The World Health Organization (WHO) says it is crucial for women to have access to quality health care throughout their pregnancy, childbirth and postpartum period and overall life course at any time and in any place, including humanitarian and crisis settings. Enabling environments that are rights-based, equitable and legally protective can help ensure quality health care is available to women and girls.
Last month, Rajat Khosla, a trained lawyer and Human Rights Adviser in Sexual and Reproductive Health and Rights (SRHR) at the WHO, gave a compelling presentation about sexual and reproductive health, and the value of maternal death surveillance and response (MDSR) data and systems in crisis settings, at a seminar we co-organised at the London School of Hygiene and Tropical Medicine (LSHTM). Watch the live recording here.
What we know:
- In 2015, the displaced population of around 65 million was equivalent to the size of the population in France.
- Half of the population of displaced persons is children and 26 million are women and girls with reproductive health needs (based on UNHCR and UNFPA data, respectively).
- Women and adolescent girls are especially vulnerable during crises to “exclusion, marginalisation and exploitation, including sexual and gender-based violence”.
As Rajat Khosla tells us, there is a clear gap in funding for SRHR noted in a review by the Inter-agency Working Group on Reproductive Health in Crises, and lack of evidence from “high-quality evaluation studies” identified by LSHTM, the Harvard School of Public Health and the Overseas Development Institute.
“What crises do is expose the extant weaknesses to provide […] services, especially services that are needed by women and children. The low resilience of health systems combined by poor data quality in emergencies, hinders the design and implementation of interventions” – Rajat Khosla
He discusses a few examples of recent crises where SRHR is increasingly gaining recognition. Ebola exposed the vulnerability of women and girls to be able to access health care services in “a system that was already broken”. When infrastructure collapsed in Nepal as a result of the earthquake, “one of the first casualties was the ability of the system to provide emergency and basic obstetric care services”.
In his presentation, Rajat Khosla recognises the gaps in data and monitoring. Civil registration and vital statistic systems do not report data on non-citizens (e.g. people living in relief camps):
“The host countries expect the home countries to be reporting on that data so we […] don’t know in terms of live births [and] mortality, what is happening to those large population places”. – Rajat Khosla
In a recent summary of perinatal deaths in South Africa, Dr Natasha R Rhoda – Senior Neonatal Consultant at Groote Schuur Hospital in Cape Town and the chairperson of the National Perinatal Mortality and Morbidity Committee in South Africa – similarly comments that unregistered stillbirths or infant deaths are not counted where immigrant populations displaced from neighbouring countries are growing. This is an important factor that merits recognition.
More credible systems of data monitoring are needed in crisis settings where women and adolescent girls face high risks to their health and well being.
To download the seminar presentation, click here.
Acknowledgements: This blog was written by Jenna de St. Jorre, Evidence for Action-MamaYe Technical Assistant at Options.