Even in War, the Sexual and Reproductive Health and Rights of Women and Girls in Ukraine Must Be Prioritized

There is ample evidence that shows the safety, health and well-being of women are always threatened and degraded in times of crisis—and we see the same scenario playing out in Ukraine.

A woman and her child get off a bus at an evacuation point on Mar. 25, 2022, in Zaporizhzhia, Ukraine. The busses carried hundreds of people evacuated from Mariupol and Melitopol. Tens of thousands of people remain trapped in Mariupol, a port city that has faced weeks of heavy bombardment by Russian forces. (Chris McGrath / Getty Images)

For the past few weeks, the world has watched in horror as the Russian invasion of Ukraine has catapulted the nation into a humanitarian disaster. The United Nations estimates more than 10 million people have been forced to flee their homes, with 6.5 million people displaced within Ukraine and 3.5 million seeking refuge in other countries. 

Those who are most affected by the humanitarian crisis in Ukraine are women, as men have been required to stay back to fight. In Ukraine, as in many humanitarian contexts, women and children are thrust into highly vulnerable and volatile situations that heighten their risk of trauma and violence and limit their access to essential services and resources, including healthcare.

Within Ukraine, the World Health Organization has confirmed more than 50 attacks on health centers and hospitals, including a maternity hospital in Mariupol, the images from which were splashed across international news. Supplies and hospital beds are in short supply, as many health centers are struggling to safely bring in essential medicines and supplies given attacks on infrastructure and ongoing fighting. Several hospitals have sustained significant damage or been destroyed. Pregnant women have been forced to seek shelter in basements or metro stations, being used as makeshift bomb shelters, as they hide from Russian airstrikes. In addition, the United Nations Population Fund (UNFPA) estimates that 80,000 Ukrainian women will give birth over the next three months and may not have access to safe maternal care.

During conflicts, disasters and other crises, sexual and other forms of gender-based violence (GBV) often increase acutely, as normal protection mechanisms within communities collapse and vulnerabilities are exacerbated by displacement, stress, instability and armed actors’ specific target of women and girls. There is ample evidence that shows that the safety, health and well-being of women are always threatened and degraded in times of crisis, and we see the same scenario playing out in Ukraine.

GBV has long been a significant issue in Ukraine, with up to 75% of women reporting in a 2019 UNFPA survey that they’ve experienced sexual or other forms of GBV, such as physical or emotional abuse, during the course of their lives. This has been particularly pronounced in eastern areas of Ukraine, which have experienced conflict and upheaval over the course of the Russo-Ukrainian War since 2014. These numbers are likely to rise in the aftermath of Russia’s invasion. Of particular concern is the increasing threat of exploitation and human trafficking as the situation in Ukraine and for those fleeing becomes increasingly dire.

The fact is, sexual and reproductive health and rights are essential and must be addressed, even in times of war. In humanitarian crises, like in Ukraine and others around the world, ensuring access to sexual and reproductive health (SRH) services can prevent unnecessary maternal deaths and sexually transmitted infections, including HIV, reduce unintended pregnancy and provide much needed care to survivors of sexual violence. Without these services, the effects of humanitarian crises on women are exacerbated and sustained.

A pro-Ukraine protest in London’s Trafalgar Square on Feb 27, 2022. (Alisdare Hickson / Flickr)

For more than 25 years, the humanitarian system has recognized the unique health needs of women and girls in humanitarian crises. The Minimum Initial Service Package (MISP) for SRH in crisis situations lays out a concise set of crucial coordination and lifesaving service provisions to be implemented at the onset of a crisis. This includes activities to prevent and respond to sexual violence, prevent and treat HIV and other sexually transmitted infections, address maternal and newborn mortality and morbidity and prevent unintended pregnancy. These activities are intended to be short-term stop gaps, until the response is able to transition to providing comprehensive SRH services. Despite this established set of standards, these priorities are often overlooked, not prioritized and under-resourced.

We cannot say we are responding to a crisis when the response is not inclusive of sexual and reproductive health and rights.

Fundamental to supporting women and families in times of crisis is ensuring that SRH services be available to women wherever they are. In any humanitarian crisis response, SRH must be considered essential with funding and efforts to integrate such services prioritized in comprehensive crisis response planning.

In addition, community organizations, local health advocates and community health networks are critical to crisis response as they are on the front lines when a crisis emerges. These networks require flexible funding and sustained support to not only be able to deliver SRH care in times of crisis, but to also sustain their presence and reach when a crisis subsides. These local health networks and SRH advocates have an essential role in mitigating the effects of both current and future, unforeseen emergencies.

When SRH services are not part of a humanitarian response, we have failed the very communities that need support the most: women and girls. We cannot say we are responding to a crisis when the response is not inclusive of sexual and reproductive health and rights. We cannot repair, rebuild and re-establish lives, livelihoods and communities when the unique needs of women are not met. We cannot achieve equity and equality for women when their well-being is not prioritized in all settings and circumstances.

As the conflict in Ukraine continues, we have an opportunity to meet the SRH priorities of women. It is urgent in this moment and essential for the future aspirations of health, progress, peace and prosperity that every woman wants to attain for herself, her family and her community.

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Nabeeha Kazi Hutchins is the president and CEO of PAI.