What is it like to have your life put on hold? Ask any of the 32 million women and girls of childbearing age who live in emergency situations.[1]
For them – many still adolescents – the future is not something they can plan. It has been thrown into doubt by warfare, displacement or other catastrophes. School, friends, a job – all may have to wait for months or even years.
But there are some things that cannot wait. In the words of Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization: “Every woman should have the right to decide whether, when and with whom she has a baby.”
This means having access to modern contraception, so women and girls can control their futures by timing, spacing or preventing pregnancies – even in the middle of a crisis.
Claiming their rights
Worldwide, an estimated 214 million[2] women in developing countries have an unmet need for modern contraception. Although this number is staggeringly high, it has been reduced in recent years by investments in sexual and reproductive health and rights. However, progress is held up by gender inequality and the on-going politicization of women’s bodies. It is fragile and could easily be reversed.
Many of these 214 million women live in poverty. And a growing number live in countries that are beset by crises – natural disasters, climate change, conflict, and displacement. Last month, UNHCR released new figures indicating that a record 65.6 million people are forcibly displaced worldwide.[3] Women and girls who are living in crises have specific sexual and reproductive health needs and must have access to a full range of sexual and reproductive health information and services, including modern contraceptives.
Contraceptives cost just a few cents, but their impact can be life changing. However, when women are denied access, for whatever reason, they face a much greater risk of unplanned and unsafe pregnancies. This is especially dangerous for adolescent girls – for whom death in childbirth is the leading cause of death globally[4] – and for all women and girls in settings with limited access to maternal services and obstetric care. Unplanned pregnancies can also lead to unsafe abortions, which account for between 5 and 13 per cent of all maternal deaths.[5] Lack of access to family planning leads to a denial of dignity for women and girls that undermines their control over their futures in already precarious times.
#HerFuture
This week, leaders, policy-makers, and advocates from around the world will gather in London at the Family Planning Summit. At the first such summit in 2012, $ 2.6 billion was pledged with the goal of reaching millions of women with contraception by 2020. Five years on, two of the summit’s key goals are to ensure that family planning is better integrated into humanitarian response, and to give all women and girls a safer, healthier and empowered future.
This will be challenging. Despite a strong evidence base for the effectiveness of sexual and reproductive health interventions in general, a recently published Lancet series on public health in humanitarian crises found only a handful of studies on the effectiveness of family planning in humanitarian settings – and none for post-abortion care or safe abortion.[6] Research into the effectiveness of interventions in fragile settings is complex, but greater investment is needed to ensure that action to reach women and girls in these most difficult of settings is based on the strongest possible evidence.
WHO’s work is about serving people regardless of where they live, poor or rich, displaced or disabled, elderly or the youth. We are committed to working with all partners to increase contraceptive options, to increase access to them, and to find more effective ways of delivering family planning, including in emergencies. Later this year, WHO will launch a multi-partner consortium to strengthen collaboration between aid agencies on the ground and researchers so that high quality evidence on sexual and reproductive health and rights in humanitarian settings is generated to better meet the needs of women and girls.
Investing in family planning saves lives. But the ripple effects are even greater. By investing in family planning we also invest in realizing human rights, upholding dignity, and sowing the seeds of truly sustainable development, especially for women and girls on the move.
[1] United Nations Office for the Coordination of Humanitarian Affairs (OCHA), (2016), “Global Humanitarian Overview 2017,”; it is estimated that 128 million people are currently in need of humanitarian assistance and 1 in 4 are women and girls of reproductive age according to UNFPA “State of the World Population 2015” report
[2] Guttmacher Institute: Factsheet on investing in contraception and maternal and newborn health, 2017
[5] Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, Gülmezoglu AM, Temmerman M, Alkema L. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014 Jun; 2(6):e323-33.
[6] Blanchet et al. Evidence on public health interventions in humanitarian crises. The Lancet, 8 June 2017.