Abridged version of CR "Sexual Reproductive Health During and Post Crisis. Experiences; Examples"

Moderator’s Note: Dear Members, Please find an abridged summary of the query on Sexual Reproductive Health During and Post Crisis. Experiences; Examples. This abridged version of the summary will be shared with CSO participant attending the WCDRR at Sendai, Japan. Sincere thanks to all members who shared their experiences and for supporting the initiative.

The PDF Version of this Consolidated Reply can be downloaded at

http://solutionexchange-un.net.in/ftp/drm/cr/WCDRR_SRH_150315.pdf

Disaster Management Community

Solution Exchange for the Disaster Management Community

FOR QUERY:  Sexual Reproductive Health During and Post Crisis. Experiences; Examples.

Compiled by G. Padmanabhan, Resource Person and Mahendra Rajaram, Moderator.  Issue Date: 15 March 2015.

From, Aditi Ghosh, Emergency Response Manager, SPRINT project, International Planned Parenthood Federation (IPPF). Posted on 09 March 2015

I work as Emergency Response Manager, in SPRINT project, which is an Initiative of International Planned Parenthood Federation (IPPF). IPPF is a global service provider and a leading advocate of sexual and reproductive health and rights for all. IPPF works in 172 countries to empower the most vulnerable women, men and young people to access life-saving services and programmes, and to live with dignity.

Sexual and Reproductive Health problems account for the leading cause of women’s ill health and death worldwide. Yet, almost all maternal deaths can be prevented. During humanitarian crisis, SRH needs increase significantly, because out of 51.2 million internally displaced people (IDP) in the world in 2013 (UNHCR), due to armed conflict and/or natural disaster, 75% – 80% are women, young people and children. The IDP women are at an increased risk of -Sexual violence; Higher STI/HIV transmission; Lack of contraceptives, which will in turn increase unwanted pregnancy; Malnutrition and epidemics due to risks of pregnancy complications; Childbirth occurs on the wayside during population movements; and Lack of access to emergency obstetric care increases risk of maternal death and disability.

Despite SRH importance, it is observed that SRH related issues don’t find place in Disaster Risk Reduction initiatives and in the post-crisis situations globally. Thus, SPRINT program was developed in order to address the current gap of SRH in crisis and post-crisis situations mostly through the implementation of the Minimum Initial Service Package (MISP) for SRH in crises.

The 3^rd World Conference on Disaster Risk Reduction at Sendai, Japan from 13^th to 18^th of March 2015, will be holding 34 working sessions on varied topics under DRR, 03 High level Partnership Dialogue meeting and 05 Ministerial Roundtable to adopt the post -2015 framework for DRR. Along with the main conference, number of international development organisations are holding side events (satellite sessions) to highlight issues and deliberate upon strategies and plan of action for the Post 2015 Framework of Action for Disaster Risk Reduction based on the Zero Draft Document.  

The Side Event (Satellite Session) initiated by SPRINT (International Planned Parenthood Federation) will be held on 16^th March 2015 at Sendai Civic Auditorium Room No:5 between 15.00 to 17.00 hours, on the topic “Why Address Sexual and Reproductive Health and Rights in Humanitarian Settings”. The session will debate and discuss the needs and challenges for Reproductive Health Services in humanitarian settings (pre, during and post crisis) and share some good practices across the globe through collaborative approach by SPRINT initiative. The session will be based on evidence based experiences and documentation. In the above context, seek inputs to the following:

·        Please share Experiences and Examples of DRR initiatives addressing SRH in crisis and post-crisis situations at the National, Regional and International levels.

·        What are needs and challenges of Sexual Reproductive Health During and Post Crisis

I look forward for the inputs and definitely shared during the sessions. For details about the session please click on http://www.wcdrr.org/conference/events/946 . Thanking in anticipation for the support and co-operation in sharing inputs.

Summary of Responses (Abridged Version):

The 3^rd World Conference on Disaster Risk Reduction at Sendai, Japan from 13^th to 18^th of March 2015, is holding series of Working Sessions, High level Partnership Dialogue meeting and Ministerial Roundtable to adopt the post -2015 framework for DRR. Many International NGOs are organising side events to high light DRR related issues, deliberate upon strategies and plan of action for the Post 2015 Framework for Disaster Risk Reduction.  One of the side event is initiated by SPRINT (International Planned Parenthood Federation) on 16^th March 2015 on the topic “Why Address Sexual and Reproductive Health and Rights in Humanitarian Settings”. This session will debate and discuss the needs and challenges for Sexual Reproductive Health Services in humanitarian settings (pre, during and post crisis). 

In this regard the Disaster Management Community of Practice, UNSE sought inputs from members on the above topic, so as to share the same during the side event and some of the members have shared important research study documents and insights that need to be analysed and considered.

The study of Swasti Health Resource Center   for Oxfam America was to understand whether and why the tsunami and its aftermath led to an increase in vulnerability to HIV, with the goal of helping aid providers and communities understand how to minimize the risks in future disasters. The study showed that majority of the communities were vulnerable to HIV infection rose after the tsunami, largely as a result of an increase in unprotected sex with non-regular partners. Risks that predated the disaster combined with trauma, unfamiliar living conditions, increased migration, and a host of other factors to create a spike in vulnerability in the immediate aftermath of the tsunami. To know more about the findings and recommendations please view the below links:

1. Oxfam America's Research brief on HIV AIDs and STD Issues after Tsunami in India.

http://www.oxfamamerica.org/static/oa3/files/reducing-vulnerability-to-hiv-before-and-after-disasters.pdf

2. Oxfam America and Swasti's toolkit on addressing sexual health issues after disasters

http://www.swasti.org/images/projects/toolsguidelines/Sexual%20Health%20in%20Humanitarian%20Emergency.pdf

The UNFPA in collaboration with NDMA has developed the MISP manual for the use of health workers and for other stakeholders. The manual was published in 2013 and can be referred at http://countryoffice.unfpa.org/india/drive/UNFPA_MinimumInitialServicePackageforSexualandReproductiveHealthDisasters(MISP)_Facili.pdf

It is observed that during the crisis the focus is more on life-saving activities and incorporation of SRH is still in the early phase, however efforts are underway to include SRH into DRR strategy. The MISP promoted by UN Agencies and International organisations are finding place in the DRR program. Collating some of the insights from various countries, the following can be considered for incorporating SRH during crisis and post crisis:  

·        The need to involve community based organizations and those working with vulnerable population during planning and preparedness activities.

·        Incorporation of SRH emergency preparedness and response into existing education platform such as in the schools of public health.

·        Development of contingency plan for different levels, scale and types of emergencies.

·        Ensuring accurate estimates of supplies such as RH kits, based on the estimated population at risk, availability of trained personnel and facilities.

·        Establishment of a good communication between the local government system and other stakeholders engaged in humanitarian crisis response.

·        It is also noted that due to lack of privacy for women to attend natures call, especially the pregnant women suffer a lot and in turn it impacts foetus resulting in birth of unhealthy child and women having other health complications.

Hence, Disaster Risk Reduction programs need to address SRH, as it will provide range of positive outcomes including reduction in maternal deaths, unintended pregnancies, the risk of acquiring sexually transmitted infections (STI), including HIV can be prevented. The SRH program would help the affected women and girls during and post emergencies to overcome the challenges associated with residing in a crisis setting and live healthy lives, thereby enhancing their Resilience to Disasters.

Responses in Full:

Hari Krishna Nibanupudi, India

Your post prompted me to share the finding of a research we conducted in in Tsunami affected coastal regions in India in 2005-2006. 

In the fall of 2006, Oxfam America undertook a partnership with the Swasti Health Resource Center of Bangalore to study what impact the 2004 Indian Ocean tsunami may have had on the risk of contracting HIV (and other STDs) in India’s coastal villages. The purpose of the research was to understand whether and why the tsunami and its aftermath led to an increase in vulnerability to HIV, with the goal of helping aid providers and communities understand how to minimize the risks in future disasters.

Key Findings:

In 29 out of the 30 communities the Swasti team surveyed, vulnerability to HIV infection rose after the tsunami, largely as a result of an increase in unprotected sex with non-regular partners. Risks that predated the disaster combined with trauma, unfamiliar living conditions, increased migration, and a host of other factors to create a spike in vulnerability in the immediate aftermath of the tsunami.

Pre-existing misconceptions increased vulnerability:  The deadly backdrop to the increase in HIV vulnerability was that many community members knew little about safe sex before the tsunami and had misconceptions about HIV. Many believed that condoms were useful only for preventing pregnancy, not disease, and that HIV could be contracted only from commercial sex workers. Other factors that contributed to vulnerability before the tsunami included unprotected sex (often following alcohol consumption) and the long separations from spouses that are required by many to make a living in the coastal communities. 

Disaster created new STD & HIV risks:  The tsunami and its aftermath precipitated increases in nearly all of the pre-existing risks and created new ones as well. Unprotected sex The biggest factor leaving coastal residents vulnerable to HIV infection was unprotected sex with non-regular partners. More than 20 percent of villagers reported having sex with someone other than their regular partner. During those encounters, fewer than 20 percent of the men and five percent of the women used condoms—primarily because condoms were unavailable or because at least one partner objected to their use. While unprotected sex took place before. 

Crowded housing crowded conditions in the temporary shelter communities were identified as a key factor contributing to increases in sexual activity with non-regular partners. Shelter design was also a factor: families were usually housed in small, single-room structures. The lack of privacy for marital sex sometimes led couples to seek sexual relationships outside their marriages. People living in temporary shelters generally believed that moving to permanent homes as soon as possible would solve many of their problems.

Trauma, alcohol, and cash: In the absence of other forms of support, some villagers turned to sex and alcohol as ways of coping with their shock and grief. In some cases they adopted a fatalistic approach, indifferent to the health risks they ran by engaging in unprotected sex. 

Erosion of traditional social structures Just as opportunities and motivations to engage in higher-risk sexual behaviour increased, the massive death toll and the dispersing of communities into temporary camps eroded the social structures that traditionally curbed sexual activity outside of marriage.

Social stigma and lack of privacy in medical settings The social stigma of contracting sexually transmitted infections prevented many people from seeking information, medical testing, or treatment for HIV or other STIs—thereby increasing vulnerability to infection.

For more Information, please see the following:

1. Oxfam America's Research brief on HIV AIDs and STD Issues after Tsunami in India.

http://www.oxfamamerica.org/static/oa3/files/reducing-vulnerability-to-hiv-before-and-after-disasters.pdf

2. Oxfam America and Swasti's toolkit on addressing sexual health issues after disasters

http://www.swasti.org/images/projects/toolsguidelines/Sexual%20Health%20in%20Humanitarian%20Emergency.pdf

I hope you will find these resources to be useful 

H.S. Sharma, India.

Challenges of Reproductive Health

1.    Lack of privacy for women to attend natures call in rural areas is a huge problems and impacts health of women, especially pregnant women. During pregnancy the woman does not take sufficient solid and liquid foods, due to fear of going out in the open for nature’s call, this effects the foetus as the foetus does not sufficient vitamins, minerals etc. for growth. This is one of the reason for Children born in the rural areas to be under weight.  This has major cardio-vascular diseases among children.

2.    Hence, it is important for Government and Communities to promote toilets, which will give privacy for women and their reproductive health will be safe and secure. This could also reduce Maternal Mortality Rate and Infant Mortality Rate.

Sowmya Ramesh, UNDP, Delhi.

In disaster situations, provision of humanitarian relief is the immediate priority. Even the health care efforts will be towards life-saving activities.  However, there is a growing need for a comprehensive health care addressing all aspects of health including sexual and reproductive health (SRH) of women and girls. SRH needs are multiple, including:

·        Poor access to skilled maternal and new born care leading to increased risk of morbidity and mortality.

·        Unmet needs for family planning including intermittent supply of contraceptives leading to unplanned pregnancy,

·        Sexual and other forms of gender based violence: intimate partner violence and sexual violence against women and girls are increasingly being reported during crisis situations.

·        Lack of attention to HIV prevention as part of SRH services.

·        Less focus on addressing the SRH needs of adolescents: Several studies highlight that adolescents are vulnerable to exploitation, violence and transactional sex during crisis situation, but there is lack of SRH services tailor made to their needs during crisis. 

Provision of SRH services during crisis situations bring a range of challenges including assessment of the needs, access to reliable data regarding population at risk and functioning facilities to name a few. Further in countries with limited resources to address the current health needs of the country, planning for comprehensive SRH care during crisis could be challenging.

Efforts to incorporate SRH care into disaster risk reduction (DRR) are in their early phases, however, there are a few examples of interventions where SRH was included as part of DRR strategy. Activities implemented in those countries provide some insights to the practices that could be considered while incorporating SRH during emergency response, including:

·        The need to involve community based organizations and those working with vulnerable population during planning and preparedness activities.

·        Incorporation of SRH emergency preparedness and response into existing education platform such as in the schools of public health.

·        Development of contingency plan for different levels, scale and types of emergencies.

·        Ensuring accurate estimates of supplies such as RH kits, based on the estimated population at risk, availability of trained personnel and facilities.

·        Establishment of a good communication between the local government system and other stakeholders engaged in humanitarian crisis response.

By providing services to address SRH needs, a range of adverse outcomes including maternal deaths, unintended pregnancies, and the risk of acquiring sexually transmitted infections (STI), including HIV, can be prevented, which would help the affected women and girls during and post emergencies to overcome the challenges associated with residing in a crisis setting and live healthy lives.

Abha Mishra, UNDP, New Delhi.

You must have come across this manual, but I felt it will be useful to inform the participants in the satellite session.

The Minimum Initial Service Package (MISP) for Sexual and Reproductive Health in Disasters: A Course for SRH Coordinators: Facilitator’s Manual has been formulated jointly by the National Disaster Management Authority (NDMA) and the United Nations Population Fund (UNFPA) in consultation with various stakeholders, academic experts and specialists in the concerned subject and officials from the Ministries and Department of Government of India and State Governments. The manual was published in 2013 by NDMA and UNFPA. The document can be viewed at

http://countryoffice.unfpa.org/india/drive/UNFPA_MinimumInitialServicePackageforSexualandReproductiveHealthDisasters(MISP)_Facili.pdf