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Reproductive health and rights in emergencies

  • Page updated onMarch 10, 2025
Reproductive health in emergencies
Photo: Bruno Abarca

In humanitarian crises, not only do gender systemic inequalities and discrimination against girls and women increase, but their freedom, rights, and health regarding sexuality and reproduction are also directly threatened. For this reason, it is essential to include essential sexual and reproductive health actions and services in emergencies that allow for the reduction of risks of gender-based violence, unintended pregnancies, sexually transmitted infections, and maternal health problems.

What are reproductive rights?

In 1994, the International Conference on Population and Development was held in Cairo. This event and the resulting program of action marked a turning point by defining reproductive health and rights and placing them among the priorities of public health and human rights.

Thanks to this and other successive advances, today we understand that in order to achieve the right to health, it is essential to advance towards reproductive health, gender equality and women's empowerment, and that for this it is essential to defend and respect the rights and freedoms of all people a:

  • That their personal autonomy, bodily integrity and privacy be respected.
  • To be able to define their sexuality, sexual orientation, gender identity and how to express it.
  • Choose their partners.
  • Have safe and pleasurable sexual experiences.
  • Decide whether or not, when and with whom they want to get married.
  • Decide whether or not, when and how to have one or more children.
  • To have access to information, resources, services and the support necessary to exercise all other rights, free from discrimination, coercion, exploitation and violence.

A minimum standard for sexual and reproductive health in emergencies

From maternal health to reproductive health in humanitarian contexts

At the same time as the Cairo conference was taking place, reproductive health was also beginning to be seen as a priority in humanitarian contexts and complex emergencies. The use of sexual and gender-based violence, for example, as a weapon of war, was widely denounced in the humanitarian emergencies of this period. In Rwanda, between 100,000 and 250,000 women were raped during three months of genocide in 1994. During the Bosnian war (1992-1995), similarly, between 10,000 and 50,000 women were raped, sometimes repeatedly for years in civilian concentration camps. In those years, the world witnessed the fragility of the sexual and reproductive health and rights of millions of women affected by humanitarian crises.

The report "Refugee Women and Reproductive Health Care: Reassessing Priorities" published in 1994 by the (now) Women's Refugee Commission analyzed the reproductive health and rights situation among displaced and refugee women in Côte d'Ivoire, Rwanda, Kenya, Pakistan, Belize, Thailand, Cambodia and Hong Kong. This critical analysis of reproductive health needs also prompted the development of new international coalitions. These included the Inter-Agency Working Group on Reproductive Health in Crises (IAWG) in 1995, or the Reproductive Health Response in Conflict Consortium.

An inter-agency field manual and a minimum initial service package

The 20th century still saw one last major milestone for reproductive health in humanitarian settings. This was the development, between 1996 and 1999, of the Inter-Agency Field Manual on Reproductive Health in Humanitarian Settings. This document and its successive updates in 2010 and 2018 (the current one) have laid the foundation and consensus around the sexual and reproductive health services that are most important in humanitarian settings, particularly among girls and women, while protecting their lives with dignity.

Within the Field Manual, a minimum set of reproductive and sexual health actions for response to humanitarian emergencies was also defined. It is the Minimum Initial Service Package for Sexual and Reproductive Health in Crisis Situations (simply MISP). This set of priority actions was born between 1996 and 1999, and has been significantly updated twice: in 2004 and in 2018. In addition, in 2010 it was included as a standard of the Sphere Handbook. Today, it is a powerful tool for advocacy, coordination and programming of these actions.

The MISP sets out a series of objectives. These include the prevention of sexual and gender-based violence and mitigation of its consequences, the prevention and treatment of HIV/AIDS and other sexually transmitted infections, the prevention of unwanted pregnancies with information, counseling and contraceptives, emergency obstetric and neonatal care to reduce morbidity and mortality, and ensuring access to safe abortion care, to the extent permitted by law (the latter mentioned only as an "additional priority"). MISP also posits that, as soon as possible, the "minimum package" should be abandoned and more needs covered.

The (limited?) scope of MISP for sexual and reproductive health in humanitarian emergencies

At the same time that, for many people, the MISP is too brief and insufficient, for others it is too ambitious and far removed from reality. 

Some consider that there are not enough elements to cover all sexual and reproductive health needs in humanitarian contexts. What about sex education? What about pregnancy monitoring and prenatal visits? What about support for menstrual hygiene management? What about cervical cancer or fertility problems? Other experts, however, criticize that MISP has covered so many objectives that it is no longer minimal or realistic for certain contexts. They argue that in the midst of the insecurity and chaos of a humanitarian emergency, one must prioritize. They also point out that this must be done based on scientific evidence, people's rights, and what is acceptable and feasible as action in the early days of a crisis response. They also criticize that the latest update of the MISP did not take into account the voice of some key actors.

MISP today falls far short of what should be a comprehensive package of health and reproductive services for stable contexts. However, there is also no consensus that it represents what is feasible or truly prioritized to reduce the excess of preventable sexual and reproductive health-related morbidity and mortality in the initial response to any humanitarian emergency. Despite being proposed as an indivisible "minimum package," this remains more an aspirational goal than a reality, in which the imposition of a adaptation to each humanitarian crisis and to each phase of its evolution.

Sexual and reproductive health

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