Sexual and Reproductive Health
© UNHCR/Sam Phelps
Sexual and reproductive health needs do not stop when there is a refugee emergency.
Refugees and other forcibly displaced persons can face disproportionate threats to their health and wellbeing, including gender-based violence, the risk of contracting HIV or other sexually transmitted infections, as well as complications in pregnancy and childbirth.
UNHCR helps provide sexual and reproductive health services so refugees and displaced persons can access life-saving care and live in dignity.
Timely and quality sexual and reproductive health services save lives. Maternal and newborn care, contraception and family planning, clinical and psychosocial services for survivors of gender-based violence, HIV prevention and treatment and addressing the specific needs of different communities all promote individual rights and afford displaced persons the freedom to decide whether, when and how often to have sex or get pregnant.
Yet, despite advances, sexual and reproductive health services are not always available at the onset of a refugee crisis, nor are comprehensive services always available later in the displacement cycle.
How does UNHCR help refugees access sexual and reproductive health services?
UNHCR works in close collaboration with host governments and partners to improve the quality of sexual and reproductive health services and to ensure refugees can access them.
UNHCR procures essential and life-saving medicines, medical equipment and contraception, as well as trains and supports government and partner health staff. UNHCR-trained and supported community health workers (most of whom are refugees) also provide culturally and linguistically appropriate information, referrals, and support so that communities can have the knowledge to improve their and their family's well-being.
While women and girls are at the centre of sexual and reproductive health care strategies, men and boys also have needs that require an inclusive response. UNHCR's sexual and reproductive health programming is culturally sensitive and promotes gender equality and inclusion. It aims to ensure the availability of quality care and holistic services that embody universally recognized human rights standards.
Maternal and Newborn Care
Most maternal and newborn deaths are preventable when skilled care is accessible before, during and after childbirth. Treatments exist for life-threatening conditions, such as post-partum hemorrhage (severe bleeding usually after delivery), eclampsia (complications of high blood pressure during pregnancy), infection and complications of unsafe abortions. Treatment also exists for severe disabilities, such as obstetric fistula (a hole between the vagina and the bladder or rectum that causes leaking urine or feces).
To meet these needs, UNHCR supplies or funds essential medicines and equipment, as well as ambulance services, laboratory services, health worker salaries and infrastructure. UNHCR also trains skilled birth attendants (such as midwives) in emergency obstetrics, neonatal care and postnatal care.
Contraception and Family Planning
Access to contraception and family planning services is a human right. With appropriate contraception and family planning, refugees may prevent unintended pregnancies, avoid unsafe abortions, and prevent maternal and newborn deaths and disabilities. Some barrier methods of contraception, such as condoms, also reduce the risk of sexually transmitted infections.
UNHCR develops guidance and trains government and partner health workers, community health workers and refugee outreach workers on contraception, family planning and sexual and reproductive health for all. UNHCR also enables access to contraceptives through health facilities, including male and female condoms, and provides information on their proper use.
HIV Prevention and Management
The refugee experience is unique and requires HIV prevention and management aligned with their specific needs. Many refugees and displaced persons may not have had access to HIV awareness information, diagnostics, or treatment in their country of origin, or they may have had their treatment interrupted during their flight. In host countries, HIV prevention services, information and education are often not accessible due to language or cultural barriers.
UNHCR enables refugee access to HIV prevention, treatment and care by working with and through governments, partners and major donors such as the Global Fund to Fight AIDS, Tuberculosis and Malaria to supply medicines (including antiretroviral drugs), condoms, laboratory diagnostics, counselling and medical treatment.
UNHCR’s advocacy, capacity building and community health work supports refugee inclusion into national health systems, policies and programmes and raises awareness amongst refugees about the services available to them. UNHCR and the World Food Programme are cosponsors of the Joint UN Programme on HIV/AIDS (UNAIDS) and co-convene the division of labour area on HIV services in Humanitarian Emergencies.
Specific Needs of Different Communities
Even with the uncertainty that overshadows the lives of many refugees, some communities are even more vulnerable such as adolescents, persons with disabilities, people who sell or exchange sex and LGBTIQ+ persons.
Adolescent Sexual and Reproductive Health
Adolescents in refugee or humanitarian settings are at increased risk of sexual abuse, exploitation and reproductive health-related disabilities or death. In fact, complications from pregnancy and childbirth are among the leading killers of adolescent girls. Babies born to adolescent mothers also face a higher risk of dying compared to those born to older mothers. In addition, adolescent girls and boys are at increased risk of acquiring sexually transmitted infections.
To address this, UNHCR and Save the Children released the Adolescent Sexual and Reproductive Health in Refugee Situations: A Practical Guide to Launching Interventions in Public Health Programming. The toolkit aims to establish and strengthen sexual and reproductive health services and empower young people to know and exercise their rights, including preventing early or unintended pregnancy, sexual violence and exploitation, and child, early and forced marriage.
People who sell or exchange sex
The harsh and often dire conditions refugees experience may be drivers to sell or exchange sex for food, shelter, money, services or goods. People who sell or exchange sex have particular health and protection needs that often remain unmet.
In response, the operational guidance Responding to the health and protection needs of people selling or exchanging sex in humanitarian settings seeks to improve access to essential health care and protection services, reduce transmission of HIV and STIs, prevent unintended pregnancies, promote safety and security, strengthen community-led responses, facilitate economic empowerment, and combat stigma and discrimination.
LGBTIQ+ Persons
People who identify as LGBTIQ+ need equitable access to health care, including sexual and reproductive health, comprehensive support for survivors of gender-based violence, pre-exposure prophylaxis for those at increased risk of HIV, and hormone therapy for transgender persons.
UNHCR’s Need to Know Guidance on Working with Lesbian, Gay, Bisexual, Transgender & Intersex Persons in Force Displacement highlights the intersecting protection and health needs for this population.
Maternal and Newborn Health
- UNHCR Operational Guideline for Improving Maternal and Newborn Health in Refugee Operations (revised version pending publication)
- High Impact Practice: Kangaroo Mother Care
- High Impact Practice: Neonatal Resuscitation
- Maternal Death Review Guidance
- Review of maternal death audits in refugee camps in UNHCR East and Horn of Africa and Great Lakes Region, 2017–2019
Saving Maternal and Newborn Lives in Refugee Situations Project (Funded by Bill and Melinda Gates Foundation)
- Expansion of the 'Saving Maternal and Newborn Lives in Refugee Settings' Project: Summary of Baseline Assessment
- Saving Maternal and Newborn Lives in Refugee Situations - Evaluation Summary
HIV Prevention and Management
- Global AIDS Strategy 2021-2026
- Integrating HIV in the Cluster Response (2020)
- HIV in Humanitarian Contexts (2019)
Specific Needs of Different Communities
- Adolescent sexual and reproductive health in refugee situations: A practical guide to launching interventions for public health programmes (Available in French)
- Adolescent Sexual and Reproductive Health (ASRH) Toolkit for Humanitarian Settings 2020 Edition (Available in Arabic - French - Spanish)
- Responding to the health and protection needs of people selling or exchanging sex in humanitarian settings