The current literature recognizes the fact that persons with disabilities have historically been deprived of their sexual and reproductive health (SRH) rights. Little is known, however, about the situation for women, men, and adolescents with disabilities in humanitarian settings. The Women’s Refugee Commission led a participatory research project with partners to explore the risks, needs, and barriers for refugees with disabilities to access SRH services, and the practical ways in which these challenges could be addressed. The study gathered information from refugee women, men, and adolescents aged 15–19 with physical, intellectual, sensory, and mental impairments in refugee settings in Kenya, Nepal, and Uganda. Findings showed that refugees with disabilities demonstrated varying degrees of awareness around SRH, especially regarding the reproductive anatomy, family planning, and sexually transmitted infections. Among barriers to accessing services, lack of respect by providers was reported as the most hurtful. Pregnant women with disabilities were often discriminated against by providers and scolded by caregivers for becoming pregnant and bearing children; marital status was a large factor that determined if a pregnancy was accepted. Risks of sexual violence prevailed across sites, especially for persons with intellectual impairments. The ability of women with disabilities to exercise their SRH rights was mixed. Refugees with disabilities showed a mixed understanding of their own rights in relationships and in the pursuit of opportunities. Findings speak to the need to realize the SRH rights of refugees with disabilities and build their longer-term SRH capacities.

Background: To address family planning for crisis-affected communities, in 2011 and 2012, the United Nations High Commissioner for Refugees and the Women's Refugee Commission undertook a multi-country assessment to document knowledge of family planning, beliefs and practices of refugees, and the state of service provision in the select refugee settings of Cox's Bazar, Bangladesh; Ali Addeh, Djibouti; Amman, Jordan; Eastleigh, Kenya; Kuala Lumpur, Malaysia; and Nakivale, Uganda. Methods: The studies employed mixed methods: a household survey, facility assessments, in-depth interviews, and focus group discussions. Results: Findings on awareness and demand for family planning, availability, accessibility, and quality of services showed that adult women aged 20-29 years were significantly more likely to be aware, to have ever used, or are currently using a modern method as compared to adolescent girls aged 15-19 years. Facility assessments showed limited availability of certain methods, especially long-acting and permanent methods. Despite availability, in all sites, focus group discussion participants-especially adolescents-reported many accessibility-related barriers to using existing services, including distant service delivery points, cost of transport, lack of knowledge about different types of methods, misinformation and misconceptions, religious opposition, cultural factors, language barriers with providers, and provider biases. Conclusion: Based on gaps, partners to the study developed short and long-term recommendations around improving service availability, accessibility, and quality. There remains a need to scale up support for refugees, particularly around adolescent access to family planning services.

BackgroundThe Inter-agency Working Group on Reproductive Health in Crises conducted a ten-year global evaluation of reproductive health in humanitarian settings. This paper examines proposals for reproductive health activities under humanitarian health and protection funding mechanisms for 2002-2013, and the level at which these reproductive health proposals were funded.MethodsThe study used English and French health and protection proposal data for 2002-2013, extracted from the Financial Tracking Service (FTS) database managed by the United Nations Office for the Coordination of Humanitarian Affairs. Every project was reviewed for relevance against pre-determined reproductive health definitions for 2002-2008. An in-depth analysis was additionally conducted for 2009-2013 through systematically reviewing proposals via a key word search and subsequently classifying them under designated reproductive health categories. Among the relevant reproductive health proposals, counts and proportions were calculated in Excel based on their reproductive health components, primarily by year. Contributions, requests, and unfunded requests were calculated based on the data provided by FTS.ResultsAmong the 11,347 health and protection proposals issued from 345 emergencies between 2002 and 2013, 3,912 were relevant to reproductive health (34.5%). The number of proposals containing reproductive health activities increased by an average of 21.9% per year, while the proportion of health and protection sector appeals containing reproductive health activities increased by an average of 10.1% per year. The total funding request over the 12 years amounted to $4.720 billion USD, of which $2.031 billion USD was received. Among reproductive health components for 2009-2013 proposals, maternal newborn health comprised the largest proportion (56.4%), followed by reproductive health-related gender-based violence (45.9%), HIV/sexually transmitted infections (37.5%), general reproductive health (26.2%), and lastly, family planning (14.9%).ConclusionFindings show that more agencies are responding to humanitarian appeals by proposing to implement reproductive health programs and receiving increased aid over the twelve year period. While such developments are welcome, project descriptions show comparatively limited attention and programming for family planning and abortion care in particular.

Standard approaches to data collection can present challenges to persons with disabilities participating in research processes. The Women's Refugee Commission applied a participatory model to examine the intersections of sexual and reproductive health and disability in Kenya, Nepal, and Uganda. Respecting the Convention on the Rights of Persons with Disabilities and a rights-based framework to research, the study engaged a variety of stakeholders-including organizations of persons with disabilities-from its inception and design, through to implementation and recommendation formulation. In Nepal especially, persons with disabilities played a central role in gathering the information from refugee women, men, and adolescents with physical, intellectual, sensory, and psychosocial impairments. Reasonable accommodations for the data collectors included the provision of personal assistants, vehicles for movement, sign language interpretation, Braille documents, and tactile ink-based diagrams; use of a ''talking pen;'' and creation of a ''supporter'' role in the facilitation process. Daily debriefings provided opportunities for collective improvement and reflection. The study offers considerations for other researchers to extend their research-on the part of the study participants and in the research process itself-to operationalize a rights-based, inclusive, and empowering approach to qualitative research.

ObjectiveTo provide information on trends on official development assistance (ODA) disbursement patterns for reproductive health activities in 18 conflict‐affected countries.DesignSecondary data analysis.Sample18 conflict‐affected countries and 36 non‐conflict‐affected countries.MethodsThe Creditor Reporting System (CRS) database was analyzed for ODA disbursement for direct and indirect reproductive health activities to 18 conflict‐affected countries (2002–2011). A comparative analysis was also made with 36 non‐conflict‐affected counties in the same ‘least‐developed’ income category. Multivariate regression analyses examined associations between conflict status and reproductive health ODA and between reproductive needs and ODA disbursements.Main outcome measuresPatterns of ODA disbursements (constant U.S. dollars) for reproductive health activities.ResultsThe average annual ODA disbursed for reproductive health to 18 conflict‐affected countries from 2002 to 2011 was US$ 1.93 per person per year. There was an increase of 298% in ODA for reproductive health activities to the conflict‐affected countries between 2002 and 2011; 56% of this increase was due to increases in HIV/AIDS funding. The average annual per capita reproductive health ODA disbursed to least‐developed non‐conflict‐affected countries was 57% higher than to least‐developed conflict‐affected countries. Regression analyses confirmed disparities in ODA to and between conflict‐affected countries.ConclusionsDespite increases in ODA for reproductive health for conflict‐affected countries (albeit largely for HIV/AIDS activities), considerable disparities remains.Tweetable abstractStudy tracking 10 years of aid for reproductive aid shows major disparities for conflict‐affected countries.