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Hidden casualty of conflict and crisis: Reproductive health

Source: Thomson Reuters Foundation - Fri, 4 Jul 2014 09:27 GMT
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A pregnant woman sits in a makeshift shelter for families displaced by fighting between government soldiers and Muslim rebels of Moro National Liberation Front (MNLF) in Zamboanga city in southern Philippines, on Sept. 18, 2013. REUTERS/Erik De Castro
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NEW YORK (Thomson Reuters Foundation) — The chaos of armed conflict and other humanitarian emergencies exacts a high price on reproductive health – a problem that deserves greater focus by health workers inside and outside crisis zones, according to the Royal College of Obstetricians and Gynaecologists (RCOG).

As global migration rises, more doctors and health care providers will encounter refugees from conflicts, natural disasters and other emergencies, and need to be sensitive to the significant reproductive health issues that such patients may experience, said the authors of “Reproductive health during conflict”, an article published Friday by The Obstetrician & Gynaecologist, the journal of the RCOG.

The article pointed out that although its focus is on conflict, the issues it addresses apply to most crisis settings.

“Conflict can negatively impact all aspects of reproductive health, directly through damage to services, gender-based violence, and forced displacement of populations, and indirectly through reductions in the availability of basic health care and breakdown of normal social institutions,” wrote the authors Benjamin Black, Paul Bouanchaud, Jenine Bignall, Emma Simpson and Manish Gupta.

High maternal mortality is one of the costs of conflict due to displacement, lack of transport, poor security and the disruption of essential health services, the report said. It noted that eight of the 10 countries with the highest maternal mortality ratios have experienced current or recent conflict, according to the World Health Organization.

The report estimates that 170,000 maternal deaths occur annually during humanitarian emergencies. It said about 15 percent of displaced pregnant women will experience a life-threatening obstetric complication including sepsis, obstructed labour, eclampsia, in which a woman suffers seizures, and haemorrhaging, the leading cause of maternal mortality globally.

Gender-based violence, including rape, during conflict is another threat to reproductive health. Along with trauma, victims may be exposed to sexually transmitted infections and HIV.

“All survivors of sexual violence should be offered post-exposure prophylaxis if the assailant is likely to have been HIV positive, or in populations where the HIV prevalence exceeds 15 percent. This includes pregnant women,” the report said.

Family planning is often another casualty of conflict as clinics may close and supplies of contraceptives become unreliable or inaccessible, resulting in an increase in unplanned pregnancies and illegal and unsafe terminations of such pregnancies.

The report estimated that unsafe termination of pregnancy accounts for 13 percent of maternal deaths globally every year, almost entirely in Africa.

A group deeply affected by conflict and often overlooked is that of adolescents, who may find themselves thrust into dangerous situations with their family structures shattered.

“Adolescents caught in, and uprooted by, conflict are particularly vulnerable to sexual violence, exploitations, transactional sex, trafficking, and harmful traditional practices,” the article said.

“Adolescent girls may be coerced into selling sex, increasing their risk of pregnancy, unsafe termination of pregnancy, sexually transmitted infections and HIV, and abuse.”

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