Service Priorities

Comprehensive Reproductive Health Care

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"Comprehensive Reproductive health care is defined as the constellation of methods, techniques and services that contribute to reproductive health and well-being by preventing and solving reproductive health problems. It also includes sexual health, the purpose of which is the enhancement of life and personal relations, and not merely counselling and care related to reproduction and sexually transmitted diseases." - International Conference on Population and Development (ICPD) Programme of Action¹

Health and development organisations worldwide have recognised the critical importance of global reproductive health for all people.

These views have been highlighted in intergovernmental consensus documents including the 1994 ICPD Programme of Action, the United Nations (UN) 2005 World Summit proceedings and the 2006 Maputo Plan of Action.² The UN Millennium Development Goals (MDGs) also address RH as a vital building block towards improving maternal health, achieving gender equality, promoting the autonomy of women, reducing child mortality and eradicating poverty.³

In addition, multiple UN agencies and other leaders in humanitarian and global health have highlighted the importance of RH for refugees and internally displaced persons (IDPs).⁴

In humanitarian emergencies, RH services are often limited and, in some cases, non-existent.

The consequences of insufficient RH care in emergencies may include:

Unplanned and unintended pregnancies due to lack of family planning, including emergency contraception
Death and permanent disability of women and girls due to lack of emergency obstetric care (EmOC) in response to complications of pregnancy and childbirth
Life-threatening complications from unsafe abortions, which are due to unplanned and unintended pregnancies, compounded by lack of post-abortion care (PAC)
Risk of HIV infection and other sexually transmitted infections (STIs) due to lack of condoms and condom education
Lack of response for gender-based violence (GBV): the use of rape as a weapon of war; the coercion of women and girls to provide sex in exchange for basic necessities; and the risk of attacks on women and girls who must travel long distances for firewood and other supplies

While these risks make a powerful case for RH services in emergencies, such services have not traditionally been an element of humanitarian response programmes, and most programmes for RH service provision have not included protocols for refugees and IDPs.

Cooperation across sectors is crucial to ensuring that displaced populations receive the standard of RH care to which all people are entitled.

Priorities for Action

While some elements of comprehensive RH care have been included in humanitarian responses, the whole range of services must be made available in emergencies.

For RH care to be truly comprehensive, it is critical that all of the following elements are implemented at the earliest possible opportunity:

EmOC, both basic and comprehensive, including PAC
Comprehensive family planning, including long-term, permanent and emergency contraception
HIV prevention and medical services; STI prevention and treatment
Prevention of all forms of GBV and medical, psychosocial and legal response services for survivors

Facts and Figures

Data on 18 countries in sub-Saharan Africa, the region of the world with the highest concentration of humanitarian emergencies, show that at any one time, roughly 6 - 14% of women and girls from 15 to 49 will be pregnant;⁵ as in any population, 15% of these pregnancies will result in unforeseen complications⁶
The risk of dying from pregnancy or childbirth in sub-Saharan Africa is one in 16. Comparatively, the risk in developed countries is only about one in 2800⁷
There are 24.7 million people with HIV in sub-Saharan Africa⁸
80 - 90% of the global burden of STIs occurs in the developing world⁹
Reports on GBV in conflict detail rape involving profound brutality towards women and girls¹⁰

UNFPA (1994). "International Conference on Population and Development Programme of Action." Link
UNFPA (1994). "International Conference on Population and Development Programme of Action." Link, UN (2005). "Resolution adopted by the General Assembly: 60/1. 2005 World Summit Outcome." Link African Union (2006). "Maputo Plan of Action for the Operationalisation of the Continental Policy Framework for Sexual and Reproductive Health and Rights: 2007-2010." (Addis Ababa) Link
UN (2000). "United Nations Millennium Declaration." (New York) Link
UNFPA (1999). "Reproductive Health in Refugee Situations: An Inter-agency Field Manual." (Geneva) Link
Macro International Inc. (1995-2006). "Demographic and Health Surveys." Link
UNFPA (1999). "Reproductive Health in Refugee Situations: An Inter-agency Field Manual." (Geneva) Link
UNFPA. "Maternal Deaths Still Unacceptably High." Link
UNAIDS (2006). "UNAIDS/WHO AIDS Epidemic Update: December 2006." Link
WHO (2006). "Prevention and Control of Sexually Transmitted Infections: Draft Global Strategy." Link
Human Rights Watch (2002). "The War Within the War: Sexual violence against women and girls in Eastern Congo." (New York) Link

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