Sexual and Reproductive Health in Emergency and Humanitarian Settings

In conflicts, disasters, and climate and health emergencies, many often consider food, shelter, and water to be the immediate needs of those impacted. While these are incredibly important requirements, women and girls are uniquely impacted by these emergencies, and sexual and reproductive health and rights must also be realized. Gayatri Patel, Chief of External Affairs at the Malala Fund and Senior Fellow with rePROs Fight Back, talks to us about the importance of SRHR provision in humanitarian settings.

Gaps in healthcare access extend to abortion, contraception, gender-based violence and sexual violence counseling and care, STI testing/treatment, and more, often brought on by impacted health infrastructure and supply chains. The implementation, support, and prioritization of these comprehensive needs is a step in the right direction for protecting women and girls in crisis scenarios. Some new practices and approaches are showing promising results, and include mobile clinics, cash assistance, legal assistance and further availability of contraception and midwives.

Links from this episode

Gayatri Patel on X
Sexual and Reproductive Health in Emergencies: Promising Practices to Address the Crisis within a Crisis
How US Abortion Politics Distorts Women’s Lives in Conflict Zones
How US Abortion Policy Harms Rape Survivors in Conflict Zones

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Transcript

Jennie: Welcome to rePROs Fight Back, a podcast on all things related to sexual and reproductive health, rights, and justice. [music intro].

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Jennie: Hey rePROs. How's everybody doing? I'm your host Jennie Wetter, and my pronouns are she/her. So, y'all, you know, I try to be open and talk about when I am, when I'm struggling on the podcast, and right now is one of those moments, like, with everything happening, it just feels like chaos everywhere. It's been for a while. My brain has been, like, fuzzy and, like, a little chaotic and, like, not as able to focus as I wish it would. You know, if I'm sitting down to try and write something for work, it's just not wanting to focus on and do the things. And so it feels like it's just making everything that much harder, which is so frustrating. Like, come on, brain, get it together. Like I just, I need you to focus a little harder so you're not making my life harder. Which, which is okay. These things happen. Go through cycles where you're a little stressed. Things don't go as they should. But yeah, I'm a little bit struggling right now 'cause my brain has decided that it would like to be on vacation apparently, and just do everything a little slower than I would like. But I'm looking forward to having some vacation in August and hopefully that will give me a chance to recharge and get my brain some quiet time. I'm envisioning lots of reading of fluffy books and seeing some family and having a pretty chill time in Wisconsin. We'll see if that's, any of that is what actually happens and coming back ready to face the rest of the fall. And I'm sure the chaos that will be election season or the chaos that has already been election season, all of the above. There's just so much happening and I feel like my brain's like, "yeah, we're done. We're done. We're just gonna check out right now." The good thing is I'm still able to focus enough to do the podcast and like, have conversations with people and hopefully interesting conversations with people, even if I may forget to ask them to introduce themselves. Sorry, Gayatri. I caught it, it was maybe halfway through the interview. So like, FYI, I have her introduce herself in the middle, but I figured it was, I'm just gonna keep it there 'cause like y'all, like I said, my brain has been chaos, and I think everything doesn't need to be perfect. And it's okay if y'all see that, like, everything's not always perfect and I forget and these things happen and it was funny and I enjoyed just, like, having her introduce herself in the middle. You know, sometimes I get so excited to talk to a friend on an episode or I'm really excited about the topic today was both—I really, I just dove right into the conversation. We started chatting right away instead of taking that pause to have her introduce herself. Whoops, my bad. I guess with that, might as well just go right into the interview, right? Like I am already talking about it. Very excited to have on the podcast today, Gayatri Patel. She's with the Malala Institute. She's also a Senior Fellow with rePROs Fight Back. She wrote a wonderful brief for us looking at sexual and reproductive health in emergency settings. We'll make sure to include a link to that brief in our show notes. And so, I'm very excited to talk to her today all about why we need to be talking about sexual and reproductive health in humanitarian settings, why it's important, what we should be doing, and what needs to be done better. So, with that, let's go to my interview with Gayatri.

Jennie: Hi Gayatri. Thank you so much for being here.

Gayatri: Hey, Jennie, how are you doing?

Jennie: I'm doing good. It's, like, a little rainy and gloomy today, but I'm doing good.

Gayatri: That's great. It's rainy and gloomy here too, but it makes me happy.

Jennie: I enjoy the, like, it makes me think of, like, curling up with a good book and, like, just staying inside—delightful.

Gayatri: Exactly. And at least it's not humid and 108 degrees.

Jennie: Yes. Okay. So, the other thing that was happening today is when we're recording this, like Netanyahu's in town and it's making me think of Gaza and conflict and, like, this was like the perfect day to have this conversation of sexual and reproductive health in humanitarian or emergency settings. But maybe like stepping back, like, when we talk about emergency settings, like what are we talking about?

Gayatri: I mean, we're talking about an emergency, it could be a conflict, like what we're seeing in Gaza. It could be a natural disaster that's led to some form of emergency and crisis. Like, you know, we've seen flooding, we've seen earthquakes, we've seen hurricanes, et cetera. So, it's any kind of setting where there is an emergency and almost immediate onset of, you know, lack of access to resources and materials that people need to live their daily lives.

Jennie: And I think when things like that happen, everybody immediately thinks of, like, food, water, shelter, but, like, that's definitely not the only needs that people have. And I think one of those ones that people don't think of right away are sexual and reproductive health needs. But it's really important to think about that early in an emergency. Can you talk a little bit about why we need to talk about sexual and reproductive health during an emergency?

Gayatri: Absolutely. I mean, I think you are right. People tend to think, like, okay, food, water, shelter—those kind of, like, hardcore needs. What they really don't necessarily consider is that, you know, people don't stop having babies. They don't stop getting pregnant or being pregnant. They don't stop getting their period. They don't stop having sex during an emergency. We know this. This is, this is life, this is fact. But at the same time, the resources and the healthcare they need does stop often when during an emergency, you do see outages and, and lack of resources to care for basic maternal health needs and so forth. And so, how that manifests is, you know, 65% of maternal deaths happen in humanitarian context, pregnancy and childbirth, which is, you know, already dangerous for adolescent girls and for young girls becomes even more dangerous during an emergency when they don't have access to any care or very limited care. But I think the main reason we have to talk about it and talk about it loudly and from the very beginning of a crisis is that, unless we're actually listening to women who are impacted by the crisis, their sexual and reproductive health needs are often just not seen, not prioritized, not responded to, and it becomes a life and death situation.

Jennie: You know, I think that's such an important point to think about is, like, you just don't stop being pregnant or stop getting your period. And these things are, you need to take into account right away because people, there are medical emergencies or just making sure you have basic access to care. But then there are other problems that creep up that increase during emergencies like gender-based violence. And I know you know a lot about this, so maybe you wanna talk a little bit about gender-based violence and child marriage in humanitarian settings?

Gayatri: Yeah, I mean, as you said, those practices, those issues tend to increase during an emergency. And there are a number of reasons why—there's loss of law and order, loss of social safety nets, unaccompanied children are at risk of sexual assault and abuse and exploitation. And so a lot of the issues increase during an emergency. At the same time the supportive services survivors need decrease or just become very, very limited. And so, you know, when you think about sexual assault and how you would normally respond to it, you would get post assault medical services, you would get, you know, prophylaxis against sexually transmitted infections. You would get emergency contraceptives to prevent unwanted pregnancies. A lot of that isn't a standard during an emergency. It's not easily accessible all the time. And so, unless we're thinking ahead and planning ahead and making sure that access to those resources and support are uninterrupted, we have a whole range of people who have experienced sexual assault or domestic violence or any, you know, other forms of gender-based violence, child marriage, but they're not getting what they need from the responses around them.

Jennie: It's one of those things, like, thinking about it in advance, like, having things prepared already and ready to go is so important. And I think that's something that has over the last several years we've been working on it. Like, you've seen this conversation happening more and more and, like, starting to get to that point where SRHR is incorporated early, but there are still clearly gaps. So, what are some of the gaps you're still seeing?

Gayatri: Well, we're seeing gaps in, you know, standard access to emergency contraceptives, access to abortion and abortion care. I mean for a lot of reasons, whether it's, you know, a legal restriction within the host country or you know, the country where the emergency's taking place or legal restriction by a donor who's, you know, funding the humanitarian response. There are so many limitations that can impact access to abortion and post-abortion care. There's a lack of investment in health infrastructure. So, as soon as, you know, hospitals or clinics or medical equipment are impacted by, you know, say an earthquake or conflict like an armed conflict, you're out of luck because you, you don't have those resources anymore. And so, I think planning ahead to make sure you have a steady stock and a steady flow of commodities and equipment that you need to respond to the reproductive and, and sexual healthcare that people need, that you have an enabling environment from a policy and legal perspective to get people to healthcare that they need. Those are things that you can plan ahead for. And so, we, you know, encourage countries to do that and for donors in particular to, to plan around that.

Jennie: Yeah, that is such, so important and like making sure that supplies can get to where they need to. I think, you know, we did an episode earlier, I think it was in May talking about about Gaza and, like, how hard it was to get supplies in, like, borders were closing and people weren't able to get like the supplies that UNFPA was trying to get in, or I mean, any supplies were talking food too, but so, it's so important. Like you can't just have the supplies, you have to have the policy at the same time to let the supplies flow.

Gayatri: Exactly. Exactly. And it's, I mean, a lot of the supplies and access can be politicized, but I think the point of humanitarian aid is that it's not political. It's intended to meet the humanitarian need irrespective of what side the person is on or how they got to that position to begin with. It is meeting a humanitarian need and if the needs for women and girls are not seen and not planned around, they're not gonna be addressed. So unfortunately, access and politicization of access is a big issue when it comes to meeting those needs on the ground.

Jennie: Okay. So, what other gaps are you seeing?

Gayatri: I mean, we're seeing...there's so many. I think we're, we're seeing, like I said, the lack of investment in infrastructure. We also see the loss of medical personnel, like people who can actually perform childbirth or who can treat newborns who are born premature or address high risk pregnancies or administer contraceptives or perform abortions, things like that are missing. And in times of crisis, it's a real gap. We're also seeing gaps really in terms of addressing mental health needs. And I think that's something that's very underappreciated, particularly in conflict or just in any crisis, that there are mental health needs, there's trauma, there's, you know, amongst children, it's, it's particularly difficult. You know, Ukraine was a good example where mental health and trauma was a big factor in how children are responding to the crisis. And so, if there isn't enough mental health care available, what does that lead to in terms of an entire generation or entire population of people who are not getting the support they need? I think just in general, creating an enabling environment for people to access resources, access information, and access, I guess, healthcare that is available in a way that meets their needs. Particularly marginalized communities like, you know, people living with disabilities, adolescent girls, racial or ethnic minorities who often have additional challenges accessing care. And you know, as from the response perspective, we really should be figuring out what those needs are and tailoring responses to meet them as well. And so, I think there are a lot of gaps in those respects and a lot of responsibility that humanitarians bear when it comes to having effective responses.

Jennie: You know, it really strikes me as like all of this comes down to, like, having all of these in-depth plans in advance because then, in the moment, it's so easy to fall into the traps of, like, treating the life and death needs, right? Like, food, shelter, emergency healthcare, but then not thinking of sexual reproductive healthcare, mental healthcare, because they are not, they don't feel in that moment if you don't have, like—these are all the things we need to have…

Gayatri: Mm-hmm.

Jennie: Like, it's easy to see them fall down the agenda.

Gayatri: Which is why we need to talk about them as life or death. And we need to talk about interventions that address these needs as lifesaving. I think that unless we create that sense of urgency and that sense of priority, they're going to just keep falling and falling down the list of things that need to be taken care of during an emergency. Because I mean, there's no way around it—emergencies are chaotic and you're never gonna be able to plan for every contingency. But recognizing this as a big category of life and death type of interventions, you have to, you must, or else you're- the consequences are gonna remain that we see 65% plus maternal deaths in a humanitarian context.

Jennie: Okay, before we move on to the next thing, I realize that...this is like I do this way more than I would like to admit on the podcast, y'all, I get so excited to talk to somebody, I forget to have them introduce themselves. Gayatri!

Gayatri: Oh no. [laughs]

Jennie: I obviously know you, so, like, I just jumped into our conversation, but like, let's go ahead and take a pause here and go: hey Gayatri, before we continue, would you like to introduce yourself and include your pronouns?

Gayatri: Don't worry, I forgot too. Hi Jennie, this is Gayatri Patel. My pronouns are she/her. I am currently the Chief of External Affairs at the Malala Fund, but I previously served as the Vice President of Advocacy at the Women's Refugee Commission and the Director of Gender Advocacy at CARE. So, I've worked in the human rights space, the development space, the humanitarian response space, and I love to think and talk about all things gender equality and gender justice.

Jennie: I have been lucky enough to work with Gayatri for quite a few years now.

Gayatri: I'm the lucky one.

Jennie: And she's been on the podcast before, but also very lucky to have her as a senior fellow for rePROs Fight Back. And this conversation is based off an amazing brief she wrote for us. We'll make sure to include it in the show notes where we were able to take advantage of all of Gayatri's expertise that she just outlined to write a great brief for us.

Gayatri: Thank you, Jennie. No, it's, it was so, it was a learning experience for me to write the brief and to kind of do the research behind it because it really illustrated kind of just the collective knowledge around what the gaps are, what the needs are. And I think naming the fact that women who are impacted by crises know what they need. They know what they're not getting and they know what they need. And listening to them as we—presumably from the outside—are trying to design responses to get them the services and support that they need. Really listening to what they're asking for and working with them to actually deliver services and fill some of those gaps because they have the local knowledge, the trust of their own communities, and we really have to have to develop those partnerships to make this effective. Jennie: In the context, right? The local context of, like, what matters to them and the way that they get it matters.

Gayatri: Exactly. Yeah. I mean we saw in Ukraine, like, the first responders, like, literally the first responders were the women's groups who were, like, let's get in there, let's get these, these, you know, unaccompanied children, let's get them sheltered. Let's make sure that they're safe and not being abducted. Let's make sure that there's uninterrupted access to contraception. You know, things like that. They know what they need and they know how to fill those gaps. We need to support them and listen to them.

Jennie: Well that brings us to just the perfect place 'cause that what's gonna be my next question is: what needs to be done to fill in these gaps and to meet those needs?

Gayatri: Well, I mean I think we have global standards that outline: what does it take? What do we need to prioritize the MISP, which is the Minimum Initial Stan...I forget, it's MISP. Everybody knows-

Jennie: I know, it's like, it's the MISP…

Gayatri: -what it stands for, but it is the gold standard when it comes to...Service, thank you. Yes, thank you. I'm sorry.

Jennie: Service Package? No, it's the acronym thing, man.

Gayatri: Yes, exactly.

Jennie: We need to implement the MISP.

Gayatri: It is that gold standard of, okay, this is, this is what we baseline need to do to meet the maternal healthcare, you know, sexual and reproductive rights in general care that we need as well as gender-based violence, which I think is often seen as like a little bit different, but a little bit connected. It should cover all of it. We need those kinds of things implemented and funded and supported and prioritized as part of the first tranche of humanitarian aid that we get out the door. We, there are standards and protocols around responding to gender-based violence in emergencies, including how to mitigate risk, how to how to, you know, establish referral protocols so that people who have experienced sexual assault get the specialized services they need There are protocols around mental health and, and how to respond to gender based violence from a mental health standpoint. In terms of what we need, we need some of those standards to be, to be implemented and operationalized and supported and regularized in any emergency. But we also need, again, to listen to: what are the local needs on the ground? And what is happening? And who's doing what? Because humanitarian response can, there are a thousand ways that it can go off track. If you have that grounding in local knowledge and local expertise and local trust, you have a much better chance of actually meeting the needs on the ground. So I think those are, those are the big priorities. And I mean, I think you can't go wrong when you plan ahead, right? Like if you're, if you're making sure that all of the levers are in place, all of the commodities are in place, the flow of information and equipment and tangible things and knowledge of all of that expertise is available and set up ahead of time, it makes for a stronger, more responsive and more efficient kind of intervention.

Jennie: And I can only imagine the funding is available, making sure that we are funding humanitarian responses.

Gayatri: Oh, absolutely. Did I not say funding?

Jennie: I mean, I just assume it's a given, but sometimes we need to be explicit.

Gayatri: I totally agree. I just, I, all of this stuff takes funding, right? It, I mean, we can't support local organizations if we're not actually funding them to do what they do. We need to fund the equipment, the commodities, the personnel, the expertise, the rebuilding of infrastructure. We need funding for all of that. And so you and I, as advocates, that's what we do. We push the US government, we push other governments to make sure that they're putting their money where the priorities are, but we also, we also look for them to put it in specific ways, including funding to those who are on the ground already. Jennie: And that just makes me think of like the next project we have you working on is looking at some of the global stuff around Project 2025, but, like, thinking through making sure that the funding is going to the groups that are doing this work. And so, going to UNFPA and groups that, if there is an unfriendly administration, can block funding to, because they don't like the work that they are doing. And you're seeing this spread to the UN system more writ large, but they are the people on the ground doing this work.

Gayatri: Absolutely. And I mean, you took the words right out of my mouth. If you're not getting funding to, you know, the big institutions like the UN, particularly UNFPA or UNICEF, if that's not trickling down to the actual aid personnel, you're not gonna get the best outcomes that you're hoping for from humanitarian response. But similarly, the policy and funding is so interconnected. If you have a policy that is very hostile to reproductive rights and choice and justice, that is going to have a chilling effect on how aid organizations meet the needs on the ground. And so, we have to look from, from a bigger picture policy perspective: are we restricting things in a way that's really just at the end of the day causing the loss of life?

Jennie: Yeah, that makes me think of, there was a really great piece a couple years ago that Jill Filipovic wrote, I think it was maybe in Cosmo—don't quote me on that though. And we, I did a podcast episode with her, but she was talking about the harm of like the Helms amendment, particularly in conflict settings where people are not being able to get safe abortion care because of the Helms amendment. And so, they're going and maybe getting unsafe care because they're having to go where the US isn't funding and then we are able to treat them after they have gotten unsafe care. And so, putting their lives at risk, getting care that we should be able to provide them safely.

Gayatri: Absolutely. I mean, that was one of the things that I think was the most illuminating for me in terms of just how impactful restrictions on abortion and post-abortion care are on lives, how risky they are, how dangerous they are. And pulling up the statistic that really surprised to me the most, which was…gimme a second.

Jennie: Yeah, and while you're looking…

Gayatri: When demand for...oh sorry. Go ahead.

Jennie: Yeah, just while you're looking we'll make sure to include a link to that episode where I talk to Jill in the show notes. So, if people want to learn more about this particular part of Helms Amendment, like they can, they can look at that, okay, you found it.

Gayatri: I found it. "Globally, 7 million women and girls are disabled or injured, and 29,000 die as a result of unsafe abortions every year." So, when we have overly restrictive environments where people cannot safely get an abortion, they are naturally going to turn to unsafe abortions. And the consequences with unsafe abortions are stark and shocking. And I just wanna say, like, that was really shocking for me as someone who has worked in this space for a while to know just the scale of what happened. 7 million women disabled or injured, and 29,000 die per year when unsafe abortion is the only option for women in any context. But you can imagine in an emergency, it could be particularly worse.

Jennie: So, one of the things I really loved about the brief is you talked about some new innovative solutions that you recommended. Can you talk about some of those?

Gayatri: Yeah, I mean, when, when we're talking about things like loss of infrastructure and feeling a sense of like disempowerment from the point of view of the survivor of gender-based violence or something like that, we really need to think through: okay, what are the innovative solutions that are actually going to address these gaps? And so, some of the practices or some of the new approaches that seem to, you know, be filling some of those gaps are things like mobile clinics, which UNFPA the UN Population Fund have really invested in over the years in terms of, in having these mobile clinics that, you know, get to hard to reach places, meet the needs of, of hard to reach populations, and really have an impact in terms of preventing maternal death, preventing newborn death, providing contraceptives and STI care, et cetera. And so, you know, really thinking through: how can we scale that up? It's not a substitute for rebuilding infrastructure, but it's something that can meet short-term needs. Similarly, I think there's a lot more investigation of the idea of cash assistance and how putting power back in the hands of people who are, you know, impacted by marginalized, by emergency and by, you know, things like gender-based violence, how to put power back into their hands. And so, cash assistance is one way where people can, you know, use money to access what they individually need or as a family need. They can get the food that they need. They can, you know, prioritize getting shelter or prioritize getting legal assistance so that they can, they can get away from abusive partners, but really, you know, putting the power back into their hand to determine what is most suitable for them and enabling them to access that. And then, you know, really just thinking through things like how to make contraception more readily available, how to makemidwives or other medical personnel who don't necessarily have, you know, the eight years of medical school training, but they have the training they need to be able to deliver babies in a healthy and hygienic environment or administer basic care for sexual assault or, you know, refer people to, to services that they need. Investing in things like that, that can kind of get into the cracks of what's missing—it seems to have promising results.

Jennie: I love hearing about new and innovative solutions and start thinking about the ways that we can scale some of them up.

Gayatri: Exactly.

Jennie: Okay. I always like to wrap up by thinking about: what can the audience do? So, what can the audience do right now?

Gayatri: I mean, I'm always going to push an audience, anybody to use their voice and, and reach out to their policymakers. I don't know. I think it's exciting. Some people find it nerdy, but, you know, call on your member of Congress or your representatives to pay attention to these needs and prioritize them. They all talk about humanitarian emergencies and because that's part of their job. And so we need to be vocal about having this be on their radar as a key critical need in an emergency from the very beginning. Call on your policy makers to fund the right approaches to humanitarian response that take into account these needs and challenge, challenge your policy makers to uphold human rights. And that means addressing those legal restrictions that make pregnancy, childbirth, sexual assault, other forms of gender-based violence, child marriage particularly, and uniquely dangerous during an emergency.

Jennie: You know, it may sound like nerdy to call on your member of Congress, but I, I especially think about it in this context is this is an issue where there's probably not that many people calling. And so, your voice may carry a lot of weight because they're hearing from so few people about this topic that one voice of like, hey, have you thought about this? Are you thinking about this? You're not, it's not like one in like hundreds or whatever. So, it can actually make a difference.

Gayatri: Yeah, it really can. And I mean, just speaking about the life threatening consequences of it. You don't wanna overdramatize, but this, I don't think this is overdramatizing anything. We're talking about real people, real lives at risk and I can't help but find that compelling and I hope that policymakers would too.

Jennie: Well, Gayatri, as always, it is such a delight to talk to you, everybody. You should definitely check out Gayatri's Brief she wrote for us. It is wonderful. It'll be in the show notes as well, and as always, like I said, a joy.

Gayatri: Thank you so much, Jennie. It's such a pleasure to be here.

Jennie: Okay, y'all, I had so much fun talking to Gayatri. It's always delightful when I get to have friends on. It's one of my favorite things to get to show off all of my very super smart friends. I'm so lucky to have so many of them. And yeah, with that, I guess I will see y'all in a week. [music outro] If you have any questions, comments, or topics you would like us to cover, always feel free to shoot me an email. You can reach me at jennie@reprosfightback.com or you can find us on social media. We're at @RePROsFightBack on Facebook and Twitter or @reprosfb on Instagram. If you love our podcast and wanna make sure more people find it, take the time to rate and review us on your favorite podcast platform. Or if you wanna make sure to support the podcast, you can also donate on our website at reprofightback.com. Thanks all!