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Barriers to providing reproductive health care for internally displaced persons

Reproductive health care for internally displaced persons is a neglected area in humanitarian relief operations. Though the international community acknowledges reproductive health is a basic human need, humanitarian agencies need to coordinate their activities if they are to provide health services effectively.

A paper from the London School of Hygiene and Tropical Medicine, in the UK, presents the results of interviews with representatives of 12 relief and development agencies providing health care for populations affected by conflict. The authors consider the barriers these agencies face when providing reproductive health care to internally displaced people (IDPs) and their strategies to overcome them.

There are an estimated 25 million IDPs worldwide, most of whom are excluded from comprehensive health interventions. IDPs can be defined as people who have had to flee their homes due to conflict or natural or human-made disasters but remain in their country of residence. Refugees are protected under the Convention Relating to the Status of Refugees, yet IDPs are not recognised internationally by any legal instrument. As a result, agencies have not been able to tackle systematically the plight of the growing number of IDPs.

Sections on reproductive health are now included in guidelines for caring for conflict-affected populations. Moreover, the Inter-Agency Working Group (IAWG) and the Reproductive Health in Conflict Consortium (RHRCC) have called for humanitarian agencies to expand their capacity to offer reproductive health services to IDPs. However, they will have to overcome the following barriers:

A lack of common goals, isolated planning and poor coordination amongst international partners, agencies and local communities means duplication of efforts and heavier workloads.

Due to financial constraints agencies have to compete for the same funds when they could perform better if they built strong partnerships.
Governments with conservative values and international government agencies whose policies reflect certain cultural or religious beliefs may not prioritise reproductive health services.
Even where agencies explicitly mandate reproductive health services, there may be little managerial commitment to providing these services.
Prioritisation of other services is common, especially in decentralised and multi-sectoral agencies.
There is no international legal framework to protect the rights of IDPs.

Reproductive health and IDP-specific responses are key to overcoming these obstacles. Agencies can also work to close the gap between the international community’s commitment to providing reproductive health care for IDPs and the restrictions agencies face in this respect. The study recommends that agencies:

raise awareness internally and with their partner organisations (including funding agencies) on reproductive health issues for IDPs
share tasks and their expertise with other agencies at the local level
improve agency management and work to strengthen inter-agency coordination and collaboration to reduce the duplication of efforts and conserve resources
explore the possibility of an international convention that recognises and protects the rights of IDPs.

Source(s):
‘Providing Reproductive Health Care to Internally Displaced Persons: Barriers Experienced by Humanitarian Agencies’, Reproductive Health Matters 16 (31), pages 33 to 43, by Nina Hakamies, Paul Wenzel Geissler and Matthias Borchert, 2008

id21 Research Highlight: 2 November 2008

Further Information:
Nina Hakamies
WHO Sri Lanka
No. 226
Bauddhaloka Mawatha
Colombo-7, Sri Lanka

Tel: +94 11 2502319
Fax: +94 11 250 2845
Contact the contributor: ninahakamies@yahoo.com

WHO Sri Lanka, Colombo, Sri Lanka

Paul Wenzel Geissler
Health Policy Unit
London School of Hygiene and Tropical Medicine
Keppel Street
London WC1E 7HT, UK

Tel: +44 20 79272490
Fax: +44 20 76375391
Contact the contributor: wenzel.geissler@lshtm.ac.uk

Health Policy Unit, London School of Hygiene and Tropical Medicine, London, UK

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