Imagine that you're nine months pregnant. You go into labor when there's no one around to help, no nearby medical facilities, and it's unsafe to even step outside because a crisis has just struck your community. You'll have to deliver your baby by yourself, risking both of your lives if there are complications. For many women in areas afflicted by war, violent conflicts, or destroyed by natural disasters, this is the reality. There are currently more than 100 million people around the globe in need of humanitarian assistance, one quarter of which are women of reproductive age, according to the United Nations Population Fund's (UNFPA) annual State of World Population report released Thursday. Those 25 million women and girls face increased risks of maternal mortality, sexual and gender-based violence, and child marriage, as their sexual and reproductive rights are severely diminished during crises.
"To women and girls, sexual and reproductive health is just as important as basics like water and shelter," Richard Kollodge, the senior editor of the State of World Population report, tells Bustle.
In the countries experiencing the most conflict and humanitarian crises, largely in Africa and the Middle East, gender inequalities are already omnipresent, so they're only exacerbated when thousands of people are displaced by a tragedy. When women are seen as second-class citizens, it only makes sense that their specific needs wouldn't be considered or they would be taken advantage of when a catastrophe strikes. "Pervasive gender-inequitable norms underlie the invisibility of women's needs," explains Jesse Rattan, director of CARE's sexual reproductive health in emergencies global program.
Although it could be considered common sense, many people don't think about the fact that women don't stop getting pregnant or having babies when a crisis hits, as the UNFPA report points out. Without access to health care, pregnant women become extremely vulnerable to infection, miscarriage, premature delivery, stillbirths, unsafe abortions, severe long-term morbidity and even death. "Pregnancy and delivery can be life threatening even in the best of circumstances," Françoise Girard, president of the International Women's Health Coalition, tells Bustle. "In an emergency situation, functioning health systems collapse or are severely compromised. Skilled health personnel are killed or flee. Clinics have no antibiotics. Roads to a clinic are not safe."
A lack of food after a disaster is a problem for everyone affected, but it becomes especially dangerous for pregnant women, as malnutrition and undernourishment can lead to complications giving birth or breastfeeding and developing anemia (which women, and especially pregnant women, are more prone to) increases the risk of maternal mortality.
Women who are already pregnant are not the only ones stripped of their sexual and reproductive rights during disasters and conflicts though — all women and girls have an increased need for birth control when it's the least available. "Family planning is a life-saving intervention: it prevents unintended and unwanted pregnancy and in turn reduces health risks of childbirth and recourse to unsafe abortions," the UNFPA report says. Following the earthquake in Haiti, the pregnancy rate in camps was three times higher than in cities beforehand, with about 66 percent of pregnancies unwanted or unplanned. Not to mention condoms also help prevent HIV and other sexually transmitted infections.
In all types of humanitarian crises, from earthquakes to ISIS's reign of terror, women experience more sexual violence. When people are sleeping in open areas without protection and are forced to walk to bathrooms at night, women and girls become targets. Gender-based violence is also used as a weapon of war for ethnic cleansing and because of the stigma attached to rape in many cultures.
Cases of intimate partner violence increase in these situations too, as many men experience a "crisis of identity" or are humiliated when they become unable to provide for their families because of a tragedy and feel the need to reassert their power and masculinity. In fact, this is the most common type of violence toward women during humanitarian crises, according to the report.
Just like all gender inequalities, it's important to note that gender-based violence does not magically appear after a crisis, but only becomes more common.
Women and girls in extreme circumstances are often driven to use transactional sex to get food, shelter, or protection. Though they choose to do so, it's out of desperation, and serves as another reason access to contraception is so important — women and girls shouldn't have to live with an unwanted pregnancy, sexually transmitted disease, or even die for doing what they deemed necessary to live.
As families struggle to survive and protect one another, many girls are married to older men as a form of protection. The Syrian refugee crisis, for example, led to a rise in child marriages among displaced girls in Jordan, Lebanon, and Egypt. Having a husband not only ensures that a young girl will be taken care of financially, with food to eat and roof over her head, parents also hope it helps protect her "honor," as she's less likely to use transactional sex for survival (though one could argue that her marriage is another form of transactional sex). The UNFPA report significantly notes: "Given their age and gender, married girls have limited power and influence to determine what happens to their bodies."
Because the problems women and girls face during times of crises are only escalations of the struggles they face every day, the UNFPA believes the solution is to address these inequalities before tragedy strikes. It's also important to make individuals, whole communities, and nations more resilient to disasters and conflict, through educating girls and investing in sexual and reproductive health and sustainable long-term development, so they are more equipped to handle emergency situations.
Prospects for displaced women and girls have significantly improved in the last 20 years, but the issue is nowhere close to being resolved. Within the humanitarian field, it's shifted from a problem of recognizing gender inequalities to making equality a reality, with funding being one of the largest obstacles. In 2014, the UN requested $19.5 billion for humanitarian aid, but only $12 billion was donated. "There just isn't enough money to go around," Kollodge says. There's no way sexual and reproductive health services can receive the funding they desperately need when there isn't enough for humanitarian relief as a whole.
However, just the fact that such a report exists and experts are researching the topic shows vast improvement.
"The humanitarian community has come really far since 1994 when, during the Rwandan refugee crisis, virtually no sexual and reproductive health services were available," Rattan says. "Now, these life-saving services are much more available. We just need to make sure they are available at a larger scale and better funded."