Reproductive Health

Women, War, Peace and Reproductive Health

The United Nations Population Fund (UNFPA) contributed content for this profile.

Introduction

Communities in crisis are suddenly deprived of reproductive health information and services. In an emergency, access to contraceptives can be a major challenge. Transportation routes may be cut off, distribution networks dissolved and health facilities destroyed. Existing supplies may fall far short of demand when large numbers of people move into a safer location. A large number of refugees and internally displaced women will be pregnant, facing delivery under dangerous conditions; others may be victims of violence including rape. Women’s reproductive health problems during conflicts may range from having no sanitary supplies for menstruation to life-threatening pregnancy-related conditions, from lack of birth control to the effects of sexual violence. For those women and girls whom become pregnant, early pregnancy carries great risk: girls aged 10 to 14 are five times more likely to die in pregnancy and childbirth than women aged 20 to 24. Unsafe abortion also carries high risks: more than 4.4 million young women aged 15 to 19 have abortions every year, 40 per cent of which are performed under dangerous conditions. more... In the past twenty years, women also have had to cope with the deadly spread of HIV/AIDS.

With the widespread use of rape in war, health systems must be prepared to provide such treatment and ensure that staff are trained to deal sensitively with patients. Although global attention has been focused for more than a decade on sexual violence as a strategy of war and as a human rights issue, the women who have suffered need direct support immediately, which they are still not getting. Rape often involves serious physical damage to a woman’s body, requiring treatment for abrasions and tears; some women even need suturing. Antibiotic treatment is necessary. Women and children account for more than 75 per cent of the refugees and displaced persons at risk from war, famine, persecution and natural disaster; twenty-five per cent of this population are women of reproductive age and one in five is likely to be pregnant. more...

The highest maternal mortality rates globally are in sub-Saharan Africa, followed by south-central Asia . Recent findings by WHO, UNICEF and UNFPA show that over her lifetime a woman living in sub-Saharan Africa has a one in 16 chance of dying in pregnancy or childbirth. Women are most at risk during childbirth in Sierra Leone and Afghanistan where one of six women will die from complications related to pregnancy and childbirth. more... Only 53 per cent of deliveries in developing countries take place with a skilled birth attendant, yet the assistance of health professionals at delivery significantly reduces death, illness and disability. Emergency conditions mean even less access to trained assistance. Up to a third of maternal death and injury and infection could be avoided if all women had access to a range of modern, safe and effective family planning services that would enable them to avoid unwanted pregnancy. more...

Key Terms

Reproductive Health: As stated by UNFPA, reproductive health is a means to sustainable development as well as a human right. Investments in reproductive health save and improve lives, slow the spread of HIV/AIDS and encourage gender equality. These in turn help to stabilize population growth and reduce poverty. Investments in reproductive health extend from the individual to the family, and from the family to the world. Improving reproductive health is a broad strategy that includes programming in these key areas:

  • Preventing HIV/AIDS
  • Making Motherhood Safer
  • Supporting Adolescents and Youth
  • Assisting in Emergencies
  • Securing Reproductive Health Supplies
  • Preventing and Treating Fistula more...


HIV/AIDS and Sexually transmitted infections (STIs): All sexually transmitted diseases and infections including HIV/AIDS thrive under crisis conditions, which coincide with limited access to the means of prevention, treatment and care. HIV/AIDS not only thrives in situations of emergency and conflict, it contributes to them. more...


Safe Motherhood: In situations of conflict and natural disaster, the following emergency reproductive health equipment and supplies help make childbirth safer: supplies for clean home deliveries include soap, plastic sheeting, razor blades, string, gloves and pictorial instruction sheets; equipment and supplies for assisted deliveries at a health facility also include stethoscopes, thermometers, plastic aprons, latex gloves, syringes, sutures, sterile gauze pads, an IV infusion set, cotton wool, burn boxes for safe needle disposal, amoxicilline and other drugs; equipment and supplies are also provided for suturing tears, resuscitation, disinfection and surgery. Safe motherhood programmes aim to reduce the high numbers of maternal deaths and illnesses by providing: care before pregnancy (antenatal); skilled birth attendants; access to emergency obstetric care; care after pregnancy (post-partum) for hemorrhage, hypertension and infection. more...


Pregnancy and delivery: Pregnancy and delivery can be dangerous for women in the best of circumstances. In poor countries, maternal mortality is nearly 40 times the rate in the industrialized nations. In countries suffering conflict, women are at even greater risk since they generally cannot get prenatal support or emergency obstetric care. Lack of access to appropriate medical care may not be the only cause of poor pregnancy outcomes. Conflict can have indirect consequences as well. During flight and acute emergency periods, spontaneous abortions (miscarriages) can increase precipitously from the physical and mental stress; women who suffer miscarriages require immediate assistance to save their lives and protect their fertility. more...


Adolescent Reproductive Health: In a crisis, the family support so vital to young people often collapses. A network that might have provided protection, help and information disintegrates, leaving young men and women more vulnerable than ever before. At the same time, youth traumatized by violence are particularly vulnerable to engaging in risky behavior as well as to sexual exploitation. Early pregnancy has serious implications for the health and well being of young girls, whose bodies have simply not developed enough to deliver safely and who are not mature enough to be parents. more...


Assisting in Emergencies: Humanitarian crises, whether caused by armed conflict or natural disaster, always hurt women and girls the most. In times of upheaval, pregnancy-related deaths and sexual violence soar. Reproductive health services, including prenatal care, assisted delivery, and emergency obstetric care, often become unavailable. Young people become more vulnerable to HIV infection and sexual exploitation. And many women lose access to family planning services, exposing them to unwanted pregnancy in perilous conditions.


Securing Essential Supplies: Without the essential commodities, from contraceptives to testing kits to equipment for emergency obstetric care, the right to reproductive health cannot be fully exercised. In many places, condoms are urgently needed to prevent the further spread of the deadly HIV virus. This complex logistical process involves many actors, including the public and private sectors. UNFPA takes a lead role in reproductive health commodity security, coordinating the process, forecasting needs, mobilizing support and building logistical capacity at the country level.


Family Planning: Family planning services are especially important when war has destroyed the health services on which people depend. Neglecting family planning has a long list of serious consequences: unwanted pregnancies, unsafe abortions resulting from unwanted pregnancies, pregnancies spaced too close together, dangerous pregnancies in women who are too old or too young, and the transmission of STIs including HIV/AIDS. Family planning allows women and men to choose whether, when and how often to have children.


Sexual Violence: Sexual and gender-based violence occurs at every stage of a conflict, from before the flight to the return home. The victims are most often women and adolescent girls and boys. Such violence is common in many armed conflicts, especially where combatants mix with civilian populations. The impact of violence, especially rape, can be disastrous. Injuries, unwanted pregnancies, sexual dysfunction and HIV/AIDS are among the physical consequences. Damage to mental health includes anxiety, post-traumatic stress disorder, depression and suicide.


Menstruation needs: Refugee and displaced women between the ages of 10 and 50 need a way to handle their menstruation, yet it is only in the past few years that humanitarian agencies have begun to include sanitary supplies in the package of relief items provided in emergencies. Without such supplies, girls have to stay home from school, mothers cannot take their children to health facilities and women may miss work or training. Providing clean cotton rags or modern sanitary products allows women to move about freely during their menstruation, instead of sitting at home or in their tents, isolated from others. more...

International Organizations & Instruments

UNIFEM Action & Analysis

UNIFEM works toward ensuring that women’s reproductive health needs are met, especially in times of conflict when their needs are more likely be neglected. Projects have focused on awareness-raising in peacekeeping missions, combating sexual and gender-based violence, and meeting emergency reproductive health needs. For example:

  • UNIFEM is participating in the first-ever comprehensive programme for the prevention and treatment of sexual and gender-based violence in the Democratic Republic of the Congo (DRC). This is a four-year project which will provide direct support to 25,000 women, young people and children in three provinces and indirect support to thousands more. The programme will include the participation of the Congolese ministries of social affairs, health, justice and women's affairs.
  • UNIFEM, UNFPA and relevant NGOs are working to develop training material on gender, women’s rights, and reproductive health issues. The main outputs of these strategies and actions are heightened awareness of uniformed personnel on reproductive health and the preparation and dissemination of training materials.
  • UNFPA is working to address reproductive health issues and gender-based violence during armed conflict; support emergency reproductive health projects and advocate for reproductive health and human rights of women and girls in emergency situations. This action is intended to increase awareness about emergency reproductive health and support to projects in more than 30 countries.
  • UNFPA along with OHCHR, UNAIDS, and OSAGI is working to document lessons learned and mainstream reproductive health and gender issues in peacekeeping operations; develop materials on HIV/AIDS, gender-based violence and other critical issues. more... 

Tools & Checklists

Independent Experts' Assessment & Recommendations 

The Independent Experts' Assessment on Women, War, Peace and Reproductive Heath and the accompanying recommendations can be accessed in this archive: Reproductive Health Archive