Taking stock of reproductive health in humanitarian settings: Preliminary findings from the global evaluation Sandra Krause Women’s Refugee Commission On behalf of the Inter-agency Working Group on Reproductive Health in Crises

Inter-agency Working Group (IAWG) on Reproductive Health in Crises 1994: Refugee Women and Reproductive Health Care: Reassessing Priorities. 1994: International Conference on Population and Development Programme of Action 1995: Formation of the IAWG on Reproductive Health (RH) in Crises

Inter-agency Working Group (IAWG) on Reproductive Health in Crises : First IAWG global evaluation of RH in humanitarian settings RH services were generally well established and consistent with pre-existing standards in stable refugee settings. Gender-based violence and HIV/AIDS services were comparatively weak. Services for internally displaced persons were severely lacking. Little information regarding the RH of populations in acute emergencies.

Global evaluation Literature review Institutional capacity assessment MISP assessment Jordan In-depth and service availability South Sudan, DRC, Burkina Faso SRH funding trends Health Information System (HIS) review and analysis

Preliminary findings: Progress Increased institutional capacity towards RH in humanitarian settings Improved policies. Increased dedicated guidelines and resources. Improved accountability to stakeholders. Increased investments in dedicated human and financial resources. Enhanced integration of disaster risk reduction in emergency management cycle.

Preliminary findings: Progress cont’d Increased RH programming in humanitarian settings Improved MISP response and comprehensiveness of clinical services. Expanded array of program delivery strategies. Increased number of emergency health and protection programs noting RH in humanitarian appeals.

Preliminary findings: Progress cont’d Increased funding for RH to conflict-affected settings overall Analysis of official development assistance (ODA) to 18 conflict-affected countries showed an increase of 298% in overall ODA for RH from This reflects a broader increases in overall ODA.

Preliminary findings: Gaps Reproductive health components Comprehensive abortion care Emergency obstetric care, including post- abortion care Long-term and permanent methods of contraception; emergency contraception Prevention of mother-to-child transmission of HIV Clinical care for survivors of sexual violence Cervical cancer screening and treatment

Preliminary findings: Gaps cont’d Quality of care Community perceptions of poor service quality. Lack of information about the benefits and availability of services. Challenges and delays to implementing comprehensive RH services. Discrepancies between NGO-supported and non-supported health facilities. Logistics and supply chain gaps.

Preliminary findings: Gaps cont’d Funding Over half (56.3%) of the 298% increase in total RH ODA disbursements was due to a substantial increase in HIV/AIDS funding. Average annual per capita ODA for RH activities to non-conflict-affected countries was 57% higher than to conflict-affected countries.

Recommendations Training and capacity development Improve capacity of Ministries of Health and NGOs. Strengthen engagement and collaboration of RH actors through the disaster planning and response cycle. Advance “task-sharing” to address human resource shortages.

Recommendations cont’d Implementation Improve information, education and communication among communities. Strengthen quality transition from MISP to comprehensive RH services. Strengthen RH supply chain management and resupply. Strengthen attention to RH in urban areas. Research agenda Dedicated and predictable funding for the IAWG on RH in Crises

Next steps Publish a series of articles in Conflict and Health (September 2014). Implement advocacy and communications campaign to disseminate findings and recommendations.

Acknowledgements IAWG Global Evaluation Steering Committee Agencies: Centers for Disease Control and Prevention Columbia University International Medical Corps Kings College London Marie Stopes International Medecins Sans Frontieres United Nations High Commissioner for Refugees United Nations Population Fund University of New South Wales Women’s Refugee Commission