Global Snapshot of Contraceptive Services across Crisis-Affected Settings

Introduction
Access to contraceptive services is both a fundamental human right and a lifesaving public health intervention. However, the Inter-agency Working Group on Reproductive Health in Crises (IAWG) 2012-2014 Global Evaluation found that the provision of contraceptive services, especially long-acting and permanent methods and emergency contraception, continues to be a gap in humanitarian health funding and programming. For example, contraceptive services made up just 14.9% of sexual and reproductive health (SRH) programming in humanitarian health appeals submitted between 2009 and 2013. In terms of absolute funds received for all SRH components during this period, contraceptive services received the smallest amount.
This inattention not only does a significant disservice to crisis-affected individuals, it undercuts the efficacy of humanitarian assistance across the board. Globally, humanitarian needs are climbing at an unprecedented pace. The United Nations High Commissioner for Refugees (UNHCR) reported that 79.5 million people were forcibly displaced at the end of 2019. In December 2019—prior to the COVID-19 pandemic—the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) estimated that 168 million people would be in need of humanitarian assistance over the course of 2020. Food insecurity is mounting, and the compounding effects of climate change are increasing both the underlying causes of displacement—including natural disasters, resource scarcity, and armed conflict—and vulnerability to shocks. The global COVID-19 pandemic has only amplified the need for humanitarian assistance. It is critical that the international community acts to maximize the impact of humanitarian aid. Investing in contraceptive services fosters resilience, promotes participation in livelihoods and education initiatives, and empowers women and girls to drive recovery efforts in the aftermath of emergencies.
Moreover, providing contraceptive services to crisis-affected communities is a critical opportunity to advance global goals. Numerous sustainable development goals depend on robust, equitable access to comprehensive contraceptive services. Moreover, the goals enumerated by the Family Planning 2020 (FP2020) partnership depend on successfully reaching crisis-affected populations with contraceptive services. As of November 2020, 31 of FP2020’s 69 focus countries had UN OCHA humanitarian response plans, flash appeals, or refugee response plans, or were included in regional refugee response plans.
The 2017 Family Planning Summit offered a valuable opportunity for the humanitarian community to make a powerful case for the feasibility and necessity of delivering contraceptive services in crises. Following the summit, a number of actors made significant commitments to accelerate efforts to improve the availability and accessibility of contraceptive services in crises, including the development of the Global Roadmap for Improving Data, Monitoring, and Accountability for Family Planning and SRH in Crises and a Bridge Funding Mechanism to facilitate immediate access to supplies at the onset of an emergency.
In 2018, the IAWG released a revision of the Inter-Agency Field Manual on Reproductive Health in Humanitarian Settings, which provides technical and program guidance to field staff, including a revised Minimum Initial Service Package (MISP) for SRH, a minimum set of priority SRH services to be implemented in an emergency.9 For the first time, the MISP for SRH includes the priority objective of preventing unintended pregnancies, and calls for the availability of a range of contraceptive methods and quality counseling for all affected individuals.
If humanitarian actors are to successfully meet the needs of crisis-affected women and girls— particularly amidst the unprecedented challenge posed by COVID-19—it is critical that stakeholders have access to robust evidence on the state of contraceptive service availability in humanitarian settings, and successful strategies for programming and service delivery.
Accordingly, the Women’s Refugee Commission (WRC) undertook a landscaping assessment to evaluate and build the evidence base on barriers, opportunities, and effective strategies to provide the full range of contraceptives, including new contraceptive technologies, to women, girls, and couples affected by crises.
The landscaping assessment comprises a literature review, global coverage survey of contraceptive service delivery in humanitarian settings (coverage survey), key informant interviews (KIIs) with stakeholders across the humanitarian-development nexus, and three case studies in diverse humanitarian settings. This document includes findings from the literature review, coverage survey, and a series of KIIs to solicit insights on how to sustain and scale contraceptive service delivery programming across transition periods along the preparedness-relief-recovery continuum.
The three case studies were conducted in Cox’s Bazar, Bangladesh, Borno State, Nigeria, and Cyclone Idai-affected areas of Mozambique, and findings from each case study are presented in individual reports.
Following the onset of the COVID-19 pandemic, WRC conducted an additional series of KIIs with diverse stakeholders, including representatives of ministries of health and stakeholders in Francophone Africa, to explore the impact of COVID-19 on contraceptive service delivery, and the prioritization of contraceptive and SRH services more broadly in COVID-19 preparedness and response across the humanitarian development nexus. Findings from these KIIs are available in Disruptions and Adaptations: The Effects of COVID-19 on Contraceptive Services across the Humanitarian-Development Nexus.
In November 2020, WRC convened technical stakeholders from a range of settings and organizations to leverage our findings to collaboratively develop actionable recommendations for governments, donors, researchers, advocates, and implementing partners to advance the availability and accessibility of sustainable, good quality contraceptive services across the humanitarian-development nexus.
These recommendations, as well as a synthesis and discussion of key findings from across all components of the landscaping assessment will be available in January 2021.

Source: Women’s Refugee Commission

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