Therese McGinn, Sara E. Casey
Conflict and Health 2016;10:8/24 Mar). DOI: 10.1186/s13031-016-0075-8
Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Ave, New York, NY 10032 USA
Therese McGinn, Email: ude.aibmuloc@22mjt.
In the early 1990s, the sexual and reproductive health needs of people affected by conflict or natural disaster were rarely met. A 1993 editorial in The Lancet identified SRH services as a complete gap in refugee settings. The groundbreaking 1994 report, Refugee Women and Reproductive Health Care: Reassessing Priorities, described how the health of women fleeing war or natural disasters was further threatened by the near complete absence of SRH services. Refugee women spoke about their SRH needs at the 1994 International Conference on Population and Development in Cairo. Also at this time, extensive media attention to the plight of women in the Bosnia and Rwanda crises raised awareness of SRH, especially sexual violence, in crises. This spurred international attention to the issue and led to the development of coalitions such as the Inter-agency Working Group on Reproductive Health in Crises and the Reproductive Health Response in Conflict Consortium; these groups in turn led to development of policy, technical and program guides, including a 1999 comprehensive field guide, updated in 2010 as the Inter-agency Field Manual on Reproductive Health in Humanitarian Settings. Despite progress, UNFPA’s 2015 State of World Population documented the growing SRH needs in emergencies and called for increased global commitment to meet them.
Although sexual and reproductive health services have become more available in humanitarian settings over the last decade, safe abortion services are still rarely provided. The authors’ observations suggest that four reasons are typically given for this gap: ‘There’s no need’; ‘Abortion is too complicated to provide in crises’; ‘Donors don’t fund abortion services’; and ‘Abortion is illegal’.
However, each of these reasons is based on false premises. Unsafe abortion is a major cause of maternal mortality globally, and the collapse of health systems in crises suggests it likely increases in humanitarian settings. Abortion procedures can be safely performed in health centers by mid-level providers without sophisticated equipment or supplies. Although US government aid does not fund abortion-related activities, other donors, including many European governments, do fund abortion services. In most countries, covering 99 % of the world’s population, abortion is permitted under some circumstances; it is illegal without exception in only six countries. International law supports improved access to safe abortion.
As none of the reasons often cited for not providing these services is valid, it is the responsibility of humanitarian NGOs to decide where they stand regarding their commitment to humanitarian standards and women’s right to high quality and non-discriminatory health services. Providing safe abortion to women who become pregnant as a result of rape in war may be a more comfortable place for organizations to begin the discussion. Making safe abortion available will improve women’s health and human rights and save lives.