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Last week marked a real victory for women. At the London Summit on Family Planning, donors made significant financial commitments to expanding family planning to some of the most impoverished women and girls in the world. The Bill & Melinda Gates Foundation, the UK government and a host of other donors—many of them developing countries themselves—pledged $4.6 billion to the effort. These funds are projected to give an additional 120 million women access to lifesaving contraception, allowing them to choose if they would like to have children, when and how many. This landmark commitment may be a major leap forward for women’s health and rights—and economic progress as well.
Yet somewhat missing from the conversation was a clear recognition of the dire need for family planning and reproductive health care in countries that are affected by humanitarian crisis. The majority of countries with the highest ratios of maternal death have been affected by conflict or disaster. And it’s estimated that upwards of 15 million women of reproductive age were affected by these crises in 2010 and 2011.
It’s clear that to really make improvements in women’s health and to save lives, family planning has to reach women living in these regions—where the risks abound and the stakes are high. In places like South Sudan and Afghanistan, women die, at alarming rates, from obstetric complications because they do not have access to maternal health care and because they don’t have access to the contraception that would have prevented unwanted pregnancies in the first place. In places that have been ravaged by war or natural disaster, clinics are scarce, roads are in poor shape and medical staff are hard to come by. In crisis settings, there are added complexities and challenges than in areas that are just economically poor, but the impact of providing family planning is just as great—or even greater.
For donors averse to risk, providing services in politically unstable countries could seem like a dangerous gamble. But in fact family planning is a safe bet. As was articulated by many at the summit, it is one of the wisest investments you can make. When a woman or girl can decide freely if and when she wants to start a family, she is more likely to stay in school, get a job, stay healthy and care for her family, all the while contributing to her community and national economy. In fact, there are direct links between family planning and political stability. Countries that do not have wide access to family planning are not able to educate and employ their burgeoning young populations, leading to conditions primed for civil unrest.
Providing family planning is not only smart, but it’s also not as difficult to do in countries affected by crisis as it may seem. Unlike other health services that require highly trained staff or surgeons, many short-term contraceptive methods like the pill and condoms can be provided by community health workers, and a broader range of methods can be made available at basic health facilities.
In research the Women’s Refugee Commission and the UN refugee agency conducted in five countries affected by humanitarian crises, we found great unmet need for family planning. Women in crisis-affected areas often did not know about family planning options, had misconceptions or couldn’t access it. But many were keen to use it once they and their partners understood the benefits. As a refugee living in Uganda told a colleague: “All these years I just kept reproducing because my husband wanted me to, and because he didn’t like me using family planning, and now I have told my daughter to never make the mistake I made by having ten children when I could have stopped.”
Family planning in crisis-affected countries, especially among refugees and others who are displaced, is critical because it can prevent many young women and girls from dying during pregnancy or childbirth or from suffering devastating obstetric injuries like fistula. In the Sahel region of Africa, which already had the world’s highest rates of child marriage and severely limited access to family planning, a severe hunger crisis is exacerbating the situation. Desperate parents are marrying off their daughters before they are 15 so that they can get the dowry money and because girls are often seen as a burden. Since their bodies are not yet fully developed and they have limited access to reproductive health information and services, these young girls are particularly at risk for pregnancy and childbirth complications and death.
Quite simply, family planning saves girls’ lives. As was recently reported by Save the Children, pregnancy is the leading killer of teenage girls worldwide. Yet, contraception is rarely available in the places it is needed the most.
We have to make sure the most vulnerable girls and women, who are often those displaced by war and disaster, have access to this lifesaving option. Getting it to them is possible and can have lasting and profound impact today and for generations to come.
Sarah Costa is Executive Director of Women's Refugee Commission