Safe Abortion Care in Humanitarian Emergencies · 2017. 1. 20. · • Safe abortion care is an...
Transcript of Safe Abortion Care in Humanitarian Emergencies · 2017. 1. 20. · • Safe abortion care is an...
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TragicallyLacking:SafeAbortionCareinHumanitarian
EmergenciesSandraKrause
Women’sRefugeeCommission
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UNHCRGlobal Trends2015
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Humanitariancrisesdisproportionatelyimpactwomenandadolescentgirls.
UNFPA © Ali Arkady/VII Mentor Program
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© UNHCR/I.Prickett
Themajorityofpreventable
deathsinwomenandchildren
under5willoccurinareasaffected
bycrises.
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Comprehensiveabortion
servicesareparticularlyimportantinhumanitariancontexts
IRC/PeterBiro
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• Assessment foundno mentionofsafeabortioninhumanitarianproposals
• Safeabortionnotavailableinassessed facilitiesinSouthSudan,DRCorBurkinaFaso
• Litreviewfoundno publishedevaluationsofsafeabortioncareinhumanitariansettings
• Limitedinstitutionalcapacityandattentiontosafeabortioncare
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Whydon’thumanitarianorganizationsprovidesafeabortionservices?
•Thereisnoneed•Abortionistoocomplicatedtoprovideincrises
•Donorsdon’tfundabortionservices•Abortionisillegalinthesesettings
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“Thereisnoneed”
• Collapseofhealthsystemsinhumanitariancrisesmeansreducedaccessto:o Emergencyobstetriccareo Familyplanningo Post-abortioncare
• SexualviolenceisassociatedwithwaroWhenraperesultsinpregnancy,negativeoutcomesmaybeexacerbated
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“Abortionistoocomplicated”
• MVAandmedicationabortioncanbeusedatthe“healthcenter”levelbymid-levelproviders
• MVAandmisoprostolavailableinspecificRHkits(notmifepristone,however)
97% - 99.5% effective
95% - 98% effective 83% - 87% effective
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“Donorsdon’tfundit.”§ HelmsAmendment,1973,mostofteninterpreted(incorrectly)to
§ restrictall information,education,servicesandreferralforabortion
§ applytoall USforeignaid§ applytoall recipients§ applytoallcountriesregardlessofnationalpolicy§ makenoexceptionforwomen’slives,rapeorincest§ BUT:Doesnotapplytoorganizations’otherfunds
§ MexicoCityclauses(GlobalGagRule)§ onlyappliedtonon-USNGOs(notUSNGOs,foreigngovernments,multilaterals)
§ onlyappliedtoUSGfamilyplanningfunds(notanyotherUSfunding)§ appliedtoall fundsoftheaffectedNGOs,evennon-USfunds§ makesexceptionsforsavingwomen’slives,rapeandincest§ notineffectnow
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“It’s‘illegal.”
Only6countriesbanabortionentirely:Chile,DominicanRepublic,ElSalvador,Malta,NicaraguaandtheVatican
Safeabortionpermitted
Woman’slife
Physicalhealth
Mentalhealth
Rapeorincest
Fetalimpair
Econ/social
Onrequest
Numberofcountries 190 132 126 99 91 69 58
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“It’sillegal.”Internationalagreementssupportingaccesstosafeabortioncare:
•GenevaConventionArticle3:Denialofsafeabortiontoarapesurvivorcanbeconsideredinviolationofherrights.•UNSecurityCouncilResolution2106:SupportsaccesstocompleteRHservices,includingsafeabortionforrapesurvivors.•Maputoprotocol:Countriesthatratifiedit(36)mustauthorizesafeabortionincasesofrape/incestandtoprotectthementalhealth,physicalhealthandlifeofthewoman.
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Why don’t we provide safe abortion to women in humanitarian settings?
Rationale True False
There’snoneed. PIt’s“illegal.” PIt’stoocomplicatedtoprovideincrisis. P
Donorsdon’tfundit. P
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Resources
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IAWGSafeAbortionCareSub-WorkingGroup
• Accesstosafeabortionforallwomenandadolescentgirlsincrisisisahumanright.
• Safeabortioncareisanevidence-basedinterventionthatpreventsmaternalmortalityandmorbidity.
• Accesstohigh-qualitysafeabortioncareforallwomenandadolescentgirlscontributestogenderequalityandsocialjustice.
• Acorepackageofevidence-basedsafeabortionservicesshouldbemadeavailabletodisplacedwomenandadolescentgirlsinallcrisissituations.
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FromAgreementtoAction
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Theneedforresearchisgreaterthanever• Operationsresearch,demonstrationprojectsorimplementationsciencetodemonstratethat,despitecultural,policyandpoliticalbarriers,servicescanbeprovidedandwillbeutilized.
• Formativeresearch,strongerqualitativeandparticipatoryresearchgivingvoicetowomeninneedof,abletoobtainordeniedabortions.
• Researchquantifyingtheextentofunwantedpregnancy,theincidenceofabortion,andunsafeabortion-relatedmortalityandmorbiditytojustifytheincreasedattentionanddemandforservices.
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