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Humanitarian Charter and Minimum Standards in Humanitarian Response

Essential health services – sexual and reproductive health standard 1: Reproductive health

People have access to the priority reproductive health services of the Minimum Initial Service Package (MISP) at the onset of an emergency and comprehensive RH as the situation stabilises.

Key actions (to be read in conjunction with the guidance notes)

Key indicators (to be read in conjunction with the guidance notes)

Guidance notes

  1. Minimum Initial Service Package: The MISP defines those services that are most important for preventing RH-related morbidity and mortality among women, men and adolescents in disaster settings. It comprises a coordinated set of priority RH services that must be implemented simultaneously to prevent and manage the consequences of sexual violence, reduce the transmission of HIV, prevent excess maternal and newborn morbidity and mortality, and begin planning for comprehensive RH services as soon as the situation stabilises. Planning for the integration of good-quality comprehensive RH activities into primary healthcare at the onset of an emergency is essential to ensuring a continuum of care. Comprehensive RH care involves upgrading existing services, adding missing services and enhancing service quality.
  2.  RH supplies: Supplies for the MISP must be ordered, distributed and stored to avoid delay in getting these essential products to the population. The Interagency Emergency Health Kit (2006) includes a limited quantity of medicines for patient post-exposure prophylaxis, magnesium sulphate and instruments and medicines for midwifery care, but not all supplies required for the MISP. The Interagency Reproductive Health Kits, developed by the Interagency Working Group on RH in crises, contain medicines and supplies for a three-month period.
  3. Sexual violence: All actors in disaster response must be aware of the risk of sexual violence including sexual exploitation and abuse by humanitarians, and must work to prevent and respond to it. Aggregate information on reported incidents must be safely and ethically compiled and shared to inform prevention and response efforts. Incidence of sexual violence should be monitored. Measures for assisting survivors must be in place in all primary-level health facilities and include skilled staff to provide clinical management that encompasses emergency contraception, post-exposure prophylaxis to prevent HIV, presumptive treatment of sexually transmitted infections (STIs), wound care, tetanus prevention and hepatitis B prevention. The use of emergency contraception is a personal choice that can only be made by the women themselves. Women should be offered unbiased counselling so as to reach an informed decision. Survivors of sexual violence should be supported to seek and be referred for clinical care and have access to mental health and psychosocial support.

    At the survivor’s request, protection staff should provide protection and legal support. All examination and treatment should be done only with informed consent of the survivor. Confidentiality is essential at all stages (see Health systems standard 5, guidance note 3 and Protection Principle 1, guidance notes 7–12).
  4. Emergency obstetric and newborn care: Approximately 4 percent of the disaster-affected population will be pregnant women. Approximately 15 percent of all pregnant women will experience an unpredictable obstetric complication during pregnancy or at the time of delivery that will require emergency obstetric care and 5–15 per cent of all deliveries will require surgery, such as caesarean section. In order to prevent maternal and newborn mortality and morbidity resulting from complications, skilled birth attendance at all births, BEmOC and neonatal resuscitation should be available at all primary healthcare facilities. BEmOC functions include parenteral antibiotics, parenteral uterotonic drugs (oxytocin), parenteral anticonvulsant drugs (magnesium sulfate), manual removal of retained products of conception using appropriate technology, manual removal of placenta, assisted vaginal delivery (vacuum or forceps delivery) and maternal and newborn resuscitation. CEmOC functions include all of the interventions in BEmOC as well as surgery under general anaesthesia (caesarean delivery, laparotomy) and rational and safe blood transfusion.

The referral system should ensure that women or newborns are referred and have the means to travel to and from a primary healthcare facility with BEmOC and newborn care, and to a hospital with CEmOC and newborn care services.