Hi, I'm Michelle Hynes. I'm an epidemiologist in the Emergency Response and Recovery branch of the the Centers for Disease Control and Prevention. I'm also an adjunct professor in the Department of Global Health at Emory University. My work is focused on sexual reproductive health in conflict settings. I worked in global health for over 20 years and much of that work has been in conflict settings in countries in Africa, Asia and South America. Today, I'm going to give you a brief overview about sexual reproduction health and complex humanitarian settings. How health outcomes are effected by these settings and what we can do about it. So, let's start by talking about the topics addressed in sexual reproductive within a complex humanitarian emergency. The term sexual and reproductive health covers a wide range of topics, including contraception, maternal and newborn health, sexually transmitted infections, including HIV. Gender-based violence, safe abortion care and adolescent sexual and reproductive health. With so many issues to address in complex humanitarian emergencies, why is it important to also focus on sexual and reproductive health? Well, to answer that question, let's take a look at some sexual and reproductive health outcomes globally. Every year, there 289,000 maternal deaths, 2.6 million stillbirths, 2.9 million neonatal deaths over 5 million pregnancy-related deaths and disparities exist. Developing countries hold 99% of this burden. Globally, 60% of preventable maternal deaths and 53% of deaths of children under five are in conflict, displacement and natural disaster settings. In developed countries, a woman's lifetime risk of dying as a result of pregnancy and childbirth is one in 1 in 4,900. In settings with conflict, displacement or natural disasters, that woman's risk is 1 in 54. The conditions of complex humanitarian emergencies tend to exacerbate poor reproductive health outcomes and increase sexual violence. Sadly, we are currently experiencing the highest levels of displacement ever recorded. As of 2015, there were over 65 million people forcibly displaced around the world. So let's think about how complex humanitarian emergencies exacerbate poor reproductive health outcome and increase the risk of sexual violence, and exploitation. Simply reaching care can be difficult, because of destruction of health facilities. Lack of trained staff. Existing health facilities that are overwhelmed and a lack of supplies. In addition, other factors may limit access to health services, such as displacement from home, security situations that limit movement, cultural restrictions, particularly around girls and women traveling alone, knowledge and attitude towards health services and staff. And finally, economic constraints. The breakdown of civil and social structures increases risk of targeted and opportunistic sexual violence and sexual exploitation, particularly when families are split apart, leaving vulnerable groups, such as girls and women to negotiate on their own for goods and services. So, what can we do about this? Let's continue with the example of maternal and newborn deaths. Most of these deaths take place around the time of labor, delivery and the first week after birth. Many of these deaths can be prevented by investing in quality care around this time. Let's take a look at maternal and newborn deaths in refugee camps compared to deaths in the host country populations. Here are maternal deaths for Afghanistan and Tanzania, and comparable deaths in refugee camps within these countries. Now, let's look at newborn deaths in the same countries. Do you notice a pattern? The ratios and rates of death are much lower in the refugee camps, but why do you think this is? In refugee camps, sexual and reproductive healthcare is often provided by humanitarian agencies. This care can be better than what is available to host country populations and we see the difference that this care can make. So, that's one example of what to do. Now, let's turn to the how to do it question. There are some key documents humanitarians use to address sexual and reproductive health in humanitarian conflict settings. Links to these resources can be found in the further reading section of this course. The first key resource is called the Minimum Initial Service Package or MISP. The focus of the MISP is to decrease mortality, morbidity and disability among populations effected by crisis, particularly women and children and is part of the humanitarian standards. Minimum refers to ensuring basic, limited reproductive health services. Emergency obstetric care would be one example of a service that should be put in place immediately. Initial, refers to use in emergencies without site specific needs assessments. We know these services make a difference. Service refers to healthcare for populations and a package refers to activities, supplies, coordination and planning that surround the service delivery needed. As a crisis improves or becomes more protracted, these minimum services and activities should be scaled up to include more comprehensive sexual and reproductive health services. Another key resource is an interagency field manual for reproductive health in humanitarian settings. This field manual contains a chapter on the MISP we just talked about as well as chapters on other topics I mentioned at the beginning of the lecture, such as contraception, maternal and newborn health and gender based violence. This manual provides guidance on the planning, implementation, monitoring and evaluation of sexual and reproductive health services throughout a humanitarian crisis. It is important to note that sexual and reproductive health services must be provided in coordination and collaboration with other humanitarian sectors and with the effected population's needs, wants and beliefs at the center of the planning and implementation process. This was just a brief overview of sexual and reproductive health in humanitarian settings and I encourage you to explore more on your own through the additional resources provided in the course. Sexual and reproductive health concerns. Women and men, girls and boys and as a key component of the response in complex humanitarian emergencies. By implementing basic services at the earliest phases of an emergency, many deaths can be avoided. Building up to comprehensive sexual reproductive health services after the emergency face of a crisis will further reduce mobility and mortality in the affected populations we serve. Thank you.
