The International Rescue Committee (IRC) helps people affected by humanitarian crises to survive, recover and rebuild their lives. New thinking is required to address the evolving and growing nature of humanitarian crises, and there is a lack of proven, cost-effective, scalable services for people affected by them. Airbel Impact Lab is IRC’s research and innovation center, designing, testing, and scaling life-changing solutions for people affected by conflict and disaster. Airbel’s aim is to find the most impactful and cost-effective products, services, and delivery systems possible.
One of the IRC’s research and innovation priorities is Sexual, Reproductive, Maternal and Newborn Heath, identified because of the pressing need, the lack of evidence on effective service delivery in humanitarian contexts, and the opportunity for identifying high impact solutions. Due to the often-limited access to formal health systems in low-resource, conflict-affected settings, IRC seeks to invest in expanding the options, the quality of services, and the uptake of health behaviors that can be self-delivered or delivered by community-based actors.
The IRC is exploring ways to ensure women and girls can safely and voluntarily prevent and terminate pregnancies themselves and adhere to good practices during and after pregnancy in the context of weak and disrupted health systems. Priorities for research and innovation include: designing effective models for self-managed contraception and abortion and creating an environment conducive to the uptake of life-saving behaviors for immediate postpartum maternal and newborn care.
The IRC is also exploring the feasibility of equipping low-literate community health workers with the tools and training to deliver high-quality SRMNH services tailored to women’s and girls’ needs, in areas where there is no reasonable access to health facilities. We will also explore the use of other community agents, such as pharmacists, traditional healers, and teachers to increase access to health knowledge and services. Moreover, innovative supply chain solutions can ensure the provision of necessary commodities like chlorhexidine, misoprostol, and contraception, at the community level.
Nathaly Spilotros is the IRC’s Sexual and Reproductive Health and Rights Advisor for Research and Innovation and leads the strategic direction and vision for the organization’s Self-managed Contraception and Abortion Global Research and Priority. In this role, she manages, coordinates, and provides technical support for operations research and innovation programs on SRHR self-care. She is excited to have joined the SCTG, as a steering committee member, earlier this year.
Health actors have provided increased attention on SRH care in recent years, but investments in access to self-care are almost never made in places where the most vulnerable women and girls live. With up to two-thirds of the world’s extreme poor estimated to live in fragile, crises, or conflict affected settings by 2030, and 61% of maternal deaths occurring in these contexts, there is a real risk that millions of vulnerable women and girls living in humanitarian and fragile settings will be left out of the self-care revolution.
All individuals, regardless of their background or current situation, have the right to make their own SRH choices and access to these essential services should not be denied. In these humanitarian situations, self-care provides a critical opportunity to ensure access to necessary sexual and reproductive health (SRH) services and is becoming increasingly recognized for its potential to fill critical gaps in disrupted health systems through increased self-management, self-testing, and self-awareness.
Despite great promise, there is a lack of funding and investment to do SRH self-care work in humanitarian settings; subsequently, there is a lack of research and previous implementation to make the case to donors for funding. So far, pilots conducted have been in isolation and not within multipronged programs with access to SRH services. Details of the interventions themselves, study settings, and factors influencing implementation have not been fleshed out, and no studies have documented articles on barriers to self-care or implementation considerations in humanitarian contexts.
Programmatic models are needed to inform decision-makers around the allocation of resources for safe and effective SRH self-care intervention implementation in areas with severely disrupted health systems. Implementation research is also needed and must inform policies and programs through both expanding the use of established self-care interventions to humanitarian contexts and generating evidence on new models of care in these settings. In particular, replication and multi-country studies are needed, along with more robust details on how promotion and support for self-care are tailored to context-specific population interests and health system considerations. The package of self-care interventions may vary based on fragility typology, acuteness and local context, and the key stakeholders and target audience may differ.
To realize its revolutionary potential in humanitarian settings, we need investment to increase the evidence base, scale up availability of commodities, and integrate self-care into national, regional, and global guidelines and standards—and this must be inclusive of humanitarian settings as well as stigmatized and frequently sidelined SRH service areas such as safe abortion care.
As a feminist organization committed to gender equality, IRC believes the right to access abortion care is central to a person’s autonomy and ability to make decisions about their future. The IRC approaches the issue of safe abortion care on the basis of evidence and derived from a careful analysis of the needs of the people we serve in humanitarian settings around the world. Prevention of unintended pregnancies through effective family planning is an important and positive driver of women’s health, and access to safe abortion saves lives, unsafe abortion being a major driver of maternal mortality worldwide. The provision of a full range of reproductive health services, including family planning and safe abortion care, is an important contribution to ensuring that all women and girls are able to fulfill their potential.
While the humanitarian community has been working to prioritize access to sexual and reproductive health services, provision of safe abortion care as a core component of emergency response and humanitarian aid delivery lags far behind.
While approximately half of abortions worldwide are unsafe, the burden of unsafe abortion and its consequences do not fall equally on all women and girls. Poor women and girls who live in countries where abortion is restricted are most likely to experience complications or die from an unsafe abortion. There is a critical gap in the data on the incidence of unsafe abortion in humanitarian settings, but the evidence available suggests heightened need.
The IRC already works to reduce the risks of unsafe abortion through provision of contraception and quality post-abortion care to treat complications resulting from unsafe procedures. But even in settings with excellent coverage of contraception, women and girls still experience unintended pregnancies; and many will seek any means to terminate a pregnancy, however risky or legally restricted the procedure. Expanding access to safe abortion is essential to protecting women’s health and saving lives.
Expanding access to safe self-managed abortion commodities is an important way to ensure women and girls who are unable to go to health facilities obtain the care they need and retain their sexual and reproductive autonomy. Safe, self-managed abortion-models include harm reduction counseling, a proven method of guiding safe self-management of abortion to women and girls with unintended pregnancies by trained health care providers. Never before rigorously evaluated in humanitarian settings, abortion self-management is a promising approach for reducing harmful consequences from unsafe abortion in humanitarian settings.
The IRC is excited to join the SCTG’s Steering Committee and advocate for the inclusion of humanitarian contexts and considerations across SCTG workstreams and strategic priorities. Our plan is to drive and strengthen cross-collaboration between this dynamic coalition as well as the Interagency Working Group on Reproductive Health in Crises (IAWG)- which works to advance SRH in humanitarian settings. We are in the process of organizing a technical consultation at the upcoming International Conference on Family Planning aimed at galvanizing momentum and commitment for self-care in humanitarian settings. Our hope is the call to action that will be developed at this consultation will provide some concrete collaboration opportunities for SCTG members globally, and we look forward to sharing this with the self-care community next year.