services during humanitarian crises, including skilled maternal care, protection against gender-based violence, and access to contraception.
After working with refugees from Burundi, Sudan, Afghanistan, Iraq, and Syria, I’ve witnessed how girls and women with the ability to control and manage their fertility could build brighter futures, and power progress for their communities. Yet, more often than not, I’ve seen their health, rights, and wellbeing sidelined in humanitarian responses.
I was hopeful when, two years ago, global leaders met in New York to unanimously declare their commitment to create more dignified refugee responses, especially for girls and women.
The New York Declaration kicked off negotiations around a Global Compact on Refugees, and I joined advocates to highlight why sexual and reproductive health services must be prioritized as lifesaving interventions in every single emergency.
Our message was simple: to truly transform the way the world responds to protracted displacement situations – precisely what the Global Compact set out to do – girls and women must be at the center.
While gender equality and women’s empowerment are now listed as priorities in the draft Global Compact, political forces have – thus far – blocked the passage of all references to sexual and reproductive health services, including access to skilled birth attendants and newborn care, voluntary contraception, and safe abortion.
Reading between the lines, I hear the same explanation as from the Macedonian border official: “We don’t need reproductive health services here.” The Global Compact for Refugees will stop short of meeting the needs of refugee girls and women worldwide unless governments step up their advocacy before December, when it will be formally adopted by the UN General Assembly.
The clock is ticking – and we must all be more steadfast and unapologetic than ever in our push to demonstrate the importance of protecting women’s bodily autonomy everywhere, including in humanitarian settings. Other international frameworks can provide helpful guidance on how a gender lens can strengthen the Global Compact on Refugees.
For example, more than 20 UN agencies and international NGOs just completed crucial updates to the Inter-Agency Field Manual, which provides authoritative guidance on how to provide reproductive health services at every stage of any humanitarian emergency.
Set to be released this fall, the revised Inter-Agency Field Manual will include stronger guidance on how to fill often-overlooked service gaps for refugee girls and women, such as skilled attendance at birth, clinical care for survivors of sexual assault, safe abortion care, HIV/STI testing and treatment, and voluntary modern contraceptives.
It also includes country success stories that show how focusing on women’s health and implementing quality sexual and reproductive health services is feasible and successful, even in the most complex environments. The Global Compact on Refugees could also get inspired from the Call to Action on Protection from Gender-Based Violence in Emergencies, a groundbreaking partnership which includes commitments from over eighty countries and NGOs to transform how gender-based violence is addressed in humanitarian emergencies.
Together, this movement fosters accountability so that every humanitarian effort, starting from the earliest stage of a crisis, protects and supports refugee girls and women who are most vulnerable to gender-based violence.
When backed by bold action, these initiatives can drive real progress for refugee girls, women, and their communities. If all girls and women had access to modern contraceptives and the full range of maternal and newborn health services, maternal death would drop roughly 73 percent, and newborn deaths would be reduced by about 80 percent.
The evidence speaks for itself: give girls and women access to healthcare – including comprehensive sexual and reproductive health services – and they will deliver more resilient families and societies during crises and well beyond. As humanitarians, we don’t accept when misguided border officials tell us that the reproductive needs of refugee girls and women don’t matter – so we can’t accept when the Global Compact for Refugees says the same.
Instead, we advocate harder than ever before to show that sexual and reproductive health services in emergencies are needed, are wanted, and are long overdue.
Marcy Hersh is the Senior Manager for Humanitarian Advocacy at Women Deliver, an advocacy organization for gender equality and the health, rights, and wellbeing of girls and women.