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Sexual and Reproductive Rights

Complex emergencies: programming based on sexual and reproductive rights

Lillian Figg-Franzoi, United Nations Office for Project Services (UNOPS)


Complex emergencies are situations in which livelihoods become disrupted and populations dislocated, requiring intervention that includes relief assistance and humanitarian aid. They are caused by conflict, famine or environmental disaster and result in political insecurity, weak societal safety, and large-scale migration of populations termed refugees or internally displaced persons (IDPs).

Because these situations are politically fragile, the governance structures that protect citizen’s civil rights become fractured. International stakeholders who intervene must then primarily protect the rights of IDPs and refugees. This is a difficult task, but rights-based programming can enable stakeholders to ensure the sexual and reproductive rights of crisis-affected populations in complex emergencies.

Sexual and Reproductive Health in Crisis Situations

Sexual and reproductive rights deserve special attention in cComplex emergencies as these disproportionally affect the vulnerable in society, most often women and children. According to the United Nations Population Fund UNFPA, women and children account for approximately 75% of most IDP and refugee populations. One fourth of IDPs are of the reproductive age, and 1 in 5 women in that group are likely to be pregnant in during the crisis situation. Not surprisingly, complex emergency situations result inare associated with a 33% maternal death rate among refugees. In complex emergencies, two primary sexual health issues include are family planning, including access to safe childbirth and contraceptives, and sexual- and gender-based violence (SGBV).

International Advocacy

Underlying the growing concern for safeguarding sexual and reproductive health of IDPs and refugees these populations is the recognition that reproductive health is a human right under international law and that populations in complex emergencies are particularly vulnerable with inadequate access to sexual and reproductive health services.

International human rights law, refugee law and humanitarian law constitute the international legal frameworks by which sexual and reproductive rights are protected in complex emergency situations. The following treaties and declarations underlie justifications for protecting sexual and reproductive rights of global populations: the Universal Declaration of Human Rights , 1966 International Covenant on Economic Social and Cultural Rights and1979 Convention on the Elimination of All Forms of Discrimination Against Women. The following specifically apply to refugees: 1951 Convention on the Status of Refugees, 1967 updated Refugee Protocol, 1949 Geneva Conventions and the 1977 Additional Protocols to the Geneva Conventions

Held in Cairo in 1994, the International Conference on Population and Development (ICPD) stressed the vulnerability of populations in complex emergency situations and highlighted the prevalence of high morbidity rates among refugees. It explicitly addressed the unalienable right of refugee and IDP populations to access sexual health services. In 2009, the World Health Organization (WHO), United Nations Population Fund (UNFPA) and the Andulasian School of Public Health convened a global consultation to address the health needs of countries experiencing protracted conflict or humanitarian emergencies. This consultation resulted in the “Granada Consensus” which highlighted four priority areas to be focused on in order to facilitate the sustainable provision of sexual and reproductive health in protracted crises. It pressed for national and local authorities to uphold sexual and reproductive rights in crises, and urged for the expansion of sexual and reproductive health service assistance during complex emergencies.

What is Rights-based Programming?

When relief stakeholders recognize human rights norms and incorporate strategies that uphold these norms into health programming, their assistance practices can become rights-based.  Ideally, rights-based programming will

  • increase accountability of program stakeholders
  • promote results from an alignment with results-based management
  • reduce vulnerabilities by focusing on marginalized and excluded groups in society
  • move assistance outside of an optional realm of benevolence and into a mandatory realm of law

A rights-based approach stresses the importance of non-stigmatization, universal access and non-discrimination. The populations who are served in assistance programming become rights-holders and function as active participants in the program. A rights-based approach meets the needs of a population and aims to empower that population.

Characteristics of Rights-based Programming in Complex Emergencies

Rights-based sexual and reproductive health programming in complex emergencies should be (1) conflict-sensitive, (2) participatory, and (3) culturally-sensitive. When a program has these characteristics, it will be better able to provide universal support to vulnerable crisis-affected populations.

Conflict Sensitive: Complex emergencies are high-risk situations. Any program implemented in a fragile environment has the potential to exacerbate, instigate or mitigate the risks of conflict. Creating tensions in disaster-affected communities can cause minor conflicts, which can then impede individual’s access to health services, undermining a rights-based approach to relief programming.

Participatory: Rights-based programming establishes that all programming must have an educational element that informs women and men about options in sexual and reproductive health. Maintaining an informative and participatory program based on dialogue and informed consent with the population is essential to discourage coercive services that undermine a person’s sexual and reproductive rights.

Culturally-Sensitive: Sexual and reproductive health is irrevocably connected to the culture and norms within a society. Programs should be designed in a way that maintains internal-ownership and respects cultural norms, while also holding community leaders accountable to international norms in sexual and reproductive rights.