This lecture is divided into multiple sections. Each covering an important aspect of sexual and reproductive health and rights. Decades of evidence show that sexual and reproductive health and rights are critical for health wellbeing and development any setting. The need for investment in information and services to meet the needs of women, men, girls and boys is even more critical in humanitarian settings where health systems, livelihoods, and social support networks maybe weakened or disrupted. Sexual and reproductive health services are often seen as lower priority than other health services in humanitarian settings. However, of the more than 100 million people in need of humanitarian assistance each year, one and four are women and girls of reproductive ages 15-49. Women and girls like those shown in these four pictures have the rights to decide whether or when they will become pregnant, to give birth safely, and to be protected from sexually transmitted diseases and gender-based violence. Although these rights are focused on individual autonomy and choices, virtually everyone needs information and services to fulfill their sexual and reproductive rights. Ensuring quality information and services are available and safe supportive environment to meet population needs and minimizing obstacles to overcome an accessing them are a critical component of all humanitarian response. Let's take contraception, family planning, and birth spacing as our first example. These terms are often used interchangeably. Contraception is a means of preventing pregnancy. Birth spacing is the practice of maintaining an interval between births. The World Health Organization recommends a minimum of two years between births as this reduces risks of health problems for both the mother and newborn. Family planning is the comprehensive range of practices that allow individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. We use the term contraception as the broadest of these three terms with the understanding that contraception can be used outside of birth spacing or family planning to improve the health of women, girls, and their communities. There are many types of contraception and preferences vary from person to a person. Contraceptive methods are often categorized as either short acting or long acting or permanent. Although there is no strict time criteria for these categories, methods are typically classified as short-acting when they provide protection from pregnancy for one act of sexual intercourse, one day, or one to several months at a time. Short-acting methods include oral contraceptives, the patch, the vaginal ring, injectables, barrier methods, fertility awareness, and the lactational amenorrhea method, and withdraw. Long-acting methods are methods that provide protection from pregnancy for years at a time. These are reversible. Why is contraception so important? When no contraception is used, approximately 85 out of a 100 sexually active women and girls will become pregnant within one year. Estimates suggests that 30 percent to 40 percent of women in need of humanitarian assistance did not want to become pregnant in the next two years, and 12 percent to 35 percent wanted to limit future pregnancies. The proportion of women who want to prevent pregnancy can be even higher in some populations. For example, nearly three and four pregnant refugees in one recent study in the Middle East wish to prevent future pregnancy and more than one-half did not desire their current pregnancy. Why is there such high unmet need? A wide array of factors such as method availability and individual knowledge, preferences and concerns influence patterns of modern contraceptive use. For example, in some crisis affected settings, there may be few appropriately trained providers available. No reliable supply of contraceptives or no safe and affordable way for women to reach where services are provided. Even when services are available, communication challenges especially language differences, workload of staff, lack of knowledge about contraceptive methods or the availability of certain methods may prevent health care workers from providing or referring clients for additional services. Social norms also prevent people especially adolescents and unmarried women from accessing services and using contraceptive methods effectively. In some cases, health provider community assumptions about these women and girls needs conflict with their own assessments of their needs. Providers thinks they know best. Finally, laws and regulations may place restrictions on who can provide methods excluding an entire Kadra as health care providers who could do it safely. For example, some longer-acting methods are only allowed to be provided by doctors. Restrictions may also be placed on who can receive methods such as excluding provision to unmarried women or requiring parental consent for minors. These regulations vary country to country and do change over time. These challenges and also promising strategies for reducing unmet need for contraception are not unique to humanitarian settings. Focused efforts and sustained investment are key to expanding method options and reducing unmet need for contraceptives. For example, in many settings, there have been good models of training health workers than informed Choice counseling, and shifting responsibilities for contraceptive provision from doctors to midwives or nurses to decrease waiting times or increase the availability of services at lower level clinics. In sharing a continuous reliable supply of family planning and contraceptive commodities is essential in all settings, however, the way this is done varies from place to place. Supporting a supply chain system that keeps service delivery point stocked is essential. In some settings, this may mean providing funds to the government or technical support. In others, it may mean directly purchasing or supplying reproductive health kids with all the supplies needed to provide services to a large population, or purchasing only specific commodities that are in short supply at a given clinic. This picture shows staff of a humanitarian agency unpacking one of those large reproductive health kids. Engaging with communities to ensure cares client-centered is another critical strategy for reducing unmet need for contraception. Essential elements of quality and care include a full choice of quality contraceptive methods, clear and medically accurate information to help women, girls make choices about what method is best for them. Equipped and technically competent providers and Client provider interactions that respect informed choice privacy and confidentiality and Client preferences and needs. Different strategies may be needed to ensure the availability and quality of services for new users, current users, who may wish to continue or to change their method, and past users who still want to avoid pregnancy. Integrating services and strengthening referral pathways to avoid missed opportunities is another strategy for reaching women and girls with unmet need. One example of this is counseling during antenatal care, pregnancy, or postnatal visits. Another is identifying mothers of young children during immunization or well childcare and referring them to a family planning clinic if they're interested in seeking services. A final strategy for reducing unmet need for contraception is to optimize the use of new technologies. An example of this is the app in the photo on this slide. This app is a job aid for health care providers to help counsel women and determine which contraceptive methods they're eligible for given their age and health conditions. Another example of new technology is research and development in contraceptive methods. In this photo, we see an injectable contraceptive. One with a self injection that can be given by women in their home or at a clinic. Wise contraception, so important. Contraception has a significant impact on maternal mortality by preventing unwanted pregnancies. Better birth spacing means better child outcomes. Access to desired contraceptive methods reduces the risk of unintended pregnancy and in turn abortion. This also contributes to sustainable rates of population growth reducing economic stress and poverty. It's possible to provide contraceptive services even in the most challenging settings. But this requires dedicated resources and commitment. Even though global guidelines identify contraceptive services as an essential life-saving component of humanitarian response efforts. Just like provision of clean water, shelter, food, this is rarely given sufficient attention, leaving many women and girls with unmet needs.
