TragicallyLacking:SafeAbortionCareinHumanitarian

EmergenciesSandraKrause

Women’sRefugeeCommission

UNHCRGlobal Trends2015

Humanitariancrisesdisproportionatelyimpactwomenandadolescentgirls.

UNFPA © Ali Arkady/VII Mentor Program

© UNHCR/I.Prickett

Themajorityofpreventable

deathsinwomenandchildren

under5willoccurinareasaffected

bycrises.

Comprehensiveabortion

servicesareparticularlyimportantinhumanitariancontexts

IRC/PeterBiro

• Assessment foundno mentionofsafeabortioninhumanitarianproposals

• Safeabortionnotavailableinassessed facilitiesinSouthSudan,DRCorBurkinaFaso

• Litreviewfoundno publishedevaluationsofsafeabortioncareinhumanitariansettings

• Limitedinstitutionalcapacityandattentiontosafeabortioncare

Whydon’thumanitarianorganizationsprovidesafeabortionservices?

•Thereisnoneed•Abortionistoocomplicatedtoprovideincrises

•Donorsdon’tfundabortionservices•Abortionisillegalinthesesettings

“Thereisnoneed”

• Collapseofhealthsystemsinhumanitariancrisesmeansreducedaccessto:o Emergencyobstetriccareo Familyplanningo Post-abortioncare

• SexualviolenceisassociatedwithwaroWhenraperesultsinpregnancy,negativeoutcomesmaybeexacerbated

“Abortionistoocomplicated”

• MVAandmedicationabortioncanbeusedatthe“healthcenter”levelbymid-levelproviders

• MVAandmisoprostolavailableinspecificRHkits(notmifepristone,however)

97% - 99.5% effective

95% - 98% effective 83% - 87% effective

“Donorsdon’tfundit.”§ HelmsAmendment,1973,mostofteninterpreted(incorrectly)to

§ restrictall information,education,servicesandreferralforabortion

§ applytoall USforeignaid§ applytoall recipients§ applytoallcountriesregardlessofnationalpolicy§ makenoexceptionforwomen’slives,rapeorincest§ BUT:Doesnotapplytoorganizations’otherfunds

§ MexicoCityclauses(GlobalGagRule)§ onlyappliedtonon-USNGOs(notUSNGOs,foreigngovernments,multilaterals)

§ onlyappliedtoUSGfamilyplanningfunds(notanyotherUSfunding)§ appliedtoall fundsoftheaffectedNGOs,evennon-USfunds§ makesexceptionsforsavingwomen’slives,rapeandincest§ notineffectnow

“It’s‘illegal.”

Only6countriesbanabortionentirely:Chile,DominicanRepublic,ElSalvador,Malta,NicaraguaandtheVatican

Safeabortionpermitted

Woman’slife

Physicalhealth

Mentalhealth

Rapeorincest

Fetalimpair

Econ/social

Onrequest

Numberofcountries 190 132 126 99 91 69 58

“It’sillegal.”Internationalagreementssupportingaccesstosafeabortioncare:

•GenevaConventionArticle3:Denialofsafeabortiontoarapesurvivorcanbeconsideredinviolationofherrights.•UNSecurityCouncilResolution2106:SupportsaccesstocompleteRHservices,includingsafeabortionforrapesurvivors.•Maputoprotocol:Countriesthatratifiedit(36)mustauthorizesafeabortionincasesofrape/incestandtoprotectthementalhealth,physicalhealthandlifeofthewoman.

Why don’t we provide safe abortion to women in humanitarian settings?

Rationale True False

There’snoneed. PIt’s“illegal.” PIt’stoocomplicatedtoprovideincrisis. P

Donorsdon’tfundit. P

Resources

IAWGSafeAbortionCareSub-WorkingGroup

• Accesstosafeabortionforallwomenandadolescentgirlsincrisisisahumanright.

• Safeabortioncareisanevidence-basedinterventionthatpreventsmaternalmortalityandmorbidity.

• Accesstohigh-qualitysafeabortioncareforallwomenandadolescentgirlscontributestogenderequalityandsocialjustice.

• Acorepackageofevidence-basedsafeabortionservicesshouldbemadeavailabletodisplacedwomenandadolescentgirlsinallcrisissituations.

FromAgreementtoAction

Theneedforresearchisgreaterthanever• Operationsresearch,demonstrationprojectsorimplementationsciencetodemonstratethat,despitecultural,policyandpoliticalbarriers,servicescanbeprovidedandwillbeutilized.

• Formativeresearch,strongerqualitativeandparticipatoryresearchgivingvoicetowomeninneedof,abletoobtainordeniedabortions.

• Researchquantifyingtheextentofunwantedpregnancy,theincidenceofabortion,andunsafeabortion-relatedmortalityandmorbiditytojustifytheincreasedattentionanddemandforservices.