Environmental Disasters in the Asia-Pacific: What About Reproductive Health in Emergencies?

Ramona Vijeyarasa

For pregnant women, any environmental disaster severely limits safe delivery options, which in turn exacerbates pre-existing vulnerabilities to maternal death and disability.

Climate change
is one of the most prominent topics of discussion in recent times, with
increasing recognition of its particular
effects on women
For those engaged in post-disaster reconstruction, attention to reproductive
health should be a primary concern. The Asia-Pacific region is indisputably
one of the most vulnerable areas to climate-change induced disasters,
as evidenced in recent time in Myanmar, China and Tsunami-affected countries. For pregnant women in this area, any environmental disaster severely
limits safe delivery options, which in turn exacerbates pre-existing
vulnerabilities to maternal death and disability. Access to contraceptives
and other family planning is often interrupted or stopped altogether,
which may lead to increased numbers of unsafe abortion as a result of
unplanned pregnancies.

This is not
a new idea. As early as June 1995, an Inter-Agency
Symposium on Reproductive Health in Refugee Situations
, held in Geneva, UN agencies, governments
and NGOs recognized the reproductive health impacts of environmental
devastation. A Minimal
Initial Services Package (MISP)

for Reproductive Health was developed to provide a set of priority reproductive
health activities and services necessary to address maternal and newborn
mortality and morbidity, the spread of HIV, prevention and response
to sexual violence and planning for comprehensive reproductive health
in crisis situations. The MISP calls on all stakeholders involved to
prioritize reproductive health needs in the very early phases of disaster

Yet, more than
10 years later, neither the MISP or comprehensive reproductive health
in emergency settings, are the norm. Marie
Stopes International (MSI)
together with the Columbia University’s Heilbrunn Department of Population
and Family Health in the Mailman School of Public Health, developed the RAISE
Initiative (Reproductive Health Access, Information and Services in
to boost the profile of reproductive health in emergency responses,
improve the implementation of the MISP on the ground and increase funding
and policies for agencies providing health services.  Maaike van
Min, Advocacy Manager from MSI/RAISE, believes that there are a number
of factors at play that are hindering the implementation of MISP in
the field. "Reproductive health is not seen as a life-saving intervention," she says.
"We also face practical challenges in getting MISP packages to the field
level, like dealing with customs clearance and having to worry about
storage and expiration of drugs."

The Women’s Commission
for Refugee Women and Children

also started working to promote the MISP almost five years ago when
its field assessments revealed the lack of implementation at the onset
of a crisis. Sandra Krause, Reproductive Health Program Director at
the Women’s Commission, agrees that "things are not where they should
be," with reproductive health often shadowed by infectious disease
control. The bottom line for Krause is "being prepared, making sure
people have done emergency preparedness training in their country, that
they’re skilled and ready." 

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Cyclone Nargis,
which hit Myanmar on May 2 and 3, 2008, and officially
killed 84,537
with 53,836 people counted as missing, offers an example of why the need for readiness.
Unfortunately, training the trainers on the MISP in Malaysia, with attendees from across the
Asia-Pacific, ended the very day Nargis hit Myanmar, with no time for
in-country roll-out of the training. If anything, this reflects the
importance of advanced preparedness for disaster management.

The need
to prioritize reproductive health after Nargis was obvious. The United Nations
Population Fund (UNFPA)

reported that in the Ayeyarwady Delta, where women traditionally give
birth at home with the assistance of midwives, the destruction of homes,
roads and means of transport severely heightened the risks of child
birth, due to the inability to reach a health facility during an obstetric
emergency and with at least 10 midwives having perished during the cyclone.
Given that an estimated
20 percent of women of reproductive age

in a refugee population will be pregnant at any one time, the effect
of this devastation should not be underestimated. From June 2008 onwards,
a joint initiative between UNFPA and the Myanmar
Medical Association (MMA)

began sending teams of doctors to hard hit areas, with many women seeking
pre- or post-natal exams and contraceptives at mobile clinics. 

Similar stories
concerning interrupted access to reproductive health services emerged
in post-Tsunami Indonesia. The 2004 Tsunami, which followed the largest recorded
earthquake in history
had profound impacts on Indonesian islands such as Aceh and Nias. According
to Oxfam
in the four villages in the Aceh Besar district surveyed for their report,
women comprised three to four times the number of men who died as a
result of the Tsunami. This shocking imbalance is partially explained
by the tendency for women to stay behind and look for children and other
relatives and the relatively lower ability of women to swim or climb
a tree to survive when compared with men. In Aceh alone, UNFPA reported the death of 10 per cent
of the 5,500 midwives, highlighting an immediate need in terms of safe

An evaluation by the Women’s
Commission for Refugee Women and Children

of the reproductive health service provision in Aceh following the Tsunami
states that condoms were not visibly made available in health centers,
which is a key activity of the MISP, due to the assumption that they
would not be tolerated by  Islamic culture. The report also states
that some midwives reported that emergency contraception (EC) would
not be provided to rape survivors due to the religious restrictions
of Islam. Rather than being a religious issue, Krause puts this down
to a lack of understanding that exists elsewhere around the globe, that
EC is not an abortifacient. Other issues are the stigma around rape
and general sexual taboos. "In Thailand they distributed EC quite
readily and this created a belief that adolescents were abusing them.
People began believing that it promoted promiscuousness," Krause explained.  

In addition
to immediate needs, there are also long-term impacts of environmental
disasters that fall on the shoulders of women. With the heightened numbers
of internally displaced persons (IDPs) and refugees, women are more
vulnerable to becoming victims of domestic and sexual violence. The household workload
after a disaster, which forces many girls to drop out of school to help
with daily tasks. Oxfam
that surviving women may also be encouraged to have more children, with
shorter intervals between them, to replace those lost by the community,
impacting women’s reproductive health, their right of choice in family
planning and their ability to earn an independent income.  

Clearly, environmental
disaster management raises many complicated issues that are beyond the
scope of this discussion. The head of Doctors
Without Borders

has recently commented that the influx of donor money for Nargis victims
has left many others in need without help. Van Min of MSI believes that
"it is often the case what when a natural disaster strikes, media
and donor attention is focused on the most affected areas, when there
are other areas also in dire need." This situation highlights the
importance of taking the approach of groups like MSI in ensuring that
country-based programs are not fully donor dependent to ensure they
are sustainable "if and when donor funding dries up." In addition,
Krause highlights the longer-term benefits of ensuring comprehensive
reproductive health care in post-conflict reconstruction: "A reproductive
health response has the capacity to make longer-term improvements. It
is a chance to ignite long-term investment and change in a country." 

Indeed, the
two-way relationship between reproductive health and women’s empowerment
is undeniable. Women’s equity is needed to achieve reproductive health,
whilst improved reproductive health affirms women’s equality in the
long-term. A gendered approach to disaster management, including ensuring
women’s participation in the recovery-phase, will unquestionably catalyze
lasting reproductive choice, gender equity and women’s empowerment. 

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