"There were no means of transport, so they prepared a bicycle. She lost a lot of blood and when she arrived at the district hospital, she wasn't paid much attention. Around 6 a.m., both the mother and baby died. I witnessed it. The woman was 38 years-old." These are the words of a man from the Kisumu district in Kenya, describing a pregnant woman in his community who had died while giving birth during the post-election violence that rocked the country in early 2008.
This kind of scenario plays out every day, around the world; more than 350,000 women die during pregnancy and childbirth every year. Ninety-nine percent of these deaths occur in developing countries, where the lack of access to quality health care and information results in high fertility rates and closely spaced births, increasing women's and girls' risk of death and disability. Indeed, pregnancy can be a matter of life or death for women and girls in these places; and, their infants' lives are in jeopardy as well.
Not surprisingly, the overwhelming majority of the countries with the highest rates of maternal death are conflict-affected. In countries like Somalia, maternal and reproductive health systems were severely limited even before disaster hit, and now, services are even weaker and scarcer. In this environment, those displaced and uprooted by conflict or disaster are at heightened risk of life-threatening complications during pregnancy and childbirth. And pervasive sexual violence, including rape, increases the likelihood of unwanted pregnancy and sexually transmitted infections. In crisis situations, sex work tends to escalate out of necessity -- with women forced to exchange sex for money or food to support their families -- and this further raises their risk of unwanted pregnancy and unsafe pregnancies and births.
To address the critical maternal and reproductive health needs of women and girls in such settings, the Women's Refugee Commission advocates for implementation of a set of priority lifesaving reproductive health activities at the very onset of humanitarian crises, known as the Minimum Initial Services Package (MISP) for Reproductive Health in Crisis Situations. This compendium outlines the priority services that must be provided to prevent death and disability, particularly among women and girls. We advocate for international aid agencies and local health organizations to ensure that basic emergency obstetric care is available at all times, clinical services for survivors of sexual assault are provided and contraceptives are accessible to meet demand. Once the situation in the country stabilizes, the full array of maternal health and family planning services should be made available.
The international community has made significant progress over the last 10 years in improving reproductive health care in emergency situations. Services are now more widely available, and these standards have been worked into international frameworks and action plans. Yet, there is much more to be done to ensure that all women and girls -- especially those uprooted by crisis -- can access high-quality reproductive health services and safely deliver their babies.
For example, meeting with maternal health care providers on the front lines in crisis-affected areas we found that many of them reported feeling isolated and unsupported in their work. Recognizing that there was a need for health providers from different conflict- and disaster-affected areas to share their experiences and knowledge, the Women's Refugee Commission created the initiative Mama: Together for Safe Births in Crises. Using social networking, Mama links doctors, nurses and midwives to each other and to experts so they can access the latest information from the field, share ideas and support one another.
Maternal health care providers obviously have a huge role to play in improving services. We have to better equip, train and support them, but they're not the only ones who can effect change. It's time we all step up our efforts to ensure that women and girls everywhere can decide freely if and when they want to have children, that all mothers can deliver their babies safely and that services are available for women who have suffered gender-based violence. From famine-ravaged Somalia to earthquake-devastated Haiti, sexual and reproductive health care has been one of the most neglected areas of humanitarian assistance. We cannot let women and girls pay the price any longer.