A/HRC/42/24
49.
Experts noted that there is frequently a striking absence of family planning and
contraception in humanitarian preparedness and response plans and a lack of availability of
a wide range of contraceptive methods, including the often-preferred copper intrauterine
device (IUD), which inhibits the informed choice at the heart of a rights-based approach.
Moreover, mobility is often restricted and educational opportunities curtailed in refugee or
internally displaced person camp settings, two human rights violations which further
restrict the ability of women and girls to access contraception.
50.
An innovative good practice shared in this context involved women trained to use
mobile technology to monitor and report on stock-outs of contraceptives. The results were
then shared with humanitarian providers to inform programming. Other experts also
highlighted the innovative opportunities technology is beginning to bring to ensuring sexual
and reproductive health in emergencies. However, the use of information and
communications technologies for health, or “eHealth”, may also lead to privacy concerns,
including with respect to security of patient data and the role of the private sector in
developing the technologies.
51.
Another aspect highlighted, and one where human rights can play a particular role,
concerns attacks against health workers as military targets or because of the kinds of
services they provide. Experts highlighted the importance of documenting and analysing
such attacks, understanding the impact they have on access to services and delivery as well
as strategies developed to overcome them, and how to concretely strengthen protection of
providers and women and girls seeking care. Attacks can also take many forms beyond
armed force, including threats, legal attacks, criminalization, defamation campaigns and
defunding. In addition, services are undermined in contexts where many service providers
at the clinical level do not receive a salary and are facing human rights challenges which
also need to be addressed.
52.
In terms of quality, experts noted that, even when services and facilities are
available, women and girls often do not seek them out not only because of security
concerns or prohibitive costs, such as those related to travel, but because of the disrespect
and abuse they may face and perceptions that the services provided are of low quality. This
is compounded by the failure of donors to prioritize or fund respectful maternity care, as it
is perceived to be a development and human rights, not a “humanitarian”, concern.
Although the evidence is well established in stable settings, the importance of further
research, including human rights analyses, on the experience of disrespect and abuse in
health-care settings in emergencies was highlighted.
53.
Health systems require reasonable capacity, with the availability of skilled human
resources and quality medicines. It is difficult to attract skilled human resources to work in
insecure and remote locations, in particular women skilled birth attendants, in contexts
where the provision of sexual and reproductive health services is not considered life-saving
and is deprioritized. Furthermore, a continuum of care needs to be emphasized at all stages
of an emergency. Insecurity often restricts the critical provision of 24/7 services, such as
emergency obstetric and neonatal care, especially when Governments and other actors
cannot ensure the continuous protection of service providers. At the same time, experts
noted that in other contexts the focus of providers was solely on providing emergency
obstetric and neonatal care rather than comprehensive sexual and reproductive health
services, which also led to gaps in service provision.
54.
Good practices shared involved embedding core human rights principles into a nonnegotiable approach to health care, including standards of care that adopted the rights of
patients as a core element of quality that was frontloaded into system delivery. This also
involved adequate resourcing and trainings for service providers, in particular during
preparedness but also at the onset of and during crises, through inclusion in refresher
trainings, as well as continued follow-up through supervision. In a number of emergencies,
this has led to rights-based services of high quality that were well received and responsive
to individual demands and needs.
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