In the world’s worst crises, access to sexual and reproductive health and rights is paramount
As countries prepare to meet in London for the Family Planning 2020 conference on July 11, Canada has a unique opportunity to remind the international community that promoting sexual and reproductive rights during humanitarian crises saves lives — just like clean water, shelter and food.
Every day, some 2,000 refugees pour into northwestern Uganda from South Sudan. Fearing conflict, over 600,000 refugees — mostly women and children — have migrated this past year alone. South Sudan is the fastest-growing refugee crisis, but the pattern is not isolated to the world’s youngest country.
In Yemen, more than half of women’s demand for contraception is unmet. Along with the reality of contraceptive failure, this led to over 550,000 unintended pregnancies in 2016. Women who want access to contraceptive and safe abortion services don’t have such a choice.
As the international community scrambles to meet basic needs like water, shelter, food and sanitation, access to sexual and reproductive health and rights — including abortion — are often treated as low priority. The consequences are grave.
The need for comprehensive sexual and reproductive health services becomes more acute in emergency settings. People affected by armed conflict and natural disasters are at increased risk of sexual violence, maternal morbidity and mortality and complications from unsafe abortions. Unsurprisingly, demand for contraceptives and abortion in humanitarian settings is fierce; for example, nearly three-quarters of pregnant Syrian refugee women surveyed in Lebanon wished to prevent future pregnancy, and more than one half did not desire their current pregnancy. Moreover, empowering individuals to claim their reproductive rights is feasible, even in the most challenging contexts.
To truly mitigate humanitarian crises, governments and civil society need to adopt a feminist and human rights-based approach. This means we cannot ignore the greater picture that surrounds gender-based discrimination. It means we must seek out rights-based, comprehensive solutions, even within crises. It means we must make sure that where reproductive services are provided, several options for each service are made available along with information that is accessible, high quality and youth friendly. The way contraceptives have been delivered in the past has worked to limit individual choice. We need to commit to ensuring that all women can exercise free, full and informed choices about their reproductive lives, including access to the full range of contraceptive methods. In crisis-affected settings, we need to invest in programs that build people’s understanding of their sexual and reproductive rights and that empower them to shape and monitor the services they receive, so that these services respond to their demands and fulfill their rights.
When, in January, the White House stopped funding organizations that provide information, referrals or services for legal abortion or that advocate for access to abortion services, it opened a US$600 million annual funding gap for reproductive health worldwide. It is more important now than ever that governments, donors and civil society commit to investing in evidence-based, comprehensive sexual and reproductive health services that ensure all people have the information and services they need to make free, full and informed choices about their bodies and their lives.
Moreover, investments must be followed with accountability systems, including data collection grounded in feminist methodologies. When disaggregated gender sensitive data is not collected, the needs of women — and the most disadvantaged among them — are made invisible. When health systems, services providers and governments coordinate towards stronger monitoring, the arguments for rights-based sexual and reproductive health become undeniable.
Last month, the Government of Canada announced its first feminist international assistance policy. This landmark policy pledges that by 2021/2022, at least 95 percent of Canada’s bilateral international development assistance investments will either target or integrate gender equality and the empowerment of women and girls. The new policy is accompanied by a $CAD650 million commitment over three years to support comprehensive sexual and reproductive health care in development contexts. This funding is intended to “fill the gaps” created by Canada’s former policies to restricted funding for sexual and reproductive health and rights, including contraception and safe abortion. Furthermore, in March 2017, Canada pledged $CAD20 million towards the She Decides movement, which seeks international cooperation to fill the global funding gap created by the United States’ Mexico City Policy. Fulfilling the fundamental rights of girls and women is the stated mandate of the She Decides movement, and we expect the July 11 London Family Planning Summit to continue, in this way, to promote choice and human rights.
As the summit aims to expand access to family planning information, services and supplies in 69 of the worlds’ poorest nations, it provides a unique and timely opportunity for Canada to put its feminist vision into action. Towards this end, Canada should include four key actions among its priorities at the summit to help unlock access to rights-based sexual and reproductive services for all women and girls affected by crisis and conflict:
First, Canada should encourage crisis-affected countries to create programs and frameworks for sexual health and rights in humanitarian settings. Many such countries continue to have low contraceptive prevalence rates, along with high maternal and infant mortality rates.
Second, Canada should announce its intention to complement its new feminist international assistance policy with a specific humanitarian policy that ensures investments in sexual and reproductive health information, education and services are a core element in all its crisis-responses.
Third, Canada should work with governments to ensure that their investments in strengthening health systems’ ability to withstand crises includes the promotion of sexual and reproductive health. Even in fragile states and chronically unstable contexts, governments have leveraged investments in humanitarian preparedness and response to mobilize new resources, improve policies and strengthen the capacity of health systems. Canada must push to unlock access to reproductive choices in times of stability as well as crisis.
Finally, Canada should coordinate its investments with other donors to ensure continuity of support for sexual and reproductive health and rights, from stable times to the acute onset of crises through protracted crises. As climate change and political instability contribute to more prevalent and longer humanitarian crises, funding and coordination mechanisms must be adapted to function effectively in long-term, protracted crises.
In the context of a political climate that threatens decades of progress on human rights, support for comprehensive sexual and reproductive health and rights in humanitarian settings is an area in which Canadian leadership could fill a vital and growing gap. The summit in London is an opportunity for Canada to underscore that access to sexual and reproductive health services in crisis-affected settings is lifesaving, empowering and cost-effective, and to fulfill its international obligation to promote human rights in some of the harshest environments in the world.