The right to life
Having dedicated my entire career to issues related to gender and rights, choosing to embark on a Master of Public Health was a plan that came slightly out of left field in some ways. While I had never given much specific thought to vaccines or cancer screening, I have always cared immensely about people and the inequities that persist between different kinds of people – particularly those inequities that are based on gender. UNC’s department of Health Behavior has been providing me with an exceptional opportunity to interrogate, through the lens of systemic oppression and injustice, the questions of why some groups of people live while others die.
It is by no coincidence that the divisions that persist along the lines of class, race, ethnicity, immigration status, (dis)ability, sexuality, and gender result in those with the lowest privileges shouldering the majority of society’s burden of illness, disease, and physical and mental harm.
When certain groups of people systematically get sick because of who they are and where they are born it is not only a public health concern, it is an issue of human rights. Environmental, social, and policy conditions have real and serious implications on who enjoys the most basic of human rights: the right to life.
When women are denied the opportunity and resources to maintain control over their own bodies, the health consequences can be significant. Access to modern family planning methods and an understanding of how to properly use them enable women to control the number of children they have, when they have them, and how long to wait between pregnancies. Research shows that mothers whose pregnancies are spaced fewer than three years apart are at higher risk of miscarriage, seeking an unsafe abortion, and even dying during childbirth. In fact, one in three maternal deaths globally could be prevented by ensuring access to family planning. For the children born of inadequately spaced pregnancies, they are more likely to be born premature, have low birth weight, or to be stillborn.
Reproductive health is, therefore, a life-saving intervention for both women and children. Perhaps nowhere is this more pronounced than in situations of conflict and natural disaster.
The impact of crisis
When disaster strikes – be it through the forces of people, politics, or nature – people’s lives are often disrupted. Displacement, insecure living conditions, separation of families, and increased violence are common, and often result in lack of access to public infrastructure including health services. Couples can find themselves unable to obtain contraception, and women experience pregnancies they didn’t necessarily intend. Even intended pregnancies become more dangerous when adequate healthcare is absent.
It is also well-documented that sexual violence increases during situations of conflict and crisis. There are many reasons for this, primarily related to abuse of power, impunity that comes when legal safeguards are disrupted, and environmental factors such as unsafe routes for necessary daily tasks such as water collection, and overcrowded camps. These increases in sexual and gender-based violence result in the need for acute responses to assist with unwanted pregnancy, unsafe abortion, contraction of STIs or HIV, and physical injuries.
Whether they come about through consensual means or through rape, the bottom line is that pregnancies do not disappear during emergencies. Failure to recognize this means that women die unnecessarily due to complications associated with miscarriage, unsafe abortion, and childbirth. While ensuring access to food and shelter might, understandably, be deemed a priority in situations of crisis, ignoring the specific health needs of women under these circumstances costs lives.
My AFE: Reproductive Health in Emergencies at Save the Children
This summer I have been working with Save the Children USA’s Reproductive Health in Emergencies program, based in their headquarters in Washington, DC. This program operates in both protracted and acute emergency contexts to integrate reproductive health into humanitarian health responses, ensuring that women are respected and supported to make reproductive choices. Focusing on family planning and post-abortion care services, Save the Children provides direct medical services, supports clinical training to local service providers, supplies health facilities with medical commodities, and invests in strengthening the systems necessary to deliver effective reproductive health responses.
Unmet reproductive health needs in Haiti after Hurricane Matthew
In October last year, Hurricane Matthew caused devastation to numerous parts of the Western Atlantic. Haiti, still recovering from the catastrophic earthquake of 2010, has been severely impacted. Many of the worst-affected locations are remote and hard to reach, and more than half the population does not have access to health services. According to UNFPA, more than a quarter of those affected by the hurricane are women of childbearing age, who require quality health services. Haiti’s maternal mortality ratio is also the worst of any country in the Caribbean or Latin America.
My role: What can the numbers tell us?
For my AFE, I am supporting Save the Children’s reproductive health response in Haiti, which is enabling 5 health facilities in Sud and Grand’Anse departments to provide family planning and post-abortion care services. Fundamental to evidence-based program implementation is the collection and analysis of quality program data, as well as an understanding of what these numbers can tell us. The ability to spot trends and make sense of the reasons that are driving them can help service providers to do their jobs better, and can help program managers to figure out if the right women are getting the right services, and whether or not the services are helping them.
As such, the main focus of my AFE has been on preparing a training program on monitoring and evaluation for the program team in Haiti. The aim is that this package will give them better tools to track their program and make greater use of the data they obtain for meaningful decision-making in their daily work. I will be heading to the field soon to deliver this training, but also to spend time on the ground to observe how the partner health facilities are currently keeping track of their clients, and how Save the Children’s data collection can be most conveniently integrated. I will also help get staff set up with more efficient data systems such as using tablets, and familiarize the team with the program database. I am building in time to learn from the Haitian staff about what makes the most sense in their specific context, and to do some creative thinking around establishing systems of best practice for data utilization. I will be working closely with the Haitian program coordinator to incorporate her team’s perspectives into the approaches developed by headquarters.
Based on key learnings from Haiti and other program locations, I will make recommendations to Save the Children on guidelines for optimal monitoring, evaluation, and data use.
Finally, in addition to supporting the Haiti program, I am looking at evidence-based approaches to integrating sexual and gender-based violence (SGBV) responses with reproductive health programs. From this research, I am developing guidelines and making recommendations to Save the Children USA that will help various country teams to take practical steps to respond to SGBV in their work.
This AFE has, in many ways, provided the perfect opportunity to apply my learning from both my public health program and the Rotary Peace Fellowship curriculum, while also enabling me to gain experience within a new topic area (reproductive health) that is still firmly rooted in my wheel house of gender and human rights. I am very appreciative of the wonderful professional development and learning opportunity that Save the Children is currently giving me, and I extend heartfelt thanks to the generous Rotarians whose support has made it possible.
 World Health Organization. (2005). Report of a WHO Technical Consultation on Birth Spacing Geneva, Switzerland, 13–15 June 2005. Retrieved from http://www.who.int/maternal_child_adolescent/documents/birth_spacing05/en/
 Ahmed, S, Li Q, Liu L, Tsui AO. (2012). Maternal deaths averted by contraceptive use: an analysis of 172 countries. Lancet.
 Inter-Agency Standing Committee. (2015). Guidelines for Integrating Gender-based Violence Interventions in Humanitarian Action, 1–366. Retrieved from http://gbvguidelines.org/wp-content/uploads/2015/09/2015-IASC-Gender-based-Violence-Guidelines_lo-res.pdf