Saving lives and protecting women: sexual and reproductive health as a key part of humanitarian response

Until a few years ago, Venezuela enjoyed higher rates of economic growth and social development than most other countries in the region. A combination of political and economic problems and international sanctions has generated a deep crisis, with dramatic cuts in public spending impacting access to food, essential services such as health care, water and sanitation, education and gas, fuel and electricity. The prolonged economic contraction and hyperinflation have driven more than 5 million people to flee the country.

Migratory flows are very varied, including those who intend to leave, those who repatriate and those who move back and forth. The official closure of borders with neighbouring countries has forced people on the move to use irregular routes, making epidemiological controls more difficult, limiting the monitoring of flows and increasing protection risks, with a differentiated impact on women and girls who are victims of various forms of gender-based violence (GBV). Care for women victims of sexual violence is one of the components of the Minimum Initial Service Package (MISP) for Sexual and Reproductive Health in Crisis. MISP is part of a series of crucial lifesaving activities in response to the sexual and reproductive health needs of affected populations at the onset of a humanitarian crisis. These needs are often overlooked, with potentially deadly consequences. The MISP has been developed by the Inter-Agency Working Group for Reproductive Health in Crisis. The UN Population Fund (UNFPA), in partnership with other stakeholders, supports the implementation of the MISP to ensure that all affected populations have access to lifesaving sexual and reproductive health services. Key implementation objectives are that there is no unmet need for family planning, no preventable maternal deaths and no GBV or harmful practices, including during humanitarian crises.

The Humanitarian Response Plan in Venezuela accounts for 1.6 million women and girls in need of protection against GBV, many of them on the move either within Venezuela or cross-border. While women and adolescent girls throughout Venezuela have traditionally suffered endemic GBV from intimate partners and other relatives, the humanitarian crisis has given rise to multidimensional and unprecedented forms of GBV. Information obtained directly from women and girls indicates that sexual violence, sex trafficking and sexual slavery are among the most common violations facing women and girls.

When emergencies occur and humanitarian response is activated, the primary role is to save lives, provide protection and ‘do no harm’. Sexual and reproductive health and GBV care is an essential part of this. The entry point is as simple as it is effective: a pregnant woman will have her baby whether the conditions for delivery are right or not. She will have her baby in the middle of an earthquake, a mudslide or a flood, or on the road on her way to another country. In all these circumstances, humanitarians must be prepared to ensure that deliveries are safe and that no woman loses her life giving life.

Maria Angelica, a minor, was attacked and raped on a border trail while travelling on foot to Colombia with her mother. Fortunately, she was able to obtain treatment at a health centre. But sexual and reproductive health services do not always save lives in such obvious ways. Alejandra, a 32-year-old woman from Puerto Piritu in the state of Anzoategui in Venezuela, says, ‘I always say that being able to prevent more pregnancies saved my life! I have two children from high-risk pregnancies. The doctor said that in the next one I could die. Two years ago I had [a contraceptive] implant and so far, so good – no more pregnancies’. When a crisis puts women in the position of having to choose between buying food and buying contraceptives, receiving contraceptives as part of humanitarian aid is as important as receiving food.

An unwanted pregnancy in the midst of a crisis is not only very difficult for both mother and baby, but it can also jeopardise the woman’s future for years, limiting her ability to get a job or make decisions about her life and future. Marisol, who is facing an unwanted pregnancy that came about due to a shortage of contraceptive supplies, tells us, ‘I didn’t think I would get pregnant, it was a one-night stand. I can’t raise a child in this situation. Now I will have to take boiled malt with some herbs or other options that I was told work to terminate the pregnancy’. This desperate choice, and other unsafe and illegal practices often conducted clandestinely, have a very high probability of ending in a complication that puts at risk the lives of women who could not avoid pregnancy because they did not have access to modern contraceptives. The provision of information on family planning and modern contraceptive options and supplies is key to preventing women like Marisol from having to put their lives at risk in this way.

In Venezuela, where the current humanitarian crisis has also severely affected the economic empowerment of women and girls, the Covid-19 outbreak has led to an increase in GBV and other economic and protection vulnerabilities. As a result, a large proportion of women and girls have resorted to harmful coping mechanisms, such as survival sex or quick and early, in some cases forced, marriages, as well as forced prostitution. Women and adolescent girls who rely on the informal sector for a livelihood are at increased risk of sexual exploitation and abuse.

The mobility restrictions imposed in response to Covid-19 have placed women and girls at greater risk of intimate partner and other forms of domestic violence, including femicide. According to the Centro de Justicia y Paz (CEPAZ) observatory, between June and November 2020 the media reported 103 cases of femicide. In the Venezuelan context, GBV has become normalised and is accepted by communities. Innovative strategies are needed to raise awareness of GBV and help prevent and mitigate it, while simultaneously promoting behavioural and social change to help eradicate attitudes and practices that perpetuate violence and gender inequalities, and to strengthen community capacity to prevent and mitigate GBV.

Some 60 national and international organisations are part of the GBV Area of Responsibility (AOR) led by UNFPA in Venezuela. Action in this AOR is governed by the Inter-Agency Minimum Standards for GBV Programming in Emergencies. Standard 1, GBV Guiding Principles, the first of three ‘foundational standards’ which underpin all GBV programmes, highlights the increased risk to women and girls due to discrimination and other barriers to access, and provides guidance on working with survivors of sexual abuse. The second foundational standard focuses on women’s and girls’ participation and empowerment, offering guidance on overcoming constraints, ensuring their participation and involving men and boys. The third focuses on staff care and support.

Ten programmatic standards cover the following: healthcare for GBV survivors; psychosocial support; GBV case management; referral systems; safe spaces for women and girls; safety and risk mitigation; justice and legal assistance; dignity kits, cash and voucher assistance; economic empowerment and livelihoods; and the transformation of social systems and norms.

A survivor-centred approach cuts across all of the programmatic standards. This translates into a model of care that places the person at the centre: her participation in the process, the recognition of her capacities, including analysis of her situation, and autonomous decision-making at all stages of the care process. Breaking with models that are more ‘tutored’ by the service provider, the aim is to empower women and build resilience.

A key part of the work on the ground has been the creation of a large number of safe spaces as meeting places to counteract the emotional effects of GBV. These spaces are part of a strategy for the protection and empowerment of women and building individual and group resilience to GBV. They are formal or informal places where women and adolescent girls feel physically and emotionally safe, where they can express their emotions and opinions. They are spaces for socialising and building or rebuilding social networks, especially deep connections and bonds between women. In a safe space, they can receive clear information about women’s human rights, social support and access to safe response services such as psychosocial support, legal counselling and medical services which do not put them at risk of revictimisation.

One woman survivor of GBV, and a safe space participant, wrote:

There was a time when I thought I couldn’t … and I couldn’t. I thought I didn’t know anything … and I knew nothing. I thought I wouldn’t have the strength and I faltered. I thought it was too much of a burden and I fell. I underestimated my ability and I was not capable. Today, after receiving support in safe spaces, I now believe that I can. That I know more than I even imagine. That I have the strength I choose to have. That there is no burden that my shoulders can’t carry and that I can go wherever I set my mind to go.

The provision of personal protective equipment has allowed face-to-face services to continue in areas with connectivity problems, but the multisectoral response has also been adapted to a remote modality. On-site services are provided in rented or leased physical spaces, equipped for that purpose, and through missions to remote areas. Making the existence of these new services known in the first place is a dissemination challenge, while mobility restrictions linked to Covid-19 and other particularities of border areas require ongoing local advocacy, which may include obtaining special permissions and adapting to restricted schedules in order to maintain access.

In areas bordering Brazil and Colombia, many women move back and forth across borders to buy necessities for their families or products for resale at informal markets in their communities. In transit, especially along irregular routes, they are at high risk of violence, especially sexual violence. Perpetrators include traffickers, men involved in regular and irregular commercial activities and agents of the security forces. When women are asked in community workshops about their main fear when using these routes, the general response is ‘to be raped’.

With the implementation of social distancing measures to curb the spread of Covid-19, technologies to enable the remote delivery of specialised GBV response services are essential. Each service provider in the AOR in Venezuela was given a mobile phone and trained in methodological adaptions for the provision of services through telephone calls, WhatsApp and text messaging. UNFPA has developed technical guidelines for remote services providing specialised psychosocial care for GBV survivors, which are being used by multiple actors associated with the response to GBV in a range of countries.

In Venezuela, humanitarian actors are committed to expanding the humanitarian response and improving their efforts to prevent and respond to GBV in ways that preserve or restore the dignity of women and girls. This is done through the delivery of menstrual hygiene kits, by supporting women on the move to access means to maintain their personal hygiene, in mass messaging and through the creation of ‘sisterhood’ or ‘sorority’ networks in safe spaces that empower vulnerable women and survivors of GBV. Sisterhood networks enable groups of women to connect in a safe physical space or through a secure channel such as WhatsApp. Empathy, respect and understanding grows between women in the network as they become aware that other women in the group have suffered experiences similar to their own.

We are convinced that sexual and reproductive health care services, including the provision of contraceptive supplies, emergency obstetric care and clinical care for victims of sexual violence, along with services that rescue and restore the dignity of women and girls, are as important as any other humanitarian service in protecting people and saving lives.

Jorge Gonzalez Caro is the National Representative for UNFPA Venezuela.