As more countries descend into fragility and conflict, and natural disasters grow in scale, aid groups are increasingly underlining the importance of including family planning services in emergency response.
For instance, mothers who've just experienced a calamity like Typhoon Haiyan in the Philippines, or Syrians living in refugee camps in Lebanon, often seek contraceptives to avoid becoming pregnant in such dire circumstances, according to Carolyn Miles, CEO of Save the Children.
"It's not that they don't want to later have children, but they certainly don't want to at that point in time,” Miles said during an interview with Devex following the launch of the organization's annual Mothers' Index last week. “And as a mother I can totally understand that, having visited with them and seeing the conditions they are living in are very, very tough.”
Miles shares with us the challenges of providing basic health care in the onset of an emergency — and sustaining it long after — and why making family planning services available to women in emergencies and long-term crises is crucial to preventing even more problems in the recovery and rehabilitation phase.
Here are some excerpts from our conversation:
What do you find is the most neglected issue in emergencies?
We talk about women and children first in emergencies, but looks like sometimes they are last. Maternal health care is one of the biggest needs. As I saw in Tacloban, we saw it before the emergency in terms of that area not having enough health care for moms before the emergency, but then when you have a natural disaster, like you had in Tacloban, the typhoon and resulting water, it basically wipes out even whatever basic system that you have.
When I sat and talk with moms, that was one of the biggest things they say they needed, particularly pregnant mothers, but also mothers with very young children. The kids were getting sick, and they didn't have access to any medicines or any basic services. If it's an area where you already have a very weak health system, then it just gets exacerbated.
I remember in Haiti, after the earthquake, I saw this same thing. Haiti's health system is far poor than the Philippines' health system, and there, it was really difficult to get health services back up and running. Many, many NGOs were doing that right after the earthquake.
It seems like sometimes, it takes an emergency for some quality health care to reach a particular area. Would you agree?
I think that's very true. I certainly saw that, as I said in Haiti, where we were working in the hardest-hit areas that were impacted by the earthquake, and it's actually outside of Port-au-Prince. They really did not have basic health services before, and we were doing clinics and mobile vans, and things like that. And a lot of women were telling us that they started to access much more health care when [the earthquake] happened.
One of the things that Save the Children tries to do in those cases, and we're doing the same thing in the Philippines, is if that's the case, we try to stay and get either the government, sometimes the private sector, to take those up, so that those moms, who are experiencing good quality - this is not great quality, but good quality - health care for the first time is sustained. In the case of Haiti, for example, the government and some private sector providers of health care were able to take over some of those clinics. So you're right. I think you definitely see those cases happen.
The real challenge is can you get those health services taken up and sustained? Because Save the Children will not be able to stay there and run health clinics forever. But hopefully the government or private sector will be able to do that to provide those health services.
One of the recommendations in this year's index was the inclusion of reproductive health services in emergency response. What are you specifically proposing here?
It's really just access to basic family planning services.
I remember sitting with a group of moms in Lebanon, who were refugees from Syria. Mothers don't want to bring their children into that kind of world, right? Most of these women have kids already, and they don't want to have another child in that situation. They are living in tents, they are living in a field, they are living in very difficult circumstances. So they do want to have access to contraceptives, and that is something that we believe is good for the mother and the other children and the child ... It's not that they don't want to later have children, but they certainly don't want to at that point in time. As a mother I can totally understand that, having visited with them and seeing the conditions they are living in are very, very tough.
We do provide access to those services, typically Save the Children is not handing out contraceptives, but we are making sure that those services are available for women, particularly for mothers.
But how do you promote this in a conservative society, where you may not get the necessary support from the government or local leaders because of their religious beliefs or political stance?
Lebanon is a good example. We do work with the government and make sure they understand what we're doing, and in that particular case, we haven't had any issues with providing access to [family planning services] and people do understand. In a place like the Philippines, again a very conservative society, I do think that in the case of emergencies and disasters, we found a lot of understanding, not just from the government, but the local leaders, the religious leaders, and we do try to enlist the help of people in those communities to understand what we're doing and to understand why we're doing it, and to be supportive, and typically, that does happen.
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