About one in four of the 129 million people around the world in need of humanitarian assistance are women and adolescent girls of reproductive age. Women and girls are at particular risk when a region or country’s social, health and other support systems collapse, exposing them to sexual violence, unwanted pregnancy, unsafe abortion, STIs (including HIV), and maternal illness and death. And yet, sexual and reproductive health services in humanitarian settings continue to lag far behind the enormous need, argues a new analysis in the Guttmacher Policy Review.

"Humanitarian agencies have made substantial advances in issuing sexual and reproductive health guidance in crisis settings. But implementation of these policies and standards has often fallen far short of what is needed," says Sneha Barot, author of the new analysis. "Fundamentally, the same barriers that can interfere with access to sexual and reproductive health care under normal circumstances are often magnified during emergencies."

Barot details how various stakeholders and agencies have collaborated to create more robust policies and guidance for sexual and reproductive health services in these settings. The analysis also discusses the numerous and complex reasons for gaps in sexual and reproductive health care that advocates and agencies have identified. Some of the key challenges:

• Cultural norms and ideological opposition to family planning and abortion, among other matters, often impede access to services, both before and during a crisis.
• Insufficient data makes it difficult to quantify the need for care, and to design and evaluate evidence-based interventions.
• Financial shortfalls lead to chronic underfunding of reproductive health care, in particular in areas like safe abortion and family planning.
• Weak overall health systems, which have often deprioritized reproductive health already, are easily overwhelmed by a crisis and unable to recover quickly.

Barot notes that these long-standing and structural challenges are now compounded by rising nationalism in the United States and many European donor countries. This trend could result in fewer resources being allocated in the future for aid and relief efforts in general and for sexual and reproductive health services in particular.

The analysis also examines the role of the U.S. government specifically. The United States contributes nearly one-third of the total amount provided globally for humanitarian assistance, making it the largest international donor.

"The United States has long been a leader in helping people around the world during crises, and the Trump administration should uphold that legacy by supporting humanitarian efforts rather than withdrawing from them," says Barot. "Bolstering relief efforts overseas for those who are most vulnerable is all the more important at a time when the administration is attempting to close U.S. borders to some of these same people who are seeking to come to this country as refugees."