Minimum Initial Service Package Research Articles

Integration of Minimum Initial Service Package for Reproductive Health in the Sister Village Program

Indonesia’s high Disaster Risk Index (DRI) encourages the government to pay extra attention to disaster management efforts. MISP must be available in health crises because the need for reproductive health services remains and increases during the disaster response period because 4% of the affected people are pregnant women, and 75% are women, adolescent girls, and children. Integrating MISP into the Sister Village program is very important as an effort to reduce the impact of disasters on reproductive health due to the disruption of health services. This research was carried out in 2022 to explore opportunities and obstacles to integrating MISP in the sibling village program. The research uses a qualitative design with a phenomenological approach. Data collection used Focus Group Discussion techniques with 10 informants who were stakeholders related to the research topic. The research results show that in the integration of MISP and the Sister Village program, the role of each stakeholder is very important to achieve program objectives. Cooperation and coordination between stakeholders is the key to success. The integration of MISP in the Sister Village program can increase community participation in reproductive health services, strengthen the relationship between the health sector and the development sector, and improve public awareness of the importance of reproductive health. Limited accessibility and infrastructure in remote villages, stigma and cultural problems in village communities, lack of support and attention from the government and related parties, as well as security and conflict problems in several areas are obstacles to the integration of this program. High Disaster Risk Index (DRI) Indonesia encourages the government to pay extra attention to disaster management efforts. MISP must be available in health crises because the need for reproductive health services remains and increases during the disaster response period because 4% of the affected people are pregnant women, and 75% are women, adolescent girls, and children. Integrating MISP into the Sister Village program is very important as an effort to reduce the impact of disasters on reproductive health due to the disruption of health services. This research was carried out in 2022 to explore opportunities and obstacles to integrating MISP in the sibling village program. It uses a qualitative design with a phenomenological approach. Data collection used Focus Group Discussion techniques with 10 informants who were stakeholders related to the research topic. The research results show that in the integration of MISP and the Sister Village program, the role of each stakeholder is very important to achieve program objectives. Cooperation and coordination between stakeholders is the key to the success of the program. The integration of MISP in the Sister Village program can increase community participation in reproductive health services, strengthen the relationship between the health sector and the development sector, and improve public awareness of the importance of reproductive health. Limited accessibility and infrastructure in remote villages, stigma and cultural problems in village communities, lack of support and attention from the government and related parties, as well as security problems and conflicts in several areas, are obstacles to the integration of this program.

Menstrual hygiene management in flood-affected Pakistan: Addressing challenges and ensuring women's health and dignity.

Pakistan's recent floods have worsened women's and girls' menstrual hygiene problems, compromising their health, dignity, and well-being. Supply chain issues, poor facilities, and cultural stigma limit menstrual products and hygiene management. Gender-sensitive disaster management and menstrual health education programmes can help. The Minimum Initial Service Package (MISP) can provide emergency reproductive health services. Involving men, working with religious leaders, and pre-disaster planning for menstrual hygiene management can help break the taboo and increase access to resources. Meeting ongoing needs requires timely menstrual hygiene product distribution, restocking, and renewal. By addressing these issues, Pakistan can empower post-flood women and girls through economic opportunities and legal protection.

Perceived facilitators and barriers to the provision of sexual and reproductive health services in response to the Syrian refugee crisis in Lebanon.

The Syrian crisis has resulted in one of the worst humanitarian disasters in modern history. Inadequate access to and use of sexual and reproductive health services is a prevailing issue among adolescent girls and young refugee women in humanitarian settings. This article aimed to explore and describe the perceived extent of implementation of the different objectives and activities outlined within the minimum initial service package for reproductive health in crisis services in Lebanon, from the perspectives of a diverse set of stakeholders from leading organizations (public, private, primary health centers, nongovernmental organizations) that were directly engaged with the Syrian refugee crisis response. This study is a cross-sectional survey conducted using a standardized and validated questionnaire. Centers that provided sexual and reproductive health services to Syrian refugees in Lebanon were mapped. The study was based on a purposive sampling approach, retrieving 52 eligible organizations to cover most areas in the country. A total of 43 centers accepted to take part in the study. The head of the center was then asked to identify one person in their center who holds adequate knowledge of the explained objectives of the survey. Accordingly, the identified person was asked to fill out the survey. A considerable portion of the respondents had limited knowledge about the specific minimum initial service package objectives and related sexual and reproductive health services. The study found the presence of a leading reproductive health agency, the Lebanese MoPH, as an essential facilitating factor for sexual and reproductive health service provision in Lebanon and has helped in overseeing the overall sexual and reproductive health coordination response for Syrian refugees (76.74% of all respondents). The identified challenges impeding adequate sexual and reproductive health services provision for Syrian refugees included (1) insufficient supplies (46.51%); (2) insufficient funds (39.53%); and (3) shortage of staff (39.53%). The recommendations for improved sexual and reproductive health service provision include the need for (1) enforcing the lead minimum initial service package agency for adequate and effective coordination, reporting, and accountability and (2) increasing funding for training staff and healthcare workers, as well as improving the overall quality of services available with the inclusion of family planning services, purchasing the necessary commodities, supplies and equipment, and covering fees associated with the different sexual and reproductive health services.

Perspectives of health practitioners on the challenges to accessing sexual and reproductive health care services for Venezuelan migrant women during the COVID-19 pandemic in Quito, Ecuador

To describe the perspectives of health practitioners on the barriers, gaps, and opportunities that Venezuelan migrant women experienced to accessing sexual and reproductive health (SRH) services during the COVID-19 pandemic and how SRH services were affected in Quito, Ecuador. Health practitioners involved in SRH services at nine public health care facilities in three zones of Quito were surveyed. The Minimum Initial Service Package readiness assessment tool survey, available from the Inter-Agency Working Group on Reproductive Health in Crisis, was adapted for use and data collection in Ecuador. Of 297 respondents, 227 were included in the analysis. Only 16% of the health practitioners agreed that discrimination against migrant Venezuelans women occurred in the health care system. Of those, only 2.3% described specific conditions associated with discrimination, including requiring identification documents (7.5%) and lack of empathy or responsiveness (6.6%). Most (65.2%) respondents reported that the COVID-19 pandemic affected the use of SRH services by women in the general population and by Venezuelan migrant women more so (56.3%) because of more limited access to SRH services, poverty, and vulnerability. There were no differences between perceptions by levels of health care facility, except with regard to the lack of supplies, awareness of discrimination, and the belief that Venezuelan migrant women were affected more negatively than the local population. The perception among health practitioners in Quito was that discrimination occurred infrequently during the COVID-19 pandemic despite affecting the health care system. However, some level of discrimination toward migrant Venezuelan migrant women seeking SRH services was acknowledged and may be underrepresented.

Sexual And Reproductive Health Needs, Experiences, Access To Services, And Interventions Among The Rohingya And The Afghan Refugee Women Of Reproductive Age In Asia: A Mixed Methods Systematic Review Protocol

Background: A humanitarian crisis disrupts the existing health care system limiting access to sexual reproductive health (SRH) services. The Asia and the Pacific region is home to 9.2 million refugees as of September 2020, most originating from Afghanistan and Myanmar. Afghan and Rohingya refugees have long been deprived of formal SRH education and face decades of discrimination in SRH services that can affect health outcomes. Purpose: This review examines the SRH status of Afghan and Rohingya refugee women of reproductive age in Asia and their needs and experiences in accessing these services and commodities. Methods: This protocol will follow the PRISMA checklist and standards for quality assessment of systematic reviews. The search strategy will be sought out all relevant peer-reviewed literature from five online bibliographic databases—SCOPUS, EMBASE (Ovid), MEDLINE (Ovid), CINAHL, and PROQUEST— using search terms related to the research questions. The review will include qualitative, quantitative, and mixed-method studies to understand the status of SRH of Rohingya and Afghan refugees across Asia. Content analysis will undertake following the Minimum Initial Service Package (MISP) objectives. The review will use the mixed methods appraisal tool (MMAT) to assess the quality of individual studies. However, no studies will be excluded based on this assessment. Result: The findings of this review will provide insight into the needs, status, and experiences of SRH of the Afghan and Rohingya refugee women of reproductive age in Asia and could contribute to health service planning to deliver evidence-based interventions and policies to improve SRH outcomes in humanitarian settings across Asia. Systematic review registration: The review was registered in the PROSPERO database with ID CRD42021253975.

Challenges of delivering reproductive health services to forced displaced populations

BackgroundOf the 80 million forced displaced persons worldwide, women and children bear greater morbidity and mortality, especially in conflict-affected regions. This is due to disruption in health service provision, breakdown of social institutions and increase in sexual and gender-based violence. Reproductive health (RH) service delivery as part of humanitarian health cluster services is outlined in the Minimum Initial Service Package (MISP). This study explores the challenges of delivering RH services to forced-displaced populations, focussing on field level stakeholders in humanitarian settings.MethodsQualitative semi-structured interviews were conducted with stakeholders from non-governmental and United Nations agencies involved in delivering RH services to conflict-affected populations. Additionally, a scoping review, using the Arksey and O'Malley framework, of the literature was also conducted reviewing challenges of delivering RH programmes to women in forced displaced populations. An inductive and deductive thematic approach was used in data analysis.ResultsEleven key informants (KIs) were interviewed from six conflict-affected countries including Syria, Afghanistan and Libya. Main emerging themes were: 1. Poor awareness of international guidelines (including the MISP) 2. Service provision barriers including lack of human resources 3. Attitudes towards SRH and women's rights 4. Disruption of health services due to COVID-19.ConclusionsThis study has highlighted the main challenges that the humanitarian actors delivering RH programmes in conflict-affected settings face. Implementation of international guidelines remains a key barrier. Key policy recommendations would be to standardise training for all RH providers, prioritise training in the MISP and address cultural attitudes towards RH. Further research exploring the use of WHO's essential medicines for RH and the long-term impact of COVID-19 on forced displaced females needs to be conducted.Key messages Providing basic essential reproductive health services to conflict affected populations remains a challenge, including implementation of standardised international guidance through the MISP.One key policy recommendation would be to prioritise training in MISP for conflict-affected humanitarian settings to ensure it is offered as part of the essential package.

Midwifery curricula inclusion of sexual and reproductive health in crisis settings in the Democratic Republic of Congo

AimThis discussion paper aims to argue for the inclusion of the Minimum Initial Service Package (MISP) for sexual and reproductive health in crisis settings in all midwifery curricula. BackgroundThe Democratic Republic of Congo continues to experience long-standing humanitarian crises that have affected the population’s health, especially in relation to sexual violence and other sexual and reproductive health issues. The MISP was established in 1996 to meet the most vital sexual and reproductive health needs of crisis-affected populations and has become an international minimum standard in humanitarian response. DesignCase study. MethodsThis paper is a case presentation describing the process and lessons learned related to the introduction of the MISP into the first- and third-year pre-service midwifery curricula at multiple midwifery education facilities in the Democratic Republic of Congo. ResultsSix main lessons were identified during the initial implementation phases of the revised midwifery curricula: seizing the opportunity to influence long-term change, engaging teamwork, addressing instructors’ concerns, mobilizing resources for curriculum implementation, assessing school infrastructure readiness during field visits, and meeting immediate humanitarian needs with in-service training. The lessons learned may assist other nations experiencing humanitarian crises with the implementation of the MISP. ConclusionsThis pre-service training strategy holds promise for both a sustainable and prompt solution to bridge the gap in competent human resources to deliver quality sexual and reproductive health services in humanitarian settings.

Sexual and reproductive health self-care in humanitarian and fragile settings: where should we start?

Recent crises have accelerated global interest in self-care interventions. This debate paper aims to raise the issue of sexual and reproductive health (SRH) self-care and invites members of the global community operating in crisis-affected settings to look at potential avenues in mainstreaming SRH self-care interventions. We start by exploring self-care interventions that could align with well-established humanitarian standards, such as the Minimum Initial Service Package (MISP) for Sexual and Reproductive Health in Crises, point to the potential of digital health support for SRH self-care in crisis-affected settings, and discuss related policy, programmatic, and research considerations. These considerations underscore the importance of self-care as part of the care continuum and within a whole-system approach. Equally critical is the need for self-care in crisis-affected settings to complement other live-saving SRH interventions—it does not eliminate the need for provider-led services in health facilities. Further research on SRH self-care interventions focusing distinctively on humanitarian and fragile settings is needed to inform context-specific policies and practice guidance.

Integrating sexual and reproductive health into health system strengthening in humanitarian settings: a planning workshop toolkit to transition from minimum to comprehensive services in the Democratic Republic of Congo, Bangladesh, and Yemen

BackgroundPlanning to transition from the Minimum Initial Service Package for Sexual and Reproductive Health (SRH) toward comprehensive SRH services has been a challenge in humanitarian settings. To bridge this gap, a workshop toolkit for SRH coordinators was designed to support effective planning. This article aims to describe the toolkit design, piloting, and final product.MethodsAnchored in the Health System Building Blocks Framework of the World Health Organization, the design entailed two complementary and participatory strategies. First, a collaborative design phase with iterative feedback loops involved global partners with extensive operational experience in the initial toolkit conception. The second phase engaged stakeholders from three major humanitarian crises to participate in pilot workshops to contextualize, evaluate, validate, and improve the toolkit using qualitative interviews and end-of-workshop evaluations. The aim of this two-phase design process was to finalize a planning toolkit that can be utilized in and adapted to diverse humanitarian contexts, and efficiently and effectively meet its objectives. Pilots occurred in the Democratic Republic of Congo for the Kasai region crisis, Bangladesh for the Rohingya humanitarian response in Cox’s Bazar, and Yemen for selected Governorates.ResultsResults suggest that the toolkit enabled facilitators to foster a systematic, participatory, interactive, and inclusive planning process among participants over a two-day workshop. The approach was reportedly effective and time-efficient in producing a joint work plan. The main planning priorities cutting across settings included improving comprehensive SRH services in general, healthcare workforce strengthening, such as midwifery capacity development, increasing community mobilization and engagement, focusing on adolescent SRH, and enhancing maternal and newborn health services in terms of quality, coverage, and referral pathways. Recommendations for improvement included a dedicated and adequately anticipated pre-workshop preparation to gather relevant data, encouraging participants to undertake preliminary study to equalize knowledge to partake fully in the workshop, and enlisting participants from marginalized and underserved populations.ConclusionCollaborative design and piloting efforts resulted in a workshop toolkit that could support a systematic and efficient identification of priority activities and services related to comprehensive SRH. Such priorities could help meet the SRH needs of communities emerging from acute humanitarian situations while strengthening the overall health system.

Maternal health among Venezuelan women migrants at the border of Brazil

BackgroundGuaranteeing the sexual and reproductive health and rights (SRHR) of populations living in fragile and humanitarian settings is essential and constitutes a basic human right. Compounded by the inherent vulnerabilities of women in crises, substantial complications are directly associated with increased risks of poor SRHR outcomes for displaced populations. The migration of Venezuelans, displaced due to current economic circumstances, is one of the largest in Latin America’s history. This study aims to provide an overview of the sexual and reproductive health (SRH) issues affecting migrant Venezuelan women in the state of Roraima, Brazil.MethodsFace-to-face interviews were conducted from 24 to 30 November 2019. Data collection covered various issues involving access to and use of SRH services by 405 migrant Venezuelan women aged 18–49 years. The Minimum Initial Service Package readiness assessment tools, available from the Inter-Agency Working Group on Reproductive Health in Crises, were used in the data collection.ResultsMost commonly, the women reported unmet family planning needs. Of these, a significant proportion reported being unable to obtain contraceptive methods, particularly long-acting reversible contraceptives, either due to the woman’s inability to access them or their unavailability at healthcare centres. Although a significant proportion of women were largely satisfied with the attention received at the maternity hospital, both before and during childbirth, 24.0% of pregnant or postpartum women failed to receive any prenatal or postnatal care.ConclusionMeeting the essential SRHR needs of migrant Venezuelan women in Roraima, Brazil is a challenge that has yet to be fully addressed. Given the size of this migrant population, the Brazilian healthcare system has failed to adapt sufficiently to meet their needs; however, problems with healthcare provision are similar for migrants and Brazilian citizens. Efforts need to be encouraged not only in governmental health sectors, but also with academic, non-governmental and international organisations, including a coordinated approach to ensure a comprehensive SRHR response. Given the current high risks associated with the SARS-CoV-2 pandemic, meeting the SRHR needs of migrant populations has become more critical than ever.

Not a luxury: a call to maintain sexual and reproductive health in humanitarian and fragile settings during the COVID-19 pandemic

Not a luxury: a call to maintain sexual and reproductive health in humanitarian and fragile settings during the COVID-19 pandemic

Adolescent girls, a forgotten population in resource-limited settings in the COVID-19 pandemic: implications for sexual and reproductive health outcomes.

Adolescent sexual and reproductive health is an essential aspect that may be forgotten in the COVID-19 pandemic. Valuable insights gained from previous humanitarian crises indicate undesirable short and long-term adolescent maternal consequences in low resource settings. Young girls are at a higher risk of dropping out of school and being forced into early child marriages and high-risk jobs that predispose them to sexual exploitation and sexual and gender-based violence. Economic recessions, supply chain disruptions and reallocation of resources may limit access and utilisation of services and commodities. The COVID-19 pandemic thus indirectly exposes adolescent girls to multiplied risks of unintended pregnancies, sexually transmitted infections including HIV and Human Papilloma Virus. Sexual and gender-based violence, including female genital mutilation cases may increase as intervention programmes to avert these are disrupted, and the resultant psychosocial and socioeconomic consequences may be devastating. Thus, a pro-active approach is required to come up with frameworks to ensure the minimum initial service package for reproductive health. A multi-sectoral collaborative intersection of relevant stakeholders in adolescent sexual and reproductive health is therefore urgently desired.

Adolescent girls, a forgotten population in resource-limited settings in the COVID-19 pandemic: implications for sexual and reproductive health outcomes

Adolescent sexual and reproductive health is an essential aspect that may be forgotten in the COVID-19 pandemic. Valuable insights gained from previous humanitarian crises indicate undesirable short and long-term adolescent maternal consequences in low resource settings. Young girls are at a higher risk of dropping out of school and being forced into early child marriages and high-risk jobs that predispose them to sexual exploitation and sexual and gender-based violence. Economic recessions, supply chain disruptions and reallocation of resources may limit access and utilisation of services and commodities. The COVID-19 pandemic thus indirectly exposes adolescent girls to multiplied risks of unintended pregnancies, sexually transmitted infections including HIV and Human Papilloma Virus. Sexual and gender-based violence, including female genital mutilation cases may increase as intervention programmes to avert these are disrupted, and the resultant psychosocial and socioeconomic consequences may be devastating. Thus, a pro-active approach is required to come up with frameworks to ensure the minimum initial service package for reproductive health. A multi-sectoral collaborative intersection of relevant stakeholders in adolescent sexual and reproductive health is therefore urgently desired.

Situation analysis for delivering integrated comprehensive sexual and reproductive health services in humanitarian crisis condition for Rohingya refugees in Cox’s Bazar, Bangladesh: protocol for a mixed-method study

IntroductionRohingya diaspora are one of the most vulnerable groups seeking refuge in camps of Cox’s Bazar, Bangladesh, arising an acute humanitarian crisis. More than half of the Rohingya refugees are...

Insights from outside BJOG

Insights from outside BJOG

Evaluating the effectiveness of sexual and reproductive health services during humanitarian crises: A systematic review.

BackgroundAn estimated 32 million women and girls of reproductive age living in emergency situations, all of whom require sexual and reproductive health (SRH) information and services. This systematic review assessed the effect of SRH interventions, including the Minimum Initial Service Package (MISP) on a range of health outcomes from the onset of emergencies.Methods and findingsWe searched EMBASE, Global Health, MEDLINE and PsychINFO databases from January 1, 1980 to April 10, 2017. This review was registered with the PROSPERO database with identifier number CRD42017082102. We found 29 studies meet the inclusion criteria. We found high quality evidence to support the effectiveness of specific SRH interventions, such as home visits and peer-led educational and counselling, training of lower-level health care providers, community health workers (CHWs) to promote SRH services, a three-tiered network of health workers providing reproductive and maternal health services, integration of HIV and SRH services, and men’s discussion groups for reducing intimate partner violence. We found moderate quality evidence to support transport-based referral systems, community-based SRH education, CHW delivery of injectable contraceptives, wider literacy programmes, and birth preparedness interventions. No studies reported interventions related to fistulae, and only one study focused on abortion services.ConclusionsDespite increased attention to SRH in humanitarian crises, the sector has made little progress in advancing the evidence base for the effectiveness of SRH interventions, including the MISP, in crisis settings. A greater quantity and quality of more timely research is needed to ascertain the effectiveness of delivering SRH interventions in a variety of humanitarian crises.

Spotlight on … global health

Spotlight on … global health

Women, war, and reproductive health in developing countries

ABSTRACTGlobally, millions of people are affected by war and conflicts every year. However, women have increasingly suffered the greatest harm by war in more different ways than men. We conceptualize a reproductive rights approach toward examining the effects of war on women’s reproductive health in developing countries. Given the rising concerns of exclusion to adequately address women’s rights, sexual and gender-based violence, and post-conflict accountability, we specifically focus on the limitations of the Minimum Initial Service Package, a UN-sponsored reproductive health service program in conflict zones while offering a broad reproductive rights-based conceptual lens for examining reproductive health care services in war-torn areas. In addition, we discuss the roles social workers may play at both micro and macro levels in war-torn areas to bring about both short term and long term gains in women’s reproductive health.

Sexual and reproductive health and rights in emergencies.

The World Health Organization defines health emergencies as sudden-onset events from naturally occurring or man-made hazards, or gradually deteriorating situations through which the risk to public health steadily increases over time.1 In recent years, conflict, violence and disasters have brought a dramatic rise in the number of displaced people, both within and across national borders. According to the Office of the United Nations High Commissioner for Refugees, in 2014, there were 60 million internally-displaced people and international migrants, half of whom come from Afghanistan, Somalia and the Syrian Arab Republic.2 The average time spent in displacement has now reached 20 years.2 Women and girls are affected disproportionately in both sudden and slow-onset emergencies3 and face multiple sexual and reproductive health challenges in emergency contexts. There are an estimated 26 million women and girls of reproductive age living in emergency situations, all of whom need sexual and reproductive health services.4 In countries designated by the Organisation for Economic Co-operation and Development as fragile states,5 the estimated lifetime risk of maternal mortality is 1 in 54.6 Three-quarters of the countries with maternal mortality ratios above 300 per 100 000 live births are fragile states.6 With disruption and lawlessness, sexual violence often increases during emergencies, exacerbating threats to the health and survival of women and girls.7 The new Global strategy for women’s, children’s and Adolescents’ Health (2016–2030)8 attributes gaps in service provision to the lack of sufficient health workers in emergency settings. The strategy therefore calls for coordinated and integrated approaches to address threats to health and well-being in emergency settings.8 Crises expose extant weaknesses in health systems, impacting differentially on sub-populations, especially women, children and adolescents. Low resilience in health systems and an absence of quality data on women’s, children’s and adolescents’ health in emergencies hinders design and implementation of sustainable interventions. To achieve the vision of Transforming our world: the 2030 agenda for sustainable development – to leave no one behind – it is imperative to protect and improve women’s, children’s and adolescents’ health and well-being in emergencies. To reach every woman, every child and every adolescent, everywhere, the global strategy recommends a series of actions. First priority is given to provision of a minimum initial service package for reproductive health9 by national health systems and external partners in emergencies.8 Second, needs and vulnerabilities have to be assessed objectively and addressed with a package of health services that includes topics such as, nutrition, human immunodeficiency virus infections, as well as water, sanitation and hygiene. Third, sustainable service delivery depends on programmes that transition from the emergency response to health systems strengthening for the long term. In addition, the strategy recognizes the critical need to ensure the safety of health workers and their facilities in conflict settings.8 Such actions need multi-year flexible financing from the start of an emergency, so that low- and middle-income countries can access funds when budget support from their government is no longer available. According to a recent evaluation, between 2002 and 2013, unmet funding requirements for reproductive health in emergencies amounted to 2.689 billion United States dollars.10 The World Humanitarian Summit, held in Istanbul, Turkey, in May 2016, is an opportunity to include the United Nations Secretary-General’s proposed agenda for humanity within the 2030 Agenda for Sustainable Development. By endorsing the Secretary-General’s call to action, summit participants can commit to the actions proposed by the global strategy for women, children and adolescents living in emergency settings.11

Advancing reproductive health on the humanitarian agenda: the 2012-2014 global review

Introduction The global landscape for reproductive health in humanitarian settings has changed dramatically since the International Conference on Population and Development (ICPD) in 1994. Mainstreaming of reproductive health into humanitarian health responses has grown, and awareness of the consequences of neglecting reproductive health services, such as maternal and neonatal mortality, HIV transmission, and unsafe abortion, has expanded. Despite these advances, significant gaps remain, and meeting the reproductive health needs of crisis-affected communities is more urgent than ever: the United Nations High Commissioner for Refugees (UNHCR) reported that 51.2 million people remained forcibly displaced due to conflict and persecution by the end of 2013—the largest number since World War II [1]. An additional 22 million were displaced in 2013 by natural disasters [2]. Figure 1. A concentrated effort to address reproductive health in emergencies commenced in 1995 when a coalition of UN agencies, national and international nongovernmental organizations (NGOs), government agencies, donors, and academic institutions established the Inter-agency Working Group on Reproductive Health in Crises (IAWG), an international network dedicated to improving the reproductive health of communities affected by conflict and natural disaster. IAWG arose from a growing concern with the lack of attention to reproductive health, despite increasing evidence of its need in emergency settings [3]. In its first decade, IAWG made large strides in advancing reproductive health through advocacy, research, standard setting, and guidance development, including the publication of the seminal Reproductive Health for Refugees: An Inter-agency Field Manual [4]. The Field Manual was the first technical guidance on implementing reproductive health in emergencies and articulated a minimum standard in reproductive health service delivery—the Minimum Initial Service Package (MISP) for Reproductive Health. IAWG also supported the creation of the Interagency Reproductive Health Kits, twelve kits of essential medicines and supplies, to support rapid implementation of the MISP [5]. By the early 2000s, IAWG and its partners—including the Reproductive Health Response in Crises (RHRC) Consortium—had achieved substantial gains. A 1999 study documented an increase in evidence, funding, policies, conferences, and new NGOs addressing reproductive health in emergencies, reflecting marked progress in advancing reproductive health on the global humanitarian agenda [6]. From 2002 to 2004, IAWG undertook its first global evaluation to assess progress [7]. The findings confirmed advancements at the policy and implementation levels since the mid-90s, but significant gaps continued across all technical areas, specifically maternal and newborn health, family planning, gender-based violence, and HIV and other sexually transmitted infections (STIs). IAWG’s second decade, from 2004 to 2014, saw the maturation of the coalition and further advancements to institutionalize reproductive health into humanitarian health responses and improve access to services. Members successfully advocated integrating the MISP as a minimum health standard in the 2004 and 2011 revisions of the Sphere Humanitarian Charter and Minimum Standards in Disaster Response and the Inter-Agency Standing Committee Health Cluster Guide[8,9]. Through IAWG’s advocacy, the MISP was included as a life-saving activity eligible for Central Emergency Response Fund funding [10]. In 2009, led by the World Health Organization (WHO) and UN Population Fund (UNFPA), IAWG and partners drafted the Granada Consensus on Sexual and Reproductive Health during Protracted Crises and Recovery, which reaffirmed comprehensive reproductive health as a right in protracted settings and fragile states [11]. The following year IAWG released an updated field-test version of the Field Manual, which included an extra chapter dedicated to comprehensive abortion care—a particularly neglected area in reproductive health service provision— as well as outlined additional priority activities to the Correspondence: sc2250@caa.columbia.edu University of New South Wales, High St, Kensington, NSW 2052, Australia Chynoweth Conflict and Health 2015, 9(Suppl 1):I1 http://www.conflictandhealth.com/content/9/S1/I1