Reproductive Health and Access to Information Services in Emergencies

The Reproductive Health and Access to Information Services in Emergencies Programme is a major new initiative that will change how reproductive health (RH) is addressed within relief organisations, field services and global decision making.

Developed by Columbia University's Heilbrunn Department of Population and Family Health in the Mailman School of Public Health and Marie Stopes International (MSI), the RAISE Programme aims to ensure that the full range of RH needs of IDP and refugees are addressed.

The goal of the RAISE Programme is to ensure that good quality comprehensive RH services are routinely provided to those in humanitarian crises. RH care should be recognised as a necessity for populations in crisis, just as food, water, sanitation, shelter, protection and basic health care are accepted as primary needs.

Launched in 2006, the RAISE Programme is working in countries including Colombia, the Democratic Republic of Congo, Sudan and Uganda. Programme partners include major relief organisations such as IRC, CARE, UN bodies, advocacy agencies and academic institutions.

The RAISE Programme comprises critical services, including:

. Emergency obstetric care: basic and comprehensive emergency obstetric care, including post-abortion care,
. Family planning: all methods, including long-term and permanent, and emergency contraception,
. Sexually transmitted infections: prevention and treatment,
. HIV/AIDS: prevention, voluntary counselling and testing, prevention of mother-to-child transmission and referral,
. Gender-based violence: medical response and referral.

The RAISE Programme is implementing these services through:

. Technical assistance and support to partners: RAISE provides assistance to partners to support programme development, identify training needs, carry out monitoring and evaluation activities, identify opportunities for collaboration, and coordinate research,
. Clinical Training: RAISE combines on-site training with clinical training at the MSI reproductive health centre in Nairobi to build the clinical skills of partners.
. Research: In collaboration with leading research institutions, RAISE will identify research priorities and develop a programme of operations research. The findings will further strengthen the evidence base relevant to RH needs in crisis settings.
. Emergency fund: RAISE manages a fund to enable rapid response to RH needs in emergencies, including natural disasters.
. Advocacy: RAISE will facilitate widespread support for comprehensive RH in crises. RAISE works with UN agencies, international bodies and humanitarian agencies, governments and private donors to influence the policy and funding environment.

Sexual Reproductive Healthcare: the case for comprehensive provision in humanitarian crises

Reproductive ill-health comprises one-third of the total global burden of disease for women and one-fifth for women and men combined. Together with the HIV/AIDS crisis and the 10 million women who die or are permanently injured due to complications in pregnancy every year, these figures illustrate the importance of sexual reproductive health (SRH).

The need for SRH care does not diminish for those forcibly displaced by conflict and natural disaster. Displacement may bring hardship and trauma that intensify a woman's need to control her own fertility. It may also bring an increased risk of gender-based violence, as witnessed in Darfur and other conflict settings.

Displaced also separates millions of IDP and refugees from SRH services. National health programmes are typically designed to address the health needs of the settled, stable population. This means that development assistance in the form of budget support and SWAPs fails to reach displaced populations.

Instead, refugees and IDP are supported through humanitarian programmes but at present, these pay inadequate attention to SRH needs. This leaves displaced people vulnerable to STI including HIV/AIDS and without safe means of preventing pregnancy. Pregnant women in refugee camps are frequently left without adequate access to pre- and post-natal care or to assistance in delivery and emergency obstetric care needs are particularly underserved. Victims of gender-based violence lack access to appropriate health-care and emergency contraception.

These health risks are serious, often life-threatening, but preventable. Displacement need not be an obstacle to quality SRH care, as demonstrated by MSI's own experience of providing SRH services in humanitarian settings. The CRHC Programme is building upon this and others' experience to spread expertise in delivering comprehensive reproductive health services in humanitarian crises.

In order to realise a global humanitarian system that routinely provides comprehensive reproductive healthcare to people in humanitarian crises, the CRHC Programme is looking to expand and develop its partnership.

Donors, UN agencies and NGOs can:

. Lead the policy environment by raising awareness of the need to better address SRH in humanitarian crises,
. Change the funding environment by allocating new resources for SRH programmes in humanitarian settings,
. Advocate to UN agencies and other donors for a more comprehensive approach to SRH in emergencies.

Relief agencies can:

Explore ways of developing technical expertise in the provision of SRH services such as joining the CRHC Programme.

For further information on CRHC please contact:

London: Leo Bryant,
Brussels: Lydia Ettema,
New York: Janet Butler-McPhee,