1 Reproductive Health in Refugee situations an Inter-agency Field Manual Reproductive Health in Refugee situations an Inter-agency Field Manual This Inter-agency Field Manual replaces the above field-test version. Additional copies of the Field Manual can be obtained from the agencies cited on the back cover. Any comments can be directed to the following: World Health Organisation (WHO). Department of Reproductive Health and Research United Nations Fund for Population Activities (UNFPA). Emergency Relief Office, Geneva United Nations High Commissioner for refugees ( UNHCR ). 1999 United Nations High Commissioner for refugees This document is issued for general distribution.
2 All rights are reserved. Reproductions and translations are authorised, except for commercial purposes, provided the source is acknowledged. Reproductive Health is a right ; and like all other human rights it applies to refugees and persons FOREWORD. living in Refugee -like conditions. To exercise this right, populations caught up in conflict and living in emergency situations must have an enabling environment and access to complete Reproductive Health information and services so they can make free and informed choices. They also must feel comfortable and secure in discussing their most private concerns with those who seek to help them.
3 Quality Reproductive Health services must be based on refugees ', particularly women refugees ', needs. They must also respect refugees ' various religious and ethical values and cultural back- grounds while conforming to universally recognised international human rights standards. There- fore, full information on options, and access to Reproductive Health services should be provided, leaving the decision to the individual. Reproductive Health care covers a wide range of services. These are defined as follows in the Programme of Action of the International Conference on Population and Development (ICPD) held in Cairo, Egypt, in September 1994: family-planning counselling, information, education, communi- cation and services; education and services for prenatal care, safe delivery and post-natal care, and infant and women's Health care; prevention and appropriate treatment of infertility; prevention of abortion and the management of the consequences of abortion; treatment of Reproductive tract infections, sexually transmitted diseases, including HIV/AIDS.
4 Breast cancer and cancers of the Reproductive system, and other Reproductive Health conditions; and active discouragement of harmful traditional practices, such as female genital mutilation. Providing comprehensive and high-quality Reproductive Health services requires a multi-sectoral integrated approach. Protection, Health , nutrition, education and community service personnel all have a part to play in planning and delivering Reproductive Health services. The best way to guarantee that Reproductive Health services meet the needs of the Refugee community is to involve the community in every phase of the development of those services: from designing programmes to launching and maintaining them to evaluating their impact.
5 Only then will refugees benefit from services specifically tailored to their needs and demands; and only then will they have a stake in the future of those services. This Inter-agency Field Manual on Reproductive Health in Refugee Situations is the result of a collaborative effort of many UN agencies, governmental and non-governmental organisations and refugees themselves. Information in this Manual is based on the normative, technical guidance of the World Health Organization. A draft of the Field Manual was first issued in 1996 and tested extensively in the field. This new version can, and should, be shaped and adapted to suit the particular circumstances and requirements of each Refugee situation as it arises and evolves.
6 We are pleased with the progress already made in meeting the Reproductive Health needs of refugees and persons living in Refugee -like situations; but we also know this is no time to lose momentum. We hope the Field Manual will serve to improve the Health and well-being of refugees and foster more responsive and appropriate actions in the field. Gro Harlem Bruntland Nafis Sadik Sadako Ogata Director General Executive Director High Commissioner WHO UNFPA for refugees UNHCR . At an Inter-agency Symposium on Reproductive Health in Refugee Situations held in Geneva, PREFACE. Switzerland in June 1995, more than 50 governments, non-governmental organisations (NGOs) and UN agencies committed themselves to strengthening Reproductive Health (RH).
7 Services to refugees . Following the symposium, an Inter-agency Field Manual on Reproductive Health in Refugee Situations was produced and distributed for field-testing around the world. This 1999 revision of the Field Manual is the result of two years of field use and comprehensive field-testing conducted under the auspices of the Inter-agency Working Group on Reproductive Health in Refugee Situations. More than 100 experienced staff from 50 agencies working in Refugee situations in 17 countries applied the Field Manual in their programmes and provided comments and suggestions for improving the content of the publication.
8 The Field Manual supports the delivery of quality RH services. Technical standards included in the Field Manual are those set by the World Health Organization. In several important areas, the Field Manual provides programmatic direction with frequent reference to additional resource materials that should be obtained and used to ensure comprehensive and reliable RH. services for refugees . Field managers of Health services in Refugee situations are the primary audience for the Field Manual. Community-services officers, protection officers and others working to meet the needs of Refugee women, young people and men should also benefit from the guidance offered in the Field Manual.
9 The purposes of the Field Manual are: to serve as a tool to facilitate discussion and decision-making in the planning, implementation, monitoring and evaluation of RH interventions;. to guide field staff in introducing and/or strengthening RH interventions in Refugee situations, based on Refugee needs and demands and with full respect for their beliefs and values; and to advocate for a multi-sectoral approach to meeting the RH needs of refugees and to foster coordination among all partners. Chapter One lays the foundation for the subsequent technical chapters on Reproductive Health and provides the guiding principles for undertaking all RH care.
10 It should be read carefully. The components of Reproductive Health described in the Field Manual are: Minimum Initial Service Package Safe Motherhood Sexual Violence Sexually Transmitted Diseases, including HIV/AIDS. Family Planning Other Reproductive Health Concerns Reproductive Health of Young People ACKNOWLEDGMENTS The entities listed contributed to this Field Action Contre la Faim Manual and are among those who believe African Medical and Research Foundation it will facilitate the delivery of Reproductive American Refugee Committee Health services in Refugee situations. CARE. Centre for Research on the Epidemiology of Disasters Centro de Capacitaci n en Ecolog a y Salud para Campesinos Center for Population and Family Health .