In the face of a disaster like Typhoon Haiyan, matters like sexual and reproductive health fall by the wayside as survivors focus on simply living day to day. One inspirational project is hoping to change that by helping governments and medical personnel support women and girls in the midst of any crisis.
UNDER normal conditions, a pregnant women wouldn’t worry much about her delivery; after all, in most urbanised areas, she would have access to a hospital, expert staff and all the necessary equipment when the time comes.
But imagine conditions that are far from normal. Imagine the fateful day of Nov 8, when Typhoon Haiyan made its catastrophic way through the Philippines, flattening, among other things, clinics and hospitals, killing medical personnel and damaging road infrastructure – and thus trapping expectant women far from any medical services.
Villages and communities were wiped out in their entirety, almost 6,000 people were killed, while the lives of 14.4 people were brutally disrupted; of that, over four million men, women and children were displaced (UN Office for the Coordination of Humanitarian Affairs).
According to the Philippines’ Department of Social Welfare and Development, an estimated 233,697 pregnant women have been affected and critically require specialised reproductive health services. In evacuation centres alone where the displaced are temporarily housed, the count of pregnant women stood at 7,973 last month.
Yet in the aftermath of such devastation, as survivors desperately scramble for basic necessities like food, drinking water and shelter, reproductive health needs are often overlooked and take a backseat to other humanitarian priorities.
This existing gap in relief efforts is what the International Planned Parenthood Federation (IPPF) is addressing. Specifically, the IPPF’s project SPRINT (Sexual and Reproduction Health Programme in Crisis and Post-Crisis Situations) deals with things like the supply of clean delivery kits for safe, hygienic and smooth deliveries to reduce the rate of maternal and newborn mortality and morbidity (the occurrence of disease/illness in the mother or baby).
Sprint also conducts counselling sessions and post-rape treatment services for victims of sexual violence; the risk of sexual violence towards both women and men have proved to increase during crisis situations.
At a recent briefing in Kuala Lumpur, Sprint’s East and South-East Asia and Oceania region manager Dr Subatra Jayaraj said a US$200,000 (RM659,300) grant has been channelled to the Philippines’ Family Planning Organisation, a local partner that the IPPF closely collaborates with for this sexual and reproduction health programme.
The funding amount, derived from an A$10mil (RM29.3mil) grant received from the Australian government, is specifically meant to assist 60,000 beneficiaries in barangays (villages) and evacuation centres over a three-month period until February.
“Of the 14.4 million affected people, 25% are women who are of reproductive age, which is equivalent to 3.6 million,” says Dr Subatra, 31, a Malaysian medical professional with 10 years of experience in community and social health development work.
“This serves to indicate the large number of women who could get pregnant by their spouses as people still have sexual intercourse even in times of crisis. There are also cases of unplanned pregnancies especially when contraception is not used, or when a girl or woman is raped.
“Right now, it is estimated that 900 babies are born daily in the typhoon-hit regions. But with limited access to medical facilities and aid, newborns are exposed to the risk of respiratory complications and infections, and mothers to childbirth complications and obstructed labour that can result in death.
“Yet these deaths are mostly preventable if a basic and sterile delivery kit is available. A simple cloth can help warm the baby against developing cold or hypothermia, while clean gloves can be used to contract a mother’s uterus to prevent excessive bleeding post delivery.
“These life-saving items are often taken for granted until times of emergency, amid chaos and ruins, when we realise they are not readily accessible,” she stresses, adding that even a clean blade makes a difference in ensuring the umbilical cord is cut without an infection hazard.
At the same briefing, Sprint resource mobilisation manager Azrul Mohd Khalib says this area of healthcare is beyond traditional health needs that are addressed during a crisis.
“Sexual reproductive health service is one area that hasn’t been adequately recognised by humanitarian responders and communities on the ground. In the Philippines, it remains an ongoing challenge, as access to reproductive health rights is often faced with opposition due to religious and cultural sensitivities.
“It cannot be emphasised enough how essential these services are – past experiences in a crisis have shown that 15% of women giving birth will encounter life-threatening emergency situations and more than 5% of them will require a Caeasarian-section,” says Azrul, 37, who is also Malaysian.
Then there’s also the issue of sexual violence and harassment being addressed by Sprint, as security and safety-related problems intensify when thousands of people rendered homeless by a disaster are crammed into a single shelter.
“Young women and children become susceptible and vulnerable to gender-based violence. A scenario could play out something like this: a girl is asked by her mother to fetch some water from a nearby water tank because the mother has to care for her baby.
“During this brief ‘journey’, a distance of say 200m, the girl is exposed to the risk of being molested, sexually harassed or raped. In fact, we are slowly receiving reports on some of these cases now post-Haiyan, but a lot tends to go unreported until much later.”
Sprint’s clinical management service helps rape survivors cope through supportive counselling and offering emergency contraception (in the first few days after a rape) as well as the prevention and treatment of sexually transmitted diseases, says Azrul.
“For women not wishing to conceive naturally, we have contraceptive methods available which empowers them to have a choice in unequal power relationships.
“Women tend to be more pragmatic when considering if the time is suitable to have more babies, but they may face resistance from their husbands who may insist on unprotected sex,” explains Azrul.
These services and kits are called the Minimum Initial Service Package for Reproductive Health in Crises and can be directly employed to address the different sexual and reproductive health needs in times of crisis.
According to Azrul, Sprint also provides training for medical practitioners and field volunteers continuously so that they are well-prepared for deployment of the kits in the event of a disaster.
Despite this, capacity-building is never enough due to the loss of manpower during a disaster, as was the case with Typhoon Haiyan.
“This remains a huge challenge when the very people who are medically-skilled and trained perish themselves or suffer such extensive trauma that they have to rebuild their own lives.
“Our training focuses on helping health professionals make do with the bare minimum in a devastated environment that is stripped off any medical facilities or clinics. It can be overwhelming even for them to work in makeshift areas devoid of their necessary tools,” Azrul says.
In the current case of the aftermath of Haiyan, logistics have also been taxing since the affected areas are outlying islands, all geographically dispersed. While aid and media attention was immediately focused on Tacloban city of Leyte province, it was only later that the authorities grasped the magnitude of destruction sustained by other provinces like Samar, Eastern Samar, Cebu and Iloilo, where access is a major hurdle.
Reports that trickled in have described staggering impairment to seaports in some of these provinces, so ships are unable to berth to deliver supplies. The only possible mode of delivery is via helicopters, says Azrul.
“In terms of logistics and coordination, this typhoon is to some extent a lot tougher than the 2004 Asian Tsunami, notwithstanding the higher death toll in Acheh (Indonesia). Back then, military aid ships could still offload commodities on one land mass, Sumatra, unlike now in the Philippines where the provinces are far apart.
“In some situations, the pre-disaster census of populations have been totally destroyed, which makes it impossible to account for people living in a village or community in an area. And sometimes, people who require these medical services are ‘hidden’ simply because they are unable to travel to the medical outposts and field hospitals,” says Azrul.
This is Sprint’s fourth response to the Philippines just this year after the country faced smaller-scale disasters earlier.
Dr Subatra says an evaluation and post-emergency review will be conducted at the end of this project implementation to gauge the effectiveness of the ground services in aiding victims.
“We are glad to see this programme already integrated by the Philippines into its health emergency response system, with the help of our partner, the Family Planning Organisation of the Philippines. It is our hope that more countries will adopt similar approaches, as access to these essential services could mean the difference between life and death.
About the project
The SPRINT initiative was established by the International Planned Parenthood Federation in 2007 with the mission of enabling access to sexual and reproductive health services to communities in different humanitarian settings across the Asia Pacific, South Asia and African regions it operates in, while advocating to governments for implementation of the services. It has responded to a host of natural disasters and man-made conflict crises – among them Cyclone Aila in Bangladesh (2009), the Sichuan earthquake in China (2008), Cyclone Nargis in Myanmar (2008) and the recent Zamboanga City conflict in the Philippines.