In a crisis or refugee situation, one in five women of childbearing age is likely to be pregnant. Conflicts and natural disasters put these women and their babies at risk because of the sudden loss of medical support, compounded in many cases by trauma, malnutrition or disease, and exposure to violence. UNFPA seeks to make motherhood as safe as possible during crisis situations by helping those who want to delay or avoid pregnancy and by providing care before, during and after delivery.
Pregnancy and childbirth are always risky in many parts of the developing world. This is especially so during and after emergencies. Many couples would prefer not to risk pregnancy or childbearing during this period but lack the means to postpone pregnancy when family planning services become unavailable.
Neglecting family planning can have other serious consequences, including unsafe abortions resulting from unwanted pregnancies. Restoring access to safe, effective contraception protects the lives and well-being of women and children and enables crisis-affected couples to manage scarce family resources more effectively.
UNFPA is able to ship male and female condoms and other family planning supplies within hours of an emergency. When the situation stabilizes, UNFPA conducts rapid assessments to determine local needs and preferences and supports efforts to make a wide range of modern methods available so that couples have access to the contraceptive of their choice.
After the tsunami hit Banda Aceh, for instance, UNFPA helped the National Family Planning Coordination Board to replenish and retrain its staff and ordered a large volume of supplies to meet needs anticipated for the next 12 months. In migrant communities of Thailand that were also hit by the tsunami, UNFPA helped establish family planning and other reproductive health services. At a camp for displaced persons in Darfur, the family planning unit served some 75 women per day. UNFPA coordinated protection for women and girls in Pakistan, where floods caused mass displacement, destroyed homes and livelihoods, limited access to basic hygiene items, put women and girls in uncustomary interactions with boys and men and increased the risk of violence. In the Horn of Africa, UNFPA has called on the international community to urgently address the unique needs of pregnant women, those in labour and mothers whose familiesâ€™ survival are particularly at risk from famine and drought.
Women who die in childbirth leave behind devastated families. Motherless children are far more likely than others to die before reaching adolescence. Those who survive are less likely to complete their education.
When crisis strikes, UNFPA sends emergency supplies and equipment to make deliveries safer and to support medical interventions where necessary. UNFPA emergency response includes rapid shipment of clean delivery kits – including a new razor blade and string for cutting and tying the umbilical cord – to help prevent fatal infections in women who cannot reach a medical facility.
As the situation develops, the Fund sends the equipment, medicine and supplies needed for clinical delivery assistance and emergency obstetric care. The specific response depends on the circumstances: Ad hoc delivery rooms may be set up in damaged buildings, mobile health clinics may be dispatched, and midwives are sometimes provided with motorcycles. More comprehensive services are organized when the worst of the crisis has passed.
Whether the emergency is due to violence, as in Timor-Leste and Kyrgyzstan, earthquakes, as in Indonesia, Pakistan and Haiti, a hurricane, as in Guatemala, massive flooding, as in Pakistan, or drought, as in the Horn of Africa, UNFPA stands ready to assist pregnant women in this time of compounded vulnerability.
Health care before and after the crucial time of delivery can save the lives of mothers and babies. It can also serve as an important point of entry for women and their infants to health information and services. This can be especially important during emergency situations, when infant and maternal mortality soars.
Prenatal care can identify general health problems that need to be treated. It can raise awareness of danger signs to look for during pregnancy. Prenatal care should also address the special nutritional needs of pregnant women. Health care providers must be trained to detect anaemia and other vitamin deficiencies that can put the mother and her unborn baby at risk. Good prenatal care and voluntary testing and counselling can also minimize the risk of HIV transmission from HIV-positive parents to their unborn children.
The 48 hours after delivery are critical: Up to 50 per cent of all maternal deaths take place during that period. And the death of a mother poses a high risk for her newborn. Post-partum care can mean the difference between life and death for both. Whether conducted in a health facility or through a visit by a midwife or trained birth attendant, post-partum care can assess the mother’s general condition after childbirth and identify haemorrhage, hypertension, infection and other life-threatening conditions that may require urgent medical attention.
Post-partum care is also an opportunity for the midwife or health worker to assess the health of the newborn and talk to the mother about infant care, breastfeeding and nutrition. Sensitive counselling is especially important if the mother is HIV-positive and risks transmitting the virus to her child through her breastmilk.
UNFPA emergency health kits include the tools health workers need to provide basic prenatal care for everything from medical examinations to medicines and supplies to prevent malnutrition, malaria and other threats to a mother’s health. UNFPA also provides training for health workers and midwives to make sure women receive the care they need during all phases of pregnancy and childbirth. The Fund also strives to make sure pregnant and lactating women get the extra nutrition they need during this period.
The Fund supports post-partum care through the provision of supplies, medicine, equipment and training to enable health workers to identify and treat life-threatening complications and share information with mothers regarding infant care and family planning. Mini-vans carrying health care workers and supplies delivered maternal and child health services to women in remote, earthquake-affected areas of Pakistan. A team of obstetricians, general practitioners and midwives visited the camps for those displaced by civil strife in Timor-Leste daily to provide antenatal care, including tetanus vaccinations and supplementary food provided by the World Food Programme. During Niger’s food crisis, UNFPA’s support encouraged women to seek antenatal care by linking visits to the clinic with supplies of cereal, pulses and oil. And in the famine and drought affecting parts of Somalia and the greater Horn of Africa, UNFPA is providing reproductive health kits to refugee communities and training and supplies to midwives deployed there. The Fund works with partners to prevent gender-based violence in the worldâ€™s largest refugee camp, Dadaab, in Kenya. The camp was designed to hold 90,000 people but is now overcrowded with five times that number.