Sexual and Reproductive Rights Situation Report: Haiti- Repro Rights After Disaster
The Sexual and Reproductive Rights Situation Report is a monthly column devoted to international policy issues and current events around these critical rights.
Since the devastating 7.0 earthquake shook Haiti on January 12, 2010, Haitians have dealt with shortages of basic needs like water and food; flooding; and even churchy American do-gooders coming for their children. As in any humanitarian crisis, the women of Haiti have been struck harder and in different ways than men because of existing inequality and gender disparities. As the humanitarian community continues to formalize and learn from its major challenges, it is paying increasing attention to women’s rights and gender issues in the post-disaster setting. I’m going to focus more specifically on women’s reproductive and sexual rights and the ways in which they are threatened in humanitarian crises.
The situation for reproductive health in Haiti was already dire before the earthquake. The country had the highest maternal death rates in the region by far, with 670 of every 100,000 deliveries resulting in the death of the mother, according to the United Nations Population Fund (UNFPA). This PBS documentary, available on Family Care International’s website, chronicles the tragedy of maternal death in Haiti, pre-quake. The 63,000 pregnant women in Haiti when the earthquake struck are at even greater risk in the aftermath of the disaster. According to CARE, a humanitarian relief and anti-poverty NGO active in Haiti, “breastfeeding mothers and young children are at greatest risk” after the quake. Soon after the earthquake, Sophie Perez, CARE country director in Haiti, said:
There are a lot of pregnant women in the streets, and mothers breastfeeding new babies. There are also women giving birth in the street, directly in the street… the situation is very critical.
Pregnant women and other vulnerable populations may be less able to fight for scarce resources, and their unique health needs may not be met. There are many sexual and reproductive health issues that are intensified in a humanitarian crisis.
Although each disaster is unique, the humanitarian community, including NGOs, government agencies and multilaterals, has begun to attempt to learn from previous disaster response efforts to improve upon outcomes. After the earthquake in Haiti, dozens of NGOs coordinated to write a letter to Secretary of State Clinton and the head of USAID encouraging a gender perspective in the US’ relief efforts, and pointing to the lessons learned and documented in a seminal document- the Gender Handbook in Humanitarian Action.
In the last decade, several working groups on reproductive rights in post-conflict and post-disaster settings have formed, including the Inter-agency Working Group on Reproductive Health in Crises. One of its theoretical initiatives is something called the Minimum Initial Service Package (MISP), which sets out to prioritize interventions at the outset of a humanitarian crisis to maximize positive reproductive health outcomes. The Inter-agency Working Group is advocating for the MISP to be “provided within the context of other critical priorities, such as water, food, cooking fuel, and shelter,” which emphasizes the basic nature and life-or-death importance of reproductive health services.
Another such group is the Reproductive Health Response in Conflict Consortium (RHRC Consortium), made up of academia and NGOs including the Women’s Refugee Commission. Much of the work on gender in humanitarian crises is based on work that these and other agencies did on the reproductive health issues for refugees and displaced persons; many of the issues are the same. Here’s a video from the Women’s Refugee Commission on the reproductive health situation in Haiti since the earthquake:
RHRC Consortium released a statement following the Haiti earthquake demanding that disaster response address the health needs of women and girls. The statement brought up a number of sexual and reproductive health issues in the post-disaster period that I hadn’t thought of before. In addition to the needs of pregnant women and new mothers, a holistic view of sexual and reproductive health includes access to contraceptives, responsive treatment for survivors of sexual violence including emergency contraception and post-exposure prophylaxis for HIV, and continuity in ART therapies for HIV positive individuals. UNFPA and the International Research and Training Institute for the Advancement of Women (UN-INSTRAW) point out other issues including “limitations on accessing prenatal and post-natal care… greater risk of vaginal infections, pregnancy complications including spontaneous abortion, unplanned pregnancy and post-traumatic stress.”
Women experience the most negative consequences of catastrophic events, particularly with regards to higher rates of injury and death, displacement, unemployment, increased incidents of HIV rates, sexual and domestic violence, increased poverty, and the disproportionate responsibility for caring for others. This is especially true for women marginalized by race, sexual orientation, gender identity, class, health, ability, age, housing, and legal status.
All of these issues highlight how existing vulnerability is magnified and intensified during a humanitarian crisis. Women are already in a position of vulnerability due to the “interaction of biological and social risk factors.” The World Health Organization (WHO) identifies among these risk factors gender roles, social taboos around menstruation and appropriate behavior for women and girls, existing economic and social marginalization and vulnerability to domestic and sexual violence.
Although women’s lives and health are often threatened in the post-disaster period, they are a tremendous resource for reconstruction. International women’s rights NGO MADRE, along with Haitian partner Zanmi Lesante, has written on women’s expertise and the marginalization of women’s experience in reconstruction. ”When relief is distributed by women, it has the best chance of reaching those most in need.” It’s also more likely that real reproductive health needs will be met.
The issue of participatory planning is front-and-center these days as NGOs plan Haiti’s future. Oxfam has been campaigning to push world leaders to include Haitian organizations and voices in the decision-making process during reconstruction (sign on to the campaign here).
The Gender and Disaster Network has summed up the need for an even more nuanced view of participation that includes populations often left out of the process in their Six Principles for Engendered Relief and Reconstruction. First, they point out, Gender analysis is “integral to plan for full and equitable recovery.” Part of engendering reconstruction is basing program development on the true needs of women, based on gender-disaggregated data, and not on stereotypes.
They advocate working with grassroots women’s organizations- the women who know what needs to happen to create a more just society and ensure future resilience. GDN also points out that the act of participation, based on a human rights approach, builds conditions for empowerment and develops capacity among women.
If disaster is not to disproportionately endanger women and girls and further entrench their social inequality and vulnerability, women’s unique needs and perspectives must be respected, accounted for and implemented in every stage of the after-disaster process of response and recovery.
Take action: Support International Planned Parenthood Federation‘s partner in Haiti, PROFAMIL, in rebuilding and providing reproductive health services; or the Global Fund for Women‘s Crisis Fund which will support Haitian women’s organizations as they rebuild.
- Brook Elliott-Buettner is a freelance human rights policy researcher and writer. More information and work is available at www.brookelliottbuettner.com.