Advancing reproductive health on the humanitarian agenda: the 2012-2014 global review

Introduction The global landscape for reproductive health in humanitarian settings has changed dramatically since the International Conference on Population and Development (ICPD) in 1994. Mainstreaming of reproductive health into humanitarian health responses has grown, and awareness of the consequences of neglecting reproductive health services, such as maternal and neonatal mortality, HIV transmission, and unsafe abortion, has expanded. Despite these advances, significant gaps remain, and meeting the reproductive health needs of crisis-affected communities is more urgent than ever: the United Nations High Commissioner for Refugees (UNHCR) reported that 51.2 million people remained forcibly displaced due to conflict and persecution by the end of 2013—the largest number since World War II 1. An additional 22 million were displaced in 2013 by natural disasters 2. Figure 1. A concentrated effort to address reproductive health in emergencies commenced in 1995 when a coalition of UN agencies, national and international nongovernmental organizations (NGOs), government agencies, donors, and academic institutions established the Inter-agency Working Group on Reproductive Health in Crises (IAWG), an international network dedicated to improving the reproductive health of communities affected by conflict and natural disaster. IAWG arose from a growing concern with the lack of attention to reproductive health, despite increasing evidence of its need in emergency settings 3. In its first decade, IAWG made large strides in advancing reproductive health through advocacy, research, standard setting, and guidance development, including the publication of the seminal Reproductive Health for Refugees: An Inter-agency Field Manual 4. The Field Manual was the first technical guidance on implementing reproductive health in emergencies and articulated a minimum standard in reproductive health service delivery—the Minimum Initial Service Package (MISP) for Reproductive Health. IAWG also supported the creation of the Interagency Reproductive Health Kits, twelve kits of essential medicines and supplies, to support rapid implementation of the MISP 5. By the early 2000s, IAWG and its partners—including the Reproductive Health Response in Crises (RHRC) Consortium—had achieved substantial gains. A 1999 study documented an increase in evidence, funding, policies, conferences, and new NGOs addressing reproductive health in emergencies, reflecting marked progress in advancing reproductive health on the global humanitarian agenda 6. From 2002 to 2004, IAWG undertook its first global evaluation to assess progress 7. The findings confirmed advancements at the policy and implementation levels since the mid-90s, but significant gaps continued across all technical areas, specifically maternal and newborn health, family planning, gender-based violence, and HIV and other sexually transmitted infections (STIs). IAWG’s second decade, from 2004 to 2014, saw the maturation of the coalition and further advancements to institutionalize reproductive health into humanitarian health responses and improve access to services. Members successfully advocated integrating the MISP as a minimum health standard in the 2004 and 2011 revisions of the Sphere Humanitarian Charter and Minimum Standards in Disaster Response and the Inter-Agency Standing Committee Health Cluster Guide8,9. Through IAWG’s advocacy, the MISP was included as a life-saving activity eligible for Central Emergency Response Fund funding 10. In 2009, led by the World Health Organization (WHO) and UN Population Fund (UNFPA), IAWG and partners drafted the Granada Consensus on Sexual and Reproductive Health during Protracted Crises and Recovery, which reaffirmed comprehensive reproductive health as a right in protracted settings and fragile states 11. The following year IAWG released an updated field-test version of the Field Manual, which included an extra chapter dedicated to comprehensive abortion care—a particularly neglected area in reproductive health service provision— as well as outlined additional priority activities to the Correspondence: sc2250@caa.columbia.edu University of New South Wales, High St, Kensington, NSW 2052, Australia Chynoweth Conflict and Health 2015, 9(Suppl 1):I1 http://www.conflictandhealth.com/content/9/S1/I1