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    Photo By: The IRC/Gerald Martone

    Minimum Initial Service Package (MISP) for Reproductive Health in Crisis Situations

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    The Women’s Refugee Commission works to ensure that women’s and girls’ vital needs are recognized and addressed from the very onset of a humanitarian emergency by promoting basic standards for sexual and reproductive health care. We are a member of the Interagency Working Group (IAWG) on Reproductive Health in Crises, which developed a set of priority practices for health care professionals called the Minimum Initial Service Package (MISP) for Reproductive Health in Crisis Situations designed to:

    • prevent and respond to sexual violence;
    • prevent excess maternal and newborn mortality and morbidity;
    • reduce HIV transmission; and,
    • plan for comprehensive RH services in a coordinated manner.

    When implemented from the onset of a crisis, the MISP saves lives and prevents illness, especially among women and girls. The MISP outlines both the necessary equipment and the actions that trained staff should undertake during the early days of a crisis (see a “cheat sheet”). The MISP cuts across many sectors besides health—such as safety and security, water and sanitation.

    Health professionals can access the MISP online and get certified in the distance learning module.


    Why is the MISP Important in Emergencies and Conflicts?

    Maternal and Infant Mortality and Disability

    Globally 15 percent of pregnancies will result in a life-threatening complication, and the risks for such complications are compounded in places that have been hit by conflict or disaster. It is essential that women and newborns receive the care they need, even in such settings. To prevent unnecessary maternal and newborn infections and deaths, skilled birth attendants should be present at all births and basic supplies—such as soap, plastic sheets, clean string and clean razor blades—must be available.

    Gender-based Violence

    Gender-based violence (GBV) may be physical, sexual or psychological in nature, and can be affected by cultural or economic pressures. Across all cultures, GBV usually impacts women and girls (though not exclusively) and leads to significant disabilities and illnesses. GBV can increase dramatically during war and other conflict. Implementing the MISP can help to prevent sexual violence and provide assistance to survivors by ensuring protection, medical services and psychosocial support.

    Often neglected, adolescents and young women are especially vulnerable to sexual violence in crisis settings. It is crucial that they are assured access to emergency contraception, postexposure prophylaxis (PEP), care for injuries and psychological care. 

    Sexually Transmitted Infections and HIV/AIDS

    Sexually transmitted infections (STIs) can spread quickly where there is poverty, powerlessness and instability. The MISP helps prevent the transmission of HIV by providing guidance on standard precautions, such as making free condoms readily available and ensuring blood for transfusion is safe. Introducing these basic services from the start of a crisis can substantially reduce HIV transmission. When a patient presents with symptoms of an STI, treatment should be provided. The MISP also requires that those on antiretroviral treatment continue to receive this medication and that antiretrovirals be administered to prevent mother-to-child transmission of HIV.

    Contraception

    At the onset of a humanitarian crisis, it is essential to make contraceptives—such as condoms, birth control pills and emergency contraceptive pills—available. During conflict, women may not have brought their routine contraceptives with them or be unable to access them at their site of refuge. Additionally, women and adolescents are more likely to be subjected to violence, including sexual assault and attacks. Many adolescents also take part in risky sexual behavior. Contraceptives must be accessible from the early stages of the crisis, and more comprehensive family planning programs need to be implemented once the situation stabilizes.


    Our Work

    The Women’s Refugee Commission has advocated for improved implementation of the MISP. Read more about our work:

    • We have developed universal information, education and communication (IEC) materials for humanitarian relief workers to distribute to communities. The materials explain priority reproductive health services and can be adapted to different contexts as needed.
    • We are working with humanitarian and development experts to develop tools to assist with incorporating sexual and reproductive health care into efforts to improve emergency preparedness.
    • In partnership with the Sexual and Reproductive Health Programme in Crisis and Post-Crisis Situations in East, Southeast Asia and the Pacific (SPRINT) Initiative, the Women’s Refugee Commission has supported trainings for first responders in South Sudan, Uganda and Haiti. Read our report.
    • We are spearheading partnerships, research and advocacy around new and underutilized reproductive health technologies and different approaches to delivering reproductive health services in humanitarian settings. Read about the 2008 consultation we co-hosted with the organization PATH that brought together humanitarian health, development and research partners to brainstorm about these issues.
    • We are piloting a community-based model of postrape care with partners along the Thai-Burma border, to examine whether this type of care is safe and feasible in a setting where insecurity and other barriers hinder access to clinics and hospitals.
    • We are examining and advocating for promising new and underutilized reproductive health technologies in humanitarian settings, including the non-pneumatic anti-shock garment (NASG), for first aid treatment of postpartum hemorrhage. 
    • We are leveraging our networks to move the field forward. Two critical networks include the Inter-agency Working Group (IAWG) on Reproductive Health in Crises and the Reproductive Health Response in Crises (RHRC) Consortium. Both networks were founded in 1995 to advance the reproductive health of crisis-affected women, men and adolescents.
    • We are advocating for the MISP to respond to emergencies. We contributed to and disseminated advocacy statements on behalf of the RHRC in Haiti, Pakistan, Kyrgyzstan and the Horn of Africa.  We have also conducted MISP assessments in Asia following the tsunami, Kenya, Haiti (an interagency assessment in Haiti) and eastern Chad.

    Reports and Resources