Respectful Care for Women and Newborns in Crisis Settings: A Human Right

By Caroline Kinsella

Maternal and newborn deaths must not be accepted as inevitable consequences of an armed conflict, natural disaster, or disease outbreak. This World Refugee Day, it is crucial that we listen to the displaced women and girls around the world demanding respectful and quality care in humanitarian settings.

UNFPA anticipates that In the next three months more than 500 babies will be born to refugee mothers from Ethiopia’s Tigray region. Of the more than 70,000 refugees who fled to neighboring Sudan as a result of the ongoing violence that began last November, an estimated 1,594 women are pregnant and in critical need of life-saving maternity care services and supplies. More than one million people remain internally displaced across Tigray, in a country that even before the onset of the fighting was experiencing some of the highest maternal mortality ratios and neonatal death numbers globally.

Alarmingly, the worldwide number of forcibly displaced individuals has reached a record total. In the Ethiopian conflict and around the globe, violence and emergencies compound the vulnerabilities of pregnant women by limiting resources, destroying infrastructure, and posing security risks to women and humanitarian health workers. Without access to cost effective and lifesaving interventions, about 500 women and girls die every day in fragile states or countries affected by humanitarian crises from pregnancy and childbirth complications. Neonatal mortality rates and stillbirths are also highest in these settings, and globally, 45% of newborn deaths occur in unstable countries or those that have recently experienced humanitarian emergencies.

In emergency situtations, the scramble to coordinate and re-establish health care services to vulnerable populations and pregnant refugees, the quality of that care is often overlooked and considered secondary to the immediate provision of resources. The abandonment, neglect, lack of consent, and other forms of abuse that women can experience during maternity care in stable settings has been amplified  in refugee settings by the COVID-19 pandemic, a lack of translation services, and tensions with host communities. When a woman experiences mistreatment and abuse at a health facility, or she does not feel comfortable voicing the care she needs, she may choose to deliver alone at home. In a humanitarian situation, giving birth without a skilled birth attendant, proper sanitation, and quality emergency obstetric or neonatal services puts the woman and her baby at heightened risk of health complications during and after delivery.

Yet respectful maternity care (RMC) is a universal human right, even in emergency settings. The Respectful Maternity Care Charter explicitly outlines the fundamental rights of childbearing women and newborns grounded in international and regional human rights instruments. To combat sexual and reproductive health-related mortalities and morbidities in crisis-affected populations, the Minimum Initial Service Package (MISP) serves as an international standard for immediate life-saving interventions in all global emergency response programs. RMC as a human right is at the core of the MISP objective to prevent maternal and newborn deaths, and the RMC Charter was added to the 2018 Inter-Agency Field Manual on Reproductive Health in Humanitarian Settings.

While every conflict and disaster context is unique with its own host of actors and challenges, a gender lens that considers the human rights addressed in the RMC Charter and access to the entire sexual and reproductive continuum of care should be central to emergency response programming. Building trust between humanitarian health workers and displaced or refugee women lays an essential foundation for quality and dignified care while navigating stressful environments.

Although there are gaps in research about health outcomes in refugee camps and other humanitarian settings, women’s voices are evidence  enough to show the need for change. The What Women Want campaign asked 1.2 million women and girls from  114 countries to state their one demand for quality reproductive and maternal health care. Responses from refugee communities in Kenya and Uganda revealed that women and girls asked for clean water, supplies, and training for refugee women to become midwives to facilitate safer childbirth and provide culturally competent and    community-based care.

Women everywhere have entitlements to the right to health, including the social determinants of health. Fulfilling these rights, including in humanitarian settings, calls for the prioritizing of respectful maternity care. Programs in these settings should be guided by human rights frameworks and humanitarian response tools with multi-sectoral coordination and longer-term investment. It is important on World Refugee Day (20 June) we make demands on states and service providers in humanitarian and crisis settings to respect the rights of refugees and internally displaced persons to help reduce preventable maternal and newborn deaths and morbidities.

Caroline Kinsella is an Advocacy and Communications Intern with White Ribbon Alliance. Email: ckinsella@whiteribbonalliance.org