Preparing for and responding to sexual and reproductive health in disaster settings: evidence from Fiji and Tonga

Abstract

Background Pacific Island countries are vulnerable to disasters, including cyclones and earthquakes. Disaster preparedness is key to a well-coordinated response to preventing sexual violence and assisting survivors, reducing the transmission of HIV and other STIs, and preventing excess maternal and neonatal mortality and morbidity. This study aimed to identify the capacity development activities undertaken as part of the SPRINT program in Fiji and Tonga and how these enabled the sexual and reproductive health (SRH) response to Tropical Cyclones Winston and Gita. Methods This descriptive qualitative study was informed by a framework designed to assess public health emergency response capacity across various levels (systems, organisational, and individual) and two phases of the disaster management cycle (preparedness and response). Eight key informants were recruited purposively to include diverse individuals from relevant organisations and interviewed by telephone, Zoom, Skype and email. Template analysis was used to examine the data. Findings Differences in the country contexts were highlighted. The existing program of training in Tonga, investment from the International Planned Parenthood Federation (IPPF) Humanitarian Hub, the status of the Tonga Family Health Association as the key player in the delivery of SRH, together with its long experience of delivering contract work in short time-frames and strong relationship with the Ministry of Health (MoH) facilitated a relatively smooth and rapid response. In contrast, there had been limited capacity development work in Fiji prior to Winston, requiring training to be rapidly delivered during the immediate response to the cyclone with the support of surge staff from IPPF. In Fiji, the response was initially hampered by a lack of clarity concerning stakeholder roles and coordination, but linkages were quickly built to enable a response. Participants highlighted the importance of personal relationships, individuals’ and organisations' motivation to respond, and strong rapport with the community to deliver SRH. Discussion This study highlights the need for comprehensive activities at multiple levels within a country and across the Pacific region to build capacity for a SRH response. While the SPRINT initiative has been implemented across several regions to improve organisational and national capacity preparedness, training for communities can be strengthened. This research outlines the importance of formalising partnerships and regular meetings and training to ensure the currency of coordination efforts in readiness for activation. However, work is needed to further institutionalise SRH in emergencies in national policy and accountability mechanisms.

Linking gender, climate change and security in the Pacific Islands Region: A systematic review

“…Within the sample, 17 articles had a significant focus on types of security in the context of climate change. This included seven articles that had a primary focus on food and nutritional security (Cleasby et al 2014 ; Eriksson et al 2017 ; Rabbitt et al 2019 ; Savage et al 2020 ; Wentworth et al 2020 ; Cauchi et al 2021 ; Mangubhai et al 2021 ); three articles that sought to expand the Women, Peace and Security Agenda in the region to include climate change impacts as a human security issue (George 2014 , 2016 ; Bhagwan Rolls and Rolls 2019 ); two articles that considered women’s roles in community resilience, with a particular emphasis on food security (Davila et al 2021 ) or ontological security (Singh et al 2022 ); one article on energy security (Sovacool et al 2012 ) or energy poverty (Teariki et al 2020 ); one article considering land tenure security and forced evictions (Day et al 2021 ); one article on sexual and reproductive health responses in post-disaster periods which included the challenges of being considered as a ‘security’ issue (Beek et al 2021 ); and one article on the gendered nature of village water committees and water security (Nelson et al 2021 ). While this illustrates that the material aspects of human security, particularly food security, are being used to frame explicit treatments of security, this tends to be siloed.…”

“…The links between gender-based violence and climate change were referred to in a number of articles, such as increases in violence during drought or post-disaster periods (George 2014 , 2016 ; Chandra and Gaganis 2016 ; Mcleod 2018 ; Bhagwan Rolls and Rolls 2019 ; Clissold et al 2020 ; van der Ploeg 2020 ; Webb 2020 ; Beek et al 2021 ; Davila et al 2021 ; Sahai 2021 ) yet the documentation of this is limited due to the sensitive nature and difficulties in researching this topic. Studies tended to note this was an issue, and shared women’s concerns about this (see in particular Mcleod et al 2018 ) but did not seek to collect data specifically on incidences of violence.…”

“…The effect contains women’s agency within unspoken boundaries (George 2016 ; Bhagwan Rolls and Rolls 2019 ). Constrained agency was evidenced across a number of articles, such as when women’s advocacy in market networks still had to be channelled through a male representative (Clissold et al 2020 ); when sexual and reproductive health workers had to ‘make extra efforts to be brought in’ and advocate for their inclusion in health responses in post-disaster periods (Beek et al 2021 , p. 8); and when ‘speech norms’ (George 2014 , p. 325) rewarded women who abstain from discussing the root causes of insecurities such as imperialism and militarisation when they engage with outside agencies such as UN or regional forums.…”

Responding to Humanitarian Crises: Midwifery Care in Bangladesh

“…Existing sociocultural and gender norms compound the effects of humanitarian or natural disasters manyfold. Gender‐based violence increases during and after natural disasters; loss of livelihood and income regresses hard‐earned economic empowerment for women; and rates of child marriage increase, leading to higher rates of adolescent pregnancy and unfavorable perinatal health outcomes 2‐5 . Sixty percent of global maternal death is thought to occur in these fragile contexts 6 .…”

“…Gender-based violence increases during and after natural disasters; loss of livelihood and income regresses hard-earned economic empowerment for women; and rates of child marriage increase, leading to higher rates of adolescent pregnancy and unfavorable perinatal health outcomes. [2][3][4][5] Sixty percent of global maternal death is thought to occur in these fragile contexts. 6 Countries with weak and centralized health systems and with high gender inequity are likely to have low resilience toward humanitarian crises including natural disasters.…”