UN Population Division, Department of Economic and Social Affairs,
with support from the UN Population Fund (UNFPA)
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| UN Population Division, Department of Economic and Social Affairs, with support from the UN Population Fund (UNFPA) |
|
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This document is being made available by the Population Information
Network (POPIN) Gopher of the United Nations Population Division, Department
for Economic and Social Information and Policy Analysis, in collaboration
with the United Nations Population Fund Emergency Relief Operations.
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AS WRITTEN
Statement by
Dr. Nafis Sadik
Executive Director, United Nations Population Fund (UNFPA)
at the
Inter-Agency Symposium on Reproductive Health in Refugee Situations
Geneva, Wednesday, 28 June 1995
Representatives of the Permanent Missions,
Colleagues from the United Nations,
Colleagues from the Non-Governmental Organizations,
Ladies and Gentlemen
May I on behalf of UNFPA welcome you to this meeting. I am very
happy that so many organizations are taking part in this symposium.
Your attendance shows your concern for this increasingly urgent and
hitherto neglected issue. UNFPA is committed to working closely
with all our colleagues within and outside the United Nations
system to find effective responses.
All people in emergency situations are vulnerable, but women and
girls are in a position of special risk from violence or sexual
abuse. In most societies, women are accustomed to discrimination as
a matter of course. The social and cultural norms that ensure their
second-class status also offer them some protection: but protection
is defined in terms of an ethical and social system dominated by
the concerns and interests of men, and without specific reference
to women. Once the customary protection is removed, women and girl
children may become effectively dehumanized. They may be regarded
as little better than sexual prey, or even as we have seen in
recent conflicts, as the vessels for a twisted ideology of ethnic
domination.
Interventions to help refugee and displaced populations have
increased one hundred-fold over the past 25 years. Yet there has
been some reluctance to include reproductive health and family
planning as part of the usual basic package of primary health care
offered by relief organizations. I hope that any conceptual
obstacles to this inclusion have been removed by the historic
consensus at last year's International Conference on Population and
Development. For the first time at such a forum, the issue of
reproductive health in emergency situations was highlighted and
taken into account. The ICPD Programme of Action puts reproductive
health, including family planning and sexual health, firmly in the
context of primary health care, and defines good health as
including good sexual and reproductive health.
It must be stressed that there is no competition between on the one
hand immediate responses to ensure survival; and on the other hand
meeting the needs for primary health care once the basic
requirements for food shelter and epidemic prevention have been
met. Reproductive health is an essential component of this second
phase of primary health care.
Principles and Policy
UNFPA recognizes that refugees and internally displaced persons and
persons in all emergency situations have the same vital human
rights to reproductive health as any community. Within its mandate,
and in close collaboration with specialized agencies, UNFPA's
policy is to focus on providing reproductive health services,
including family planning, for these populations. UNFPA's
assistance for emergency situations will be based on the same
principles which guide the rest of our work:
(1) all couples and individuals have the basic right to decide
freely and responsibly the number and spacing of their
children and to have the information, education and means to do so;
(2) an integrated approach provides the most suitable response to
the reproductive health needs of women and men;
(3) information and services are provided on the basis of respect
for voluntary choice;
(4) programmes will be executed with the full involvement of the
community, especially women;
(5) as wide a range as possible of safe and effective modern
methods of family planning, technically approved by the World
Health Organization will be available;
(6) coercion in any form is unacceptable.
UNFPA will pay special attention to making responses to emergencies
more gender sensitive. We are guided by the Programme of Action of
the ICPD, which contains a number of important and visionary
provisions pertaining to women's empowerment, and to all aspects of
women's reproductive health and rights, including family planning
and sexual health. We need to ensure, for example, that gender
perspectives are properly reflected in training of staff for
emergencies and that women are fully involved and consulted on all
aspects of the planning, implementation and monitoring of emergency
services. Special care will have to be given to the needs of
adolescents, especially adolescent girls, in the areas of
reproductive health and sexual violence.
UNFPA is in a position to assist emergency situations through its
extensive network of country directors and field offices. In some
countries the national programme already includes provision for
refugees. In this case, the principal course of action is to
strengthen or rebuild existing RH/FP structures, and provide
medical equipment, drugs, and contraceptive supplies.
Elsewhere projects have been specifically developed for refugees or
internally displaced persons, for example in Burundi, Tanzania and
Uganda. Most such projects include clinical and counselling
services in family planning, advice and prevention for STDs
including HlV/AIDS, supplies, equipment and training. Our project
in Bosnia additionally consists of responding to the psycho-social
needs of women traumatized by violent events, including sexual
violence.
UNFPA's support will be tailored to local conditions, and to the
needs and demands of the populations, and available resources.
Support will be provided in the following general areas:
- Prenatal, delivery (including assisted delivery) and postnatal
care of mothers at the primary health care level with appropriate
referral to host institutions acting as backup;
- Prevention of abortion, management of the consequences of unsafe
abortion, and post-abortion counselling and family planning;
- Management of emergency contraception.
- Prevention of reproductive tract infections including sexually
transmitted diseases and HIV/AIDS, through preventive counselling,
condom distribution and treatment of symptomatic infections, as
part of primary health care;
- Family planning/child spacing information and services. including
counselling and follow-up services aimed at all couples and
individuals.
- Prevention and treatment of infertility and sub-fecundity, as
part of primary health care.
- Routine screening for other female reproductive health
conditions, such as urinary tract infections, cervical infections,
and breast cancer, when local expertise allows it, and when
potential followup exists.
- Special attention will be given to sexual violence.
- Harmful sexual practices such as female genital mutilation should
be discouraged.
In combination these elements assure continuity of care for
reproductive health. It will not be possible to implement all of
them in all situations, given the precarious living conditions of
refugee populations: reproductive health concepts will be adapted
to the situation on the ground. But we will at all times keep them
before us as the minimum requirements for assuring good sexual and
reproductive health.
UNFPA's Response
Based on these principles, UNFPA has taken the following major
steps: In June 1994, our Executive Board decided that UNFPA should
"assist urgently, in an appropriate way and with the collaboration
of other specialized agencies, the population of Rwanda". This
decision institutionalized a UNFPA presence in emergency
situations.
In September, 1994, the ICPD Programme of Action clearly defined
objectives and broad lines of assistance to refugees and internally
displaced persons, specifically for the most vulnerable
groups--women and adolescent girls.
In November 1994, UNFPA set up an Emergency Relief Office, based in
Geneva, to identify needs, develop projects and promote a
co-ordinated response. It will support our Country Directors and
Country Support Teams, and identify operational partners.
Very shortly an agreement will be signed between UNFPA and UNHCR
which will facilitate collaboration on common activities and
maximize inputs of both agencies. In those cases where reproductive
health coordination already exists, UNFPA will integrate its
activities under the umbrella of ongoing activities. In other
instances, UNFPA will be considered as a catalytic agent.
Ladies and Gentlemen, we are all confronted with a new
challenge--to ensure that all populations in emergency situations
receive reproductive health and family planning services
corresponding to their needs, and that these are adapted to their
demands and cultural sensitivity. This is an unfortunate necessity,
but one to which we must respond with all the energy and enthusiasm
at our disposal. In the best case, we may learn through our work in
emergency situations how to hone the speed and flexibility of our
response in more peaceful times.
If we can do this, our work will also lead to the development and
strengthening of all reproductive health activities. This symposium
is part of that global effort for better reproductive health, of
which we are all part. Our success will help to reduce the
pressures generated by conflicts and emergencies. Let us keep that
aim before us in the days ahead.
May I wish you all an excellent and productive meeting.