The National Disaster Management Authority (NDMA) has asked the States to integrate a package of priority sexual and reproductive health activities in their disaster management plans to reduce morbidity and mortality, particularly in women and girls during disaster situations.
Reproductive health interventions for communities affected by natural disasters require special knowledge and skills. Displaced women and young girls experience elevated risks from pregnancy, childbirth, rape and escalated spread of HIV/AIDS and other health problems. Studies have also reported adverse reproductive health outcomes following disasters, including early pregnancy loss, premature delivery, still births and delivery-related complications.
Women and girls also often confront discrimination and gender based violence in the aftermath of disasters. Pregnant and lactating women may not have access to necessary health care and food supplements.
The Minimum Initial Service Package (MISP) for reproductive health is a set of priority activities to be implemented at the beginning of the humanitarian response. It consists of life saving interventions and is designed to prevent and respond to sexual violence, prevent excess neonatal and maternal mortality and morbidity, and reduce HIV transmission.
Released in the Capital in May, the MISP – a cluster of reproductive health services to meet the minimum requirements in a disaster situation with the intent that comprehensive services will be provided as soon as situation permits—was sent to States only in the last week of June after the Uttarakhand disaster. It has been drafted in collaboration with the United Nations Population Fund.
The MISP is aimed at preventing and managing the consequences of disasters by ensuring systems are in place to protect affected population, particularly women and adolescent girls from sexual violence, ensuring medical services, including psycho-social support are available for survivors of sexual violence and reducing HIV transmission by enforcing respect for universal precautions against HIV/AIDS, guaranteeing the availability of free condoms, and safe blood transfusion.
Preventing excess maternal and neo-natal mortality and morbidity by providing clean delivery kits for use by mothers or birth attendants to promote clean home deliveries, providing midwife delivery kits to facilitate clean and safe deliveries at the health facility, and initiating the establishment of a referral system to manage obstetric emergencies is also part of the activities.
The MISP programme is significant as it would enable India to have trainers who could roll out State and district training programmes, advocate for the inclusion of SRH in State and district disaster management plans and health plans and work to integrate and implement reproductive health services as a standard in disaster response.
“Disasters can change life in an instant, destroying homes and communities, often leaving families and individuals without basic necessities, from food and water to hygiene supplies, contraceptives and medical care. In the aftermath, pregnancy-related deaths and sexual violence soar. It is estimated that in any displaced population and at any given point, almost 4 per cent of the population is pregnant, of which, 15 per cent women experience obstetric complications, risking their lives,” said Frederika Meijer, UNFPA Representative in India.
Reproductive health services, including prenatal care, assisted delivery, and emergency obstetric care, are often unavailable. Many women lose access to family planning services, exposing them to unwanted pregnancy in perilous conditions. And young people become more vulnerable to HIV infection and sexual exploitation, she explained.
With the launch of the MISP Manual, family planning, safe abortion and young people’s specific needs would factor in emergency-response in the country. The manual would also help in data collection to allow for appropriate, effective and efficient relief, Ms. Meijer said.
