Courage in a crisis
How do you give birth in a refugee camp?
How do you stay safe from further harm?
How do you rebuild your life?
The APGPD hosted a round-table meeting with key agencies responding to humanitarian crises. Their presentations focused on maternal health, gender-based violence and gender inequality. Among their key points, they stressed:
During a crisis, the provision of sexual and reproductive health care is life saving and empowering. When we uphold this right – both in times of peace and stability as well as times of crisis – individuals and communities thrive.
Crises affect women, men, boys and girls differently. Because crises exacerbate pre-existing gender-inequalities, women and girls are often disproportionately affected. For example, all forms of gender-based violence increase during conflict, disasters and displacement, and maternal mortality spikes. Two-thirds of the world’s preventable maternal deaths occur in such crises; and up to 70 per cent of women have experienced gender-based violence in some crises.
Humanitarian assistance is more effective, fair and transformative when it includes women and girls and those most excluded. This means incorporating their specific needs into humanitarian response programs – such as reproductive health programs and activities to prevent and respond to violence. It also means including women and girls as participants and partners in the design and delivery of humanitarian assistance. Women and girls are not just survivors – they are humanitarians. When we recognise, use and expand everyone’s experience, knowledge and skills –including the most marginalised, we help lay stronger foundations on which everyone can rebuild.
The five agencies called for Australia to continue to be at the forefront of globally championing women’s and girls’ empowerment. This requires increasing investment in our humanitarian assistance efforts, and increasing funding for sexual and reproductive health and gender-based violence programs.
CARE Australia’s CEO, Sally Moyle, opened with an introduction on how crises affect women, men, boys and girls differently. The way people’s gender influences their roles, their experiences, their relationships, and their rights significantly affects their lives. This is especially true of sexual and reproductive health and gender-based violence. At the very least, we need to be sensitive to gendered needs and experiences and respond to them. We can also aspire to transform some of the harmful gender norms that perpetuate inequality, discrimination and injustice.
For example, CARE’s work in the refugee camps in Cox’s Bazar includes establishing safe spaces for women and children to come together, talk, share experiences, support each other and access useful services. Beyond providing a good or service, such as dignity kits and psychosocial support, these spaces support women to help each other and question unfair gendered roles and expectations. In Cox’s Bazar, CARE also approaches men in teashops, meeting them where they are.
The Chief of the International Planned Parenthood Federation’s Australia and New Zealand Office, Johanna Wicks, spoke of the achievements of Australian Aid in supporting live-saving sexual and reproductive health and rights services in crisis and post-crisis situations across the Asia-Pacific Region.
This includes responding to Tropical Cyclone Gita, the most intense cyclone to hit Tonga since reliable records began. IPPF supported Tonga Family Health to provide sexual and reproductive health services, including cervical cancer screenings, and dignity kits, as well as awareness sessions on gender-based violence, disability, and sexual rights. Many women accessed contraceptives and family planning advice for the very first time, ‘and that can be life-changing’.
Marie Stopes International Australia’s Executive Officer, Chris Turner, spoke of the lessons the organisation has learned from its work in fragile states. Different contexts require different services and delivery approaches.
Marie Stopes has been working in Yemen for example since 1996. It has adapted its activities to reaching internally displaced people living in informal settlements, where often there is no access to safe water sanitation, health care, or education. Marie Stopes delivers its sexual and reproductive health services through mobile outreach and equips its teams to provide clean drinking water and wider primary health services. Meanwhile in Afghanistan, it has a network of female midwives working in their communities to deliver high-quality contraception services door-to door. In Cox’s Bazar, the organisation has recently launched two mobile health teams and is working towards partnering with local organisations.
Plan’s research found adolescent girls did not have much information on sexual and reproductive health issues, including menstrual hygiene, relationships, contraception, and pregnancy – in part due to stigma and negative community attitudes. There was a lack of youth focused health services and barriers to accessing education (including child marriage). Teenage pregnancy was very high, which is particular concerning as pregnancy and birth related complications are the leading cause of death for 15-19 year old girls, and their babies are 50 per cent more likely to be stillborn or die in the first few weeks after birth.
‘When adolescent girls around the globe are able to make choices about when they get pregnant, when they are able to protect themselves from HIV and sexually transmitted infections, and when they are able to stay safe and healthy during their pregnancy and child birth, they have the best chance of transition to adulthood as happy, healthy and empowered young women.’
The Head of Save the Children’s Emergency Health Unit, Dr Unni Krishnan, shared harrowing stories from his work in Cox’s Bazar. The United Nations estimates that over 50,000 children will be born in Cox’s Bazar by the end of 2018– the largest and most crowded refugee camp in the world. Many of these pregnancies are the result of sexual violence.
Save the Children is operating nine health clinics and a primary healthcare centre. It is seeing a high number of women and girls seeking sexual and reproductive health services –just over half are seeking antenatal care, about a third are seeking family planning and just under a fifth are seeking post-natal care. Adolescent girls (aged 15-19) make up nearly a third of those seeking contraception, and a quarter of those seeking antenatal care.
All agencies underlined the impact that sexual and reproductive health services has in saving and transforming lives. This is true in the relatively peaceful development context as well as the urgency of a humanitarian crisis. The more these agencies can do to save and transform lives, the better the future we can all share in.