Opinion: How to improve sexual and reproductive health care in conflict zones

This year has thrown crisis after crisis at a world already struggling with the impacts of the COVID-19 pandemic. From the escalation of violence in Gaza to the ongoing civil war in Tigray, and the rapid fall of Afghanistan just a few weeks ago, this turbulent year has seen subsequent crises in a world already struggling with the impacts of the pandemic.

Conflicts, war, and situations of political instability exacerbate existing inequalities — with women, girls and marginalized groups suffering disproportionately — not only due to the conflict itself, but from a lack of access to basic sanitation and health care facilities, as well as the increased risk of sexual violence, gender-based violence, early marriage, and human trafficking.

With an increasing number of people living in conflict-affected areas — nearly 100 million people — combined with the ongoing COVID-19 pandemic, 2021 has continued to highlight the importance of well-maintained health infrastructure and trained health care workers, including access to high-quality sexual and reproductive health care.

When attacks escalated in the protracted conflict zone of Gaza earlier this year, an estimated four women per household needed reproductive health care, and an estimated 87,000 women in the Gaza Strip and nearby areas were pregnant. The International Planned Parenthood Federation’s humanitarian response outreach involved visiting families to offer contraceptive advice and services, as well as maternity care.

Such responses are critical to improving sexual and reproductive health care in conflict zones. To include sexual and reproductive health care in their responses, here are five approaches governments, along with development and humanitarian experts should take:

1. Put women and girls first by prioritizing sexual and reproductive health care

Too often, sexual and reproductive health care is an afterthought in conflict situations, with other basic necessities and essential services taking precedence. But women and girls are disproportionately affected by reproductive health issues in conflict zones, with three in five preventable maternal deaths occurring in conflict, displacement, and natural disasters and one in five women likely to be pregnant during a crisis.

Women and girls are also more often left behind in ensuing evacuation efforts due to the burden of caring responsibilities, patriarchal and cultural beliefs, and the fact they are often already the most vulnerable in affected communities.

Without access to sexual and reproductive health care, women and girls are likely to suffer severe consequences from lack of care, including high rates of sexually transmitted infections, unintended pregnancy, unsafe abortion, miscarriage, premature labour, unassisted deliveries, and even death.

By prioritizing sexual and reproductive health care in international and local responses to conflict, providing adequate and dedicated aid funding, and plugging critical gaps in care with gender-sensitive solutions, governments can ensure women and girls focus on their health first.

2. Provide integrated health care

Not only do unplanned pregnancy rates increase exponentially in humanitarian settings, but a staggering 70% of women are likely to experience gender-based violence, alongside increased transmission rates of STIs, increases in unsafe abortions, and heightened mental health issues.

Contraceptive care in conflict zones is often an entry point for women, girls, and their families into health care systems. In Gaza, support by the Palestinian Family Planning and Protection Association isn't just about providing contraception but also comprehensive care packages including primary health care, sexual health care, mental health help, COVID-19 care, access to legal counsellors, and extended support for women's families.

For children, who account for nearly 50% of the population in Gaza, youth volunteers from the PFPPA provided much-needed entertainment and psychological support while family members received care. By providing a package of integrated care solutions in disrupted health systems, rather than focusing on individual services, response teams are likely to see better outcomes.

3. Include comprehensive sexuality education

The right to education takes a significant hit in times of crisis, and adolescent girls in conflict zones are 90% more likely to be out of school. Not going to school increases the possibility that girls will become vulnerable to various types of violence, such as child marriage, and increases the risk of unplanned pregnancies among teenagers and young women.

But a good education isn't just about going to school, and the inclusion of comprehensive sexuality education, which teaches young women and their communities about consent, contraception, and unintended pregnancy, is just as important as schoolbooks.

CSE is also shown to lower the chance of child marriage and increase contraception uptake, allowing girls to focus on themselves first. Providing CSE in long-term humanitarian response plans to protracted crises, such as conflicts, offers a sustainable solution to misinformation and taboos around sexuality amongst the community.

4. Build a community around access to sexual and reproductive health care

IPPF is locally owned and globally-connected, and having local people work with the community makes a huge difference when providing sexual and reproductive health care in conflict zones.

While using contraception is an individual choice, engaging community leaders and trusted local staff members helps build strong relationships between providers and communities, as well as within communities themselves, and helps to engage those on the fringes of already marginalized groups. Locally-owned services also retain the agency of communities, ensuring that the people providing care are the people who know the community best — a fundamental need in chaotic situations like conflict.

5. Remember that each conflict zone is different

While it's tempting to take a one size fits all approach to humanitarian responses, technical experts must remember that with each conflict comes different challenges, different burdens, and different solutions.

And just like those living in non-conflict situations, every woman and girl's stories and needs are different. Conflict zones require tailored, specific, and dignified humanitarian responses created through an intersectional lens and co-designed with local partners. Conflict-related humanitarian responses are a unique opportunity to provide long-term solutions for women and girls’ sexual and reproductive health.