This week marks the third anniversary of the conflict in Syria. In the last eight months, the number of Syrians in need of humanitarian assistance has risen from 6.8 million to 9.3 million, many of whom are women.
These are women who are disproportionately vulnerable to sexual and gender-based violence. Women who want to delay or avoid pregnancy. And women who have an increased need for reproductive health services.
Evidence shows that during emergencies, the need for reproductive health information and services rises partially due to an increased desire to delay or avoid pregnancy, but the ability to access critical reproductive health care services declines. The Minimum Initial Service Package (MISP) for Reproductive Health is the international standard for reproductive health care in emergency settings, however, these services are often neglected from the start of emergencies and funding for these programs is often inadequate. The MISP is supposed to be implemented in the initial phase of a crisis before a transition can be made to more stable health care provision. But often, crises, like the one in Syria, stretch on far longer, creating gaps in care and uncertainties for women.
One report that looked at MISP implementation in the Zaatri Refugee Camp and Irbid City in Jordan found that overall MISP services were largely being implemented. However, there was limited knowledge and availability of services for survivors of sexual violence. Additionally, inadequate lighting and the absence sex-segregated toilets in Zaatri Camp and the long distances women in Irbid City needed to travel to access services, led to an increased risk of gender based violence.
Though there are 12 different kits that support the objectives of the MISP and are meant to cover a range of reproductive health needs in the early phase of crises—from contraception to clean delivery—there are still several critical reproductive health needs not adequately addressed by the kits.
For example, the Clinical Delivery Assistance Kit (Kit 6) only includes one medicine for postpartum hemorrhage: oxytocin. While oxytocin is effective in treating postpartum hemorrhage, it must be kept cold or it will lose effectiveness. Oxytocin is packed and sent separately from the rest of the kit in order to keep it cold. Misoprostol, another drug that has proven effective for preventing postpartum hemorrhage and does not need to be kept cold, is absent from Kit 6. Adding misoprostol to Kit 6 would allow for prevention of postpartum hemorrhage without needing to ship and store one drug separately in a cold place.
In addition to including misoprostol as part of the Clinical Delivery Assistance Kit, a new kit should be created for medical abortion in countries where abortion is legal. The MISP kits include emergency contraceptive pills for post-rape care and an entire kit for the management of miscarriage and complications with abortion, however, access to safe abortion is not directly addressed by any of the MISP kits.
A separate kit, containing the drugs misoprostol and mifepristone for medical abortion, would allow for safe abortions to be performed in countries where abortion is legal. In countries where abortion is restricted, the kit could simply not be ordered. Medical abortion is a safe, cost-effective, high-quality service that has the potential to decrease the number of unsafe abortions, reduce disabilities and save the lives of women in emergency settings. It is not enough that the MISP kits address complications of abortion; they must also help women access safe abortion services.
Meeting the needs of women in conflict affected areas—including access to a full range of reproductive health services—is life-saving. To do this, not only does the MISP need to be comprehensive, but activities, supplies and funding for the MISP must be prioritized in humanitarian settings.