The ICPD+5 review process
RENNES, France, 5 November–Reproductive health should be made an integral part of the general health care provided all over the world, including that provided to refugees and displaced persons, an international gathering of experts from relief organizations urged today. The Technical Meeting on Reproductive Health Services in Crisis Situations also called for increased funding and human resources to provide reproductive health care to people displaced by war and natural disasters.
These recommendations were two of the general conclusions that the meeting's general rapporteur, Wilma Doedens, collated from the reports of six working groups. These groups made a wide range of proposals to improve agencies' ability to ensure safe motherhood, prevent and treat sexually transmitted diseases, help survivors of sexual violence and promote adolescent reproductive health in crises.
The three-day meeting was organized by the United Nations Population Fund (UNFPA) and hosted by the Ecole Nationale de la Santé Publique (ENSP), as part of "ICPD+5", a global review of progress in implementing the recommendations of the 1994 International Conference on Population and Development (ICPD) in Cairo. That Conference called for comprehensive reproductive health care for all, including refugees and displaced people
Three dozen experts in women's health and emergency assistance from international agencies and non-governmental organizations took part, drawing on a wide range of experience in helping refugees and displaced people throughout the world. They included representatives of the Office of the United Nations High Commissioner for Refugees (UNHCR) and the International Federation of Red Cross and Red Crescent Societies (IFRC), which have worked in a joint initiative with UNFPA to provide emergency reproductive health care in Africa's Great Lakes region.
Among the other key recommendations: all relief workers should be given some basic training on reproductive health; emergency reproductive health curricula should be developed and promoted in universities; and a database of relevant books, materials and reproductive health curricula in institutions should be created and kept up to date.
The working groups addressed six major themes: minimum reproductive health services in emergencies; sexual violence; adolescent reproductive health; coordination of reproductive health services; information systems--needs assessment, data collection, indicators and monitoring; and sexually transmitted diseases (STDs) and HIV/AIDS. Several groups stressed that participation by the target community is the only way to arrive at culturally appropriate and sustainable programmes. This requires training local counterparts of international relief workers and involving community representatives in all phases of programmes.
In her summary, the general rapporteur also underscored the need for ongoing advocacy efforts to make decision makers, relief workers, health care providers and other personnel aware of the importance of integrating reproductive health into general health care.
Earlier, the working group rapporteurs summarized their discussions, citing lessons learned, failures and constraints encountered, and proposals for future actions.
For example, the working group on adolescent reproductive health proposed that relief workers look at the "whole" adolescent and ensure a full range of services and support for him or her. Such an approach, the group felt, could help remove the stigma attached to reproductive health issues. They agreed that international agencies and organizations must make all reproductive health programmes more adolescent-friendly by making relief workers, health care providers and other personnel more aware of the concerns of young people. They also called for training of more local staff and of refugees and displaced persons in order to build local capacity to maintain programmes.
The working group on reproductive health minimum services in emergencies emphasized that basic care should include individual delivery kits, widespread availability of condoms and universal precautions against HIV/AIDS, and prevention of and response to sexual violence and unwanted pregnancies. But, the group agreed that the minimum package might also include other reproductive health services identified in the ICPD Programme of Action, and should be modified to respond to changing circumstances.
The working group on sexual violence concluded, among other things, that the ICPD had brought awareness of the problems of reproductive health for refugees to the policy level, increased the commitment of donors and also made the issue of sexual violence more visible. Countering sexual violence, the group stated, is a natural part of any reproductive health package. Relief workers should focus on preventing and treating sexual abuses of women, while at the same time including men as part of the solution. While there is an obvious need for emergency contraception and post-abortion services, other activities, such as the training of refugee camp guards, are also necessary.
In effort to curb sexual violence, the working group agreed, relief workers should go beyond the reproductive health aspects and promote community awareness. Cultures must be changed to ensure that perpetrators are punished, women are empowered and communities understand that sexual violence is shameful.
The working group called for the collection of information on the nature and extent of sexual violence among refugees and people in emergencies. It also recommended the development of multisectoral responses to sexual and gender violence. Survivors should have medical and psycho-social services, legal recourse and protection from further harm. Relief workers, security forces, refugees and affected populations should be educated about the causes, results and responses to sexual violence in refugee settings, and NGO staff should be trained in sexual violence prevention and services.
Finally, the working group recommended stronger advocacy for the ratification of international human rights treaties and fulfilment of human rights obligations, with particular emphasis on the rights of women.
The working group on information systems stressed the need to obtain the best possible size estimates of populations at risk, making full use of existing guidelines for such undertakings. Population surveys, focus groups, monitoring and other tools should be used to assess reproductive health conditions within displaced communities. Relevant data from all sectors, not just those from the health ministries in national capitals, should be utilized. Definitions need to be standardized across agencies and governments, the working group also recommended.
In closing the meeting, Alphonse MacDonald, Director of the UNFPA Office in Geneva, said: "Whatever we do must always be based on the free choice of the person being served, be it a refugee, an internally displaced person or other everyday person. We need to ensure that people have correct, up-to-date and culturally appropriate information, and to make many options available for people to choose from."
Continued dialogue and information exchange on reproductive health for refugees is critical, Mr. MacDonald said. More effective efforts must be made to inform the public of activities to ensure the reproductive health of people caught up in crises. Those living in the countries and localities that receive refugees and displaced persons should always be considered when planning and implementing programmes, he emphasized.
The Director of the ENSP, Dr. Pascal Chevit, said the meeting was an opportunity to consider new ways of providing training in reproductive and general health. His institution will consider developing new training methods as a priority. Many of the meeting's recommendations can be applied to other types of crisis, such as unemployment, homelessness and lack of income in many developed and developing countries.
The outcome of this meeting, along with those of other forums in the ICPD+5 series of round tables and technical meetings, will serve as inputs to an international forum in The Hague, Netherlands, from 8 to 12 February 1999, and to a report the United Nations Secretary-General will submit to the 30 June-2 July 1999 special session of the General Assembly.
For information purposes only. Not an official document.