Opinion: The long road to addressing sexual and reproductive health needs of Rohingya refugees

A health worker assesses patients during a door-to-door visit in Kutupalong, Cox's Bazar. Photo by: Kamrul Hasan / BRAC / CC BY-NC

In a brightly decorated women-friendly center at the Kutupalong Extension camp in Lambasia, about an hour’s drive north of Cox’s Bazar in southern Bangladesh, Rohingya refugee women and girls of all ages gathered in a semi-circle around a staff member leading a group discussion.  

Some women had babies resting in their laps and some were talkative, while others sat quietly, with expressions of anger, despondency, and despair.

Many had come seeking answers about what can be done to protect themselves while living in the camp’s temporary shelters and how to prepare for the impending monsoon season. While it had not rained heavily since August 2017, when the violence in Northern Rakhine State began forcing hundreds of thousands of Rohingya to seek safety in Bangladesh, the women understood the grave danger of monsoon season. Heavy rains can take an already precarious situation from bad to significantly worse.

My colleagues from the Women’s Refugee Commission and I had the opportunity to visit Cox’s Bazar at the invitation of the United Nations Population Fund, which supports the local women’s center. We were there to support health responders in providing lifesaving, quality sexual and reproductive health services through a review of existing tools, training materials, and guidelines.

While the crisis is unrelenting — the number of Rohingya who have sought safety in Bangladesh has surged by nearly 700,000 since August 2017 — I was encouraged by what we observed during our brief visit. Namely, there has been a tremendous effort on the part of the national government, U.N. agencies, and both national and international nongovernmental organizations to address the enormous needs of the Rohingya refugees, including health, protection, shelter, water and sanitation, psychosocial, and other concerns.

In humanitarian crises, sexual and reproductive health services become both an extraordinary challenge, as well as a lifesaving need. Of the 129 million people around the world who require humanitarian assistance, approximately one-quarter are women and adolescent girls of reproductive age. Neglecting reproductive health in a humanitarian setting can have dire consequences, including increases in mortality and morbidity, sexually transmitted infections, unintended pregnancies, and unsafe abortions, among other risks.

Fortunately, there is already evidence-based guidance on sexual and reproductive health that has become the standard of care in humanitarian situations. Known as the Minimum Initial Services Package, or MISP, this guidance was developed in the late 1990s by the Inter-agency Working Group on Reproductive Health in Crisis, a multi-agency coalition hosted by the Women’s Refugee Commission.

UNFPA and partners have made implementing this protocol an immediate priority — and have seen important progress. From the earliest days of the response in Bangladesh, UNFPA has provided critical trainings in sexual and reproductive health care, including for health workers caring for survivors of sexual violence, and establishing emergency obstetric and newborn care services and referral mechanisms, with the aim of reducing maternal illness, disability, and early deaths.

An estimated 22 percent of pregnant Rohingya women and adolescent girls give birth in health facilities. To increase safe deliveries, these humanitarian organizations began offering incentives — such as transportation vouchers, solar lanterns, and “mama packs” that include clean blankets and newborn hats — to encourage women to access safe deliveries at health facilities, and clean delivery supplies for those who deliver at home.

Demonstrating the important intersection between humanitarian and development work, UNFPA and its partners also deployed graduates of its midwife training program, which began in Bangladesh in 2010, to refugee and host communities to improve coverage for safe deliveries at health facilities.

As part of efforts to address the high levels of sexual violence associated with the conflict in Rakhine State and throughout displacement, UNFPA extended its partnership in Bangladesh with the global nongovernmental organization Ipas to address the needs of women and girls to access safe abortion care. These partners have also worked to ensure the availability of a full range of contraceptive methods to meet the immense demand they have found among Rohingya women and girls.

These extraordinary efforts demonstrate the power and potential of health providers working in tandem with partners to address the sexual and reproductive health needs of the expanding Rohingya population in the face of many obstacles. Building on this work to improve both the coverage and quality of these services, including for adolescents and marginalized populations, will require significant dedicated support from donors and implementing agencies.

As we left the women’s center in Cox’s Bazar, a group of girls began to play jump rope in the outdoor entry space of the confined compound, laughing and enjoying themselves. At the same time, a group of boys gathered on the other side of the wall, drawn close by curiosity and the sounds of laughter.

Just then, a woman turned to us with her arms uplifted toward the sky, a simple gesture that reminded us of the fast-approaching monsoons.

Left with this impression of hope juxtaposed with despair, our visit to Cox’s Bazar reinforced our appreciation for the remarkable sexual and reproductive health care response to date, the need to scale up these exemplary efforts, and a deeper understanding of the long and difficult road ahead.

About the author

  • Sandr

    Sandra Krause

    Sandra Krause is the reproductive health program director at the Women's Refugee Commission, where she provides strategic direction on sexual and reproductive health advocacy and research. She has been active in the public health arena for 25 years, 20 of which have been devoted to international health working in various regions including Thailand, Haiti, Colombia, and Croatia, as well as numerous countries in sub-Saharan Africa. Sandra has conducted reproductive health needs assessments in multiple emergency settings. She has established health programs for refugees and internally displaced persons in Somalia, Sudan, and Malawi, where she was a country director. Sandra established the health unit and worked as the international health advisor for six years at the headquarters of a leading humanitarian response agency.