Contraceptive services in humanitarian settings and in the humanitarian-development nexus: Gaps and recommendations from a state-of-the-field landscaping assessment
Creators: name: Rich, Sarah
name: Jacobi, Lily
Publisher: name: Gates Open Research
Year: 2023

description: <b>Introduction</b><br> Contraception is lifesaving and a priority health service in emergencies, yet contraceptive services remain a gap in humanitarian settings. To meet the needs of people affected by crises, stakeholders need robust evidence on the state of contraceptive service provision across diverse humanitarian settings and clear, actionable recommendations to inform funding, programming, advocacy, and research. Accordingly, the Women’s Refugee Commission (WRC) undertook a landscaping assessment from 2018 to 2020 to evaluate and build the evidence base on barriers, opportunities, and effective strategies to provide contraception to women and girls affected by crises. The assessment included a literature review, survey, case studies, and key informant interviews (KIIs). WRC also facilitated an extensive process to distill findings into collaboratively generated, evidence-based recommendations. In November 2020, WRC convened stakeholders from the Inter-Agency Working Group (IAWG) on Reproductive Health in Crises and FP2030 to share findings and jointly develop recommendations to advance sustainable, high-quality contraceptive services in crisis-affected settings. WRC is adapting these recommendations to develop concrete roadmaps for action for four key audiences: donors, governments, development actors, and humanitarian actors. <br> <br> <b>Research question</b><br> The primary research question was: What is the current state of contraceptive service delivery in crisis-affected settings? Sub-questions included: What is the current published evidence base on demand for, access to, and effective program models to deliver contraceptive services in humanitarian settings? To what extent are quality contraceptive services being delivered in diverse humanitarian settings? What are key barriers and facilitators to maintain contraceptive programming at transition periods from preparedness, to response, to recovery? How has the COVID-19 pandemic impacted contraceptive service delivery in settings across the humanitarian-development nexus, and what program adaptations have proven successful? <b>Methodology</b> <br> The literature review assessed the published evidence base from 2010 to 2019 on contraceptive services in humanitarian settings. WRC identified and reviewed 75 peer-reviewed and 22 grey publications. <br> <br> The survey used purposive sampling to capture a snapshot of contraceptive programming across humanitarian settings. Twenty organizations participated, representing 84 programs across 42 countries/territories. Data were collected November 2018-January 2019 using Kobo. <br> <br> Case studies were conducted in 2019 in Cox’s Bazar, Bangladesh; Borno State, Nigeria; and Cyclone Idai-affected Mozambique. Across sites, WRC conducted 29 KIIs with government, UN, and partners; 18 facility assessments; 40 provider knowledge/attitudes assessments; and 29 focus group discussions with 307 community members. <br> <br> WRC conducted two sets of global KIIs using purposive and snowball sampling. Fourteen interviews, in 2019, focused on contraceptive programs from preparedness to relief to recovery. Twenty-nine interviews, in 2020, explored COVID-19’s effects on contraceptive services across the nexus. <br> <br> All data were collected in accordance with WRC’s Ethical Guidelines. Qualitative data were coded and analyzed using NVivo. Quantitative data were analyzed using SPSS and Excel. <br> <br> At the interactive consultations, WRC used the Mural software, which creates a virtual “white board,” to validate findings and develop recommendations with approximately 120 Anglophone and Francophone participants. <br> <br> <b>Key findings</b> <br> The assessment findings show that people affected by crisis want and need contraceptive services, but that access to contraception remains limited and uneven in crisis-affected settings. Overall, contraception remains under-prioritized in humanitarian preparedness, response, and recovery. Among the 20 organizations that completed the contraceptive programming survey, one-fourth of their health programs did not include contraceptive services. <br> <br> Key informants who provided or supported contraceptive service delivery during the COVID-19 pandemic further underlined the need to continue raising awareness that contraceptive services are part of the minimum standard of SRH care in all emergencies. Many key informants reported that contraception and other SRH services were particularly impacted during the pandemic because key decision-makers did not perceive them to be essential or lifesaving. <br> <br> The findings also show that within existing contraceptive programming in humanitarian settings, several specific gaps continue to hinder access to high-quality contraceptive services, including: provision of the full range of contraceptive methods, particularly LARCs and EC; access to contraceptive services for adolescents and members of marginalized populations; contraceptive commodity availability; data collection and use for contraceptive service delivery programs; preparedness for contraceptive service delivery prior to an emergency, including through collaboration across humanitarian and development partners; localization of humanitarian response, including government and local NGO engagement and leadership, for contraceptive service delivery. The assessment also revealed an acute need for a stronger evidence base on effective strategies and program models to deliver contraceptive services in humanitarian settings. <br> <br> <b>Discussion</b><br> The assessment findings reinforce the need to continue advocating with governments, donors, and implementing agencies across the humanitarian-development nexus to prioritize contraception as part of SRH in crises, from preparedness to response to recovery. Each of these stakeholders has an essential role in meeting the SRH needs of people affected by crises. It is critical to build consensus that contraception is lifesaving and part of the package of essential health services that must be made available to all women and girls affected by crises. <br> <br> The assessment also identifies a clear set of barriers that must be addressed to improve existing contraceptive access for people affected by crises. Specifically, stakeholders must mobilize to improve access to the full method mix, including LARCs and EC; address barriers for adolescents and marginalized populations to meet their demand for contraception; improve data collection and use; and strengthen supply chains to improve contraceptive commodity security. To address these gaps, stakeholders should collectively strengthen preparedness for SRH to mitigate the impact of crises and invest in local partners to foster effective, efficient SRH response and support sustainable recovery. Finally, it is critical to continue building the evidence base on effective contraceptive programming. <br> <br> Assessment findings, with the corresponding, collaboratively developed recommendations, offer a roadmap with concrete, evidence-based, validated steps for donors, governments, humanitarian actors, and development actors to advance contraceptive access in humanitarian settings and across the humanitarian-development nexus, in turn improving the health and autonomy of women, girls, and others affected by crises.<br> <br> See more here: https://www.womensrefugeecommission.org/research-resources/contraceptive-services-humanitarian-settings-and-the-humanitarian-development-nexus/