1
TOWARDS A COMPREHENSIVE APPROACH
OF SEXUAL AND REPRODUCTIVE RIGHTS
AND NEEDS OF WOMEN
DISPLACED BY
WAR AND ARMED CONFLICT
A Practical Guide for Programme Officers
Marleen Bosmans, Prof. Dr. Marleen Temmerman
International Centre for Reproductive Health, Ghent University
2003
With the support of the Flemish Interuniversity Council, VLIR.
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Ghent, July 2003
ISBN: *
International Centre for Reproductive Health
Ghent University
De Pintelaan 185 P3
B-9000 Gent
Belgium
Tel.: +32 9 240 35 64
Fax: +32 9 240 38 67
E-mail: [email protected]
Website: http://www.icrh.org
This document is issued for general distribution. All rights are reserved. Reproductions and
translations are authorised, except for commercial purposes, provided the source is acknowledged.
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With this we want to acknowledge
o Marleen Thomas, Leen De Becker, Carla Dauw and Tania Braems at the Belgian
Directorate General for Development Cooperation and Nicole Malpas at the
Belgian Technical Cooperation for their enthusiast cooperation and support
o Judy El-Bushra, Florence Tercier Holst-Roness, Samantha Guy, Wilma Doedens,

ANNEX 1 Glossary of Terms 29
ANNEX 2 ICPD and ICPD +5 Reproductive Health Indicators 33
ANNEX 3 Reference Addresses 36
ANNEX 4 Bibliography 39
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LIST OF ABBREVIATIONS
AIDS Acquired Immunodeficiency Syndrome
CBO Community Based Organization
DGDC Directorate General for Development Cooperation
FP Family Planning
HIV Human Immunodeficiency Virus
IAWG Interagency-Working Group on Reproductive Health
in Refugee Situations
IDP Internally Displaced Person
IEC Information, Education, Communication
IUD Intra-uterine Device
MISP Minimum Initial Service Package
NGO Non-governmental organization
PHC Primary Health Care
RH Reproductive Health
SRH Sexual and Reproductive Health
STD Sexually Transmitted Disease
STI Sexually Transmitted Infection
UNHCR United Nations High Commisioner for Refugees
UNFPA United Nations Population Fund
VCT Voluntary Counselling and Testing
VAW Violence against Women
WHO World Health Organisation
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I. INTRODUCTION

meeting on “Sexual and Reproductive Needs and Rights of Women Displaced by
War and Armed Conflict” (Ghent, 25-27 November 2002) the draft was peer
reviewed. A more final version was discussed during a lunch conference organized
by the Belgian Technical Cooperation.
As it happens, this kind of guides will always need continuous adapting and updating,
but we hope that it will be a useful tool for all involved in the development,
implementation , monitoring and evaluation of SRH humanitarian aid programmes in
paving the way for a more comprehensive, gender sensitive and culture sensitive
approach of displaced women’s SRH.
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II. PURPOSE AND USE OF THE GUIDE
1. OBJECTIVES
1.1. OVERALL OBJECTIVE
The guide is meant as a tool for programme officers to support a comprehensive
approach of SRH rights and needs of women displaced by war and armed conflict.
1.2. SPECIFIC OBJECTIVES
? To get an overview of the key issues to be taken into account for a better
understanding of the impact of conflict on the SRH rights and needs of women
displaced by war and armed conflict.
? To assure a multidisciplinary, multisectoral and integrated approach of women’s
sexual and reproductive rights and needs by including legal, political, economical,
social, cultural and health aspects which determine women’s SRH status.
? To identify needs and gaps in the approach of sexual and reproductive rights and
needs of women displaced by war and armed conflict.
? To guide the development of comprehensive SRH programmes in conflict
situations within a long term perspective.
? To gain insight in the contribution of a specific SRH project to the improvement of
the SRH status of women displaced by war and armed conflict.
1.3. TARGET GROUP

Ideally, the following steps should be taken when preparing field visits and meetings
with the different stakeholders.
1. Literature review
- Basic information on the conflict, the situation of
displacement.
- Basic information on the SRH status of women in the
country or region of origin.
- Basic information on the SRH provisions in the host
region or community.
- Policy documents, reports and publications of
stakeholders involved.
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2. Identification of
stakeholders in
the provision of
SRH services
In principle a wide variety of stakeholders involved in SRH
programmes for refugee and internally displaced women
should be contacted such as:
- humanitarian organizations:
o active in the field of refugee health
o local, national as well as international
o preferably organizations working on one or more
aspects of SRH
- human rights organizations:
o active in the defense of human rights of
refugees/IDP, and more specifically of women’s rights
- women's organizations:
o women's organizations active in the refugee/IDP
communities

conclusions and
recommendation
s
Formulation of preliminary conclusions and
recommendations on basis of the outcome of the literature
review, the interviews, the focus groups discussions and the
visits to the camps and settlements.
7. Feed back
Discussion of the preliminary conclusions and
recommendations at a joint meeting with representatives of
the counterpart and other directly involved stakeholders.
8. Report
Report of the field visit with final conclusions and
recommendations.
9. Dissemination
Dissemination of the report among the stakeholders
involved.
10. Strategy
formulation
Formulation of a joint strategy in close concertation with the
counterpart in order to develop a more comprehensive
approach of SRH of women displaced by war and armed
conflict.
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III. GUIDE
1. CONFLICT ANALYSIS
Since the end of the Cold War there has been a dramatic increase in the number of
armed conflicts and wars, most of them taking place in developing countries and
more particularly in Least Developed Countries. In these countries the massive
displacement of people and the vast flow of refugees often provoke devastating

traumatization, refugees, internal displaced persons,
main victims (military, civilians, ethnical groups; women,
elderly, children, young men).
- Kind of socio-economical destruction: damage to
infrastructure (buildings, houses, hospitals, roads,
energy supplies, transport).
- Kind of ecological destruction: drinking water supply,
agricultural production, mines.
- Geographical spread of the conflict: capital, main towns,
certain areas.
- Peace efforts: economical aid, peace keeping forces,
care for refugees and internally displaced persons, care
for injured persons.
Conflicting parties
- Number of parties.
- Kind of parties: conflicting states, military forces
(national, regional, international), guerrilla, paramilitary,
armed groups, armed civilians.
Causes
- Interests: political, economical power, territorial
autonomy
- Values: cultural, religious, ideological.
- Collective identity: ethnicity, nationalism
- Irrational: hatred, revenge, aggression.
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2. DISPLACEMENT
Forced displacements of people and refugee movements are no longer side effects
of war and armed conflict but are increasingly used as tactics in war. Moreover, the
situation of refugees and IDPs is urging humanitarian organizations to revise their
policies and programmes and to reconsider them within a long-term strategy as there

- Massive or individual.
- Place of origin.
- Migration movements.
- Duration.
Displaced
population
- Number.
- Socio-demographical characteristics (sex, age, civil status,
family composition, education, employment).
- Registration system.
- Access to social services, including SRH services.
- Special provisions for sole female headed households.
Living conditions
- Settlement (closed camps, open camps, refugee centres,
dispersed among hosting community).
- Housing (tents, slums, brick houses).
- Access to basic goods and services (water, food, fuel,
sanitary provisions).
- Measures to guarantee women’s access to basic goods
and services.
- Security and protection (presence of military forces, armed
groups, gangs, civil security patrols).
Management and
organization
- Institutions and authorities in charge (national,
international, governmental, non-governmental, community
based organizations).
- Organization of the displaced population.
- Organization of the displaced women.
- Participation of the displaced in the management.

Coordination
- Coordinating mechanisms (members, mandate, objectives,
effectiveness, efficiency).
- Participation of national NGOs and authorities.
- Participation of national women’s and human rights
organizations.
- Participation and role of the counterpart in these
mechanisms.
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SRH coordinating
mechanisms
-
- Specific mechanisms for coordinating SRH mechanisms
(members, mandate, objectives, effectiveness, efficiency).
- Participation of national NGOs and authorities.
- Participation of national women’s and human rights
organizations.
- Participation and role of the counterpart in these
mechanisms.
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4. IMPACT OF THE CONFLICT ON THE SRH STATUS OF
DISPLACED WOMEN
4.1. IMPACT ON THE POLITICAL ENVIRONMENT
Conflict situations and massive displacement of people may seriously affect the
national and local health system. The kind and scope of SRH services that can be
provided in a certain setting are highly dependent on the national health policy in the
host country, and more particularly on the national protocol and guidelines on SRH of
the host country. These protocol and guidelines do not necessarily provide for all
SRH related services - including family planning (FP), safe motherhood, sexually
transmitted infections (STI) and HIV/AIDS, and violence against women.

policy.
4.2. IMPACT ON THE LEGAL ENVIRONMENT
The promotion of women’s sexual and reproductive rights is fundamental for
improving women’s SRH. The awareness among stakeholders involved in the
provision of SRH services about the importance of women’s human rights, and more
particular of women’s sexual and reproductive rights, is gradually growing but is still
no real priority for most of them.
Women’s and human rights organizations which pay attention to women’s sexual and
reproductive rights can help to gain a better insight in the national regulations and
standards that affect the SRH of women, and more particularly the SRH of the
displaced women. Comprehensive SRH programmes for displaced women should
include support to advocacy and counselling efforts aimed at improving the legal
status of women as well as support to the development of a legal framework for the
protection of women’s sexual and reproductive rights.
The following topics should be considered:
Domestic law
-
Recognition of women’s rights as human rights in
domestic law.
-
Legal standards concerning SRH related issues such as:
marriage, widowhood, unwanted pregnancies, gender-
based violence, harmful traditional practices (such as
early marriage, female genital mutilation, dowry, honour
killings), support to HIV/AIDS infected.
Other legal systems
- Impact of customary law on displaced women’s SRH.
- Impact of tribal law on displaced women’s SRH.
- Impact of religious law on displaced women’s SRH.
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- Impact of the family.
- Impact of prevailing gender-relationships: man-women,
boy-girl, elderly-young.
- Impact of changing gender-relationships.
- Impact of religion.
- Empowerment programmes (including economic
empowerment).
Harmful traditional
- Kind of harmful traditional practices (e.g. early marriage,
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practices
female genital mutilation, widow marrying, dowry brides,
honour killing).
- Prevalence of harmful traditional practices.
Health staff
- Origin (international, national, local, members of the
displaced community).
- Knowledge of the language of the displaced.
- Knowledge, belief and attitudes towards prevailing SRH
practices.
- Efforts to employ and train female health staff.
- Efforts to employ and train members of the displaced
community.
- Training in cross-cultural skills.
- Gender-training.
Information-
Education-
Communication
(IEC)
- Participative approach (involving women, community

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The IAWG was established as an outcome of the Inter-agency Symposium on Reproductive Health in Refugee
Situations that took place in Geneva in 1995. The group was initially comprised of UNHCR, UNFPA and the
Reproductive Health for Refugees Consortium (RHRC) members and has been expanding ever since along with
the growing recognition for the importance of SRH issues in conflict situations. The IAWG was created to
ensure a better coordination and information sharing for various aspects of refugee reproductive health related
programming, monitoring and evaluation, as well as a tool development and research.
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UNHCR, Reproductive Health in Refugee Situations. An Inter-agency Field Manual., 1999. The UNFPA
Reproductive Health Kit contains:
? For use at primary health care/health centre level: 10.000 population for three months:
0. Training and administration.
1. Condoms.
2. Clean delivery sets.
3. Post-rape management.
4. Oral and injectable contraceptives.
5. STD drugs.
? For use at health centre or referral level: 30.000 population for three months:
6. Professional midwifery delivery kit.
7. IUD insertion.
8. Management of the complication of unsafe abortion.
9. Suture of cervical and vaginal tears.
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In emergencies the following topics in the provision of SRH services should be
considered:
Coordination
- Identification and employment of a SRH coordinator.
- Planning for the provision of comprehensive SRH services.

the local health system should be supported and supplemented with additional

10. Vacuum extraction.
? For use at the referral level: 150.000 population for three months:
11. A – Referral-Level Surgical (reusable equipment).
11. B – Referral-Level Surgical (consumable items and drugs).
12. Transfusion (HIV testing for blood).
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services such as counselling for post-traumatic stress disorder.
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The SRH needs of
the host population should not be neglected neither and humanitarian SRH should
include them in their programmes where necessary.
Over the past years several guidelines, manuals and tools have been developed for
the implementation, monitoring and evaluation of SRH programmes for refugees and
IDPs. Serious efforts have been made to make these tools widely available but there
is still a huge need for having the development of comprehensive SRH programmes
to be accepted as a standard policy and practice in humanitarian aid operations.
In stabilized conflicts the following topics should be considered:
Needs assessment
- Quantitative needs assessment.
- Qualitative needs assessment.
- Participatory approach: active participation of
o the displaced community
o the displaced women
o “less visible” women (such as widows, sole female
heads of household, elderly women).
SRH services
- Participatory approach: active participation of the displaced
community and the women in the design.

- Breastfeeding.
- Skilled attendance of deliveries.
- Emergency obstetric care.
- Abortion (where legally permitted).
- Post-abortion care.
- IEC activities.
Family Planning
- Counselling.
- Availability of modern contraceptives (condoms, oral
contraceptives, injectables, IUD).
- Accessibility of modern contraceptives.
- Regular and reliable supply of modern contraceptives.
STI/HIV/AIDS
- Counselling.
- Treatment.
- Care.
- Support to HIV/AIDS infected.
- Voluntary Counselling and Testing (VCT).
- Safe blood supplies.
- IEC activities.