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After ‘Yolanda’. Prioritizing Sexual and Reproductive Health and Rights The Philippine Experience. Before ‘Yolanda’.
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After ‘Yolanda’ Prioritizing Sexual and Reproductive Health and Rights The Philippine Experience
Before ‘Yolanda’ • Poverty, landlessness and sexual exploitation were already major social and economic problems for the people of Eastern Visayas, which was considered the third poorest in the Philippines (Oxfam assessment) • Situation was exacerbated by weak infrastructure and struggling agricultural and fishing sectors, with almost two million people earning less than $2 per day, • Women were especially vulnerable. “Eastern Visayas is known as a source of women and children for sexual exploitation, and men and boys for labor exploitation. This is primarily due to the high poverty incidence in the region.” (IOM’s National Project Development Officer Romina Sta. Clara.)
When Yolanda struck When news of the “Super Typhoon” emerged, the national government immediately issued a warning to all areas under threat, with President Aquino even launching an unprecedented national televised address warning the people about the coming disaster Some national officials (including the defense and local government chiefs) were deployed to Leyte to oversee the preparations and responseto the typhoon
When Yolanda struck • As Yolanda approached the Philippines, approximately 800,000 people were evacuated and disaster response personnel and equipment were quickly deployed. Such immediate action by the authorities, say aid agencies and local responders helped save many lives and facilitated the subsequent relief effort. • Yolanda was the strongest typhoon to make landfall ever recorded, with wind speeds of 315 kph (195 mph). The accompanying storm surge sent a wave up to five metres high smashing through coastal communities, killing many who thought they were safe.
After Yolanda • Shortly after the disaster, the government estimated that more than 2.1 million families were affected by Yolanda, equivalent to around 9.53 million individuals (DSWD), with majority found in Leyte and Samar, but also Aklan, Iloilo, Palawan, Bohol and Bicol • Some months later, in an assessment, Oxfam put the number of affected individuals at a much-higher 15 million, with at least 5,600 killed and over 26, 200 injured • Over four million are still displaced from their homes,with 1.2 million homes damaged or destroyed
After Yolanda • DSWD also estimates some 96,039 displaced families with 449,416 individuals staying in 1,790 evacuation centers. Some 36,600 other families composed of 182,379 individuals have sought shelter in homes of friends and relatives. • Among those affected by the typhoon were front-liners like police and soldiers, social workers, medical and rescue personnel, with the local governments in affected areas practically paralyzed • Lack of power and communication facilities hampered immediate rescue and relief efforts
Response to Yolanda Outpouring of relief and assistance from both the national government and foreign governments UN designated its disaster response an “L3” – its highest classification, with UN emergency response team reaching Tacloban within 12 hours of Yolanda striking land • At the request of the business community, whose establishments had been subjected to looting by survivors, among the first personnel to be brought to Leyte and Samar were police and soldiers for peacekeeping duties, with personnel from the Department of Health, the Department of Social Welfare and Development and other agencies closely following
Response • More support mobilized by international organizations and agencies, including the Red Cross, IOM, Fuel for Relief Fund and thousands of individual donors • So far, an estimated three million people have received food assistance including rice, high energy biscuits and emergency food items More than 35,000 households received tarpaulin sheets or tents (particularly in Eastern Samar and Leyte provinces) with efforts to reach another 478,000 households under way
Response • About 80 per cent of people still in Tacloban City had access to clean water and about 60,000 hygiene kits had been distributed. • This and other aid – including health care, services to protect children, and cash transfers – have helped keep families alive, prevented outbreaks of disease, and begun to help people to rebuild their lives. • In the context of Yolanda’s severity and the logistical challenges it created, these are notable successes. (Oxfam assessment)
Reproductive Health Issues • DSWD counts 233,697 pregnant women affected by the typhoon and requiring specialized reproductive health services. In evacuation centers alone where the displaced are temporarily housed, a total of 7,973 pregnant women had been counted as of late last year. • “The biggest challenge is really the continuation of maternal healthcare services. With so many health centres destroyed, women have no place to go for their pre-natal examinations. Midwives will have to go find the pregnant women, but often the midwives are also among the affected population.” (Amelita Robles, provincial health officer)
Repro Health • -- Health experts fear conditions in evacuation centers can put pregnant women at heightened risk of malnutrition and pre-term labour. “In the centers, she is dependent on food rations, which are usually rice and canned goods. These will not provide the necessary nutrients that a pregnant woman needs” (UNFPA officer) • Malnutrition in pregnant women can also increase the chances that their babies will be sick, or die. • The psychological trauma of a disaster on the scale of Yolanda may bring on premature labor, say health workers, and if the baby is delivered pre-term, there is a lower rate of survival
Repro Health • The needs of pregnant women from [confirmation of] pregnancy to… giving birth need to be integrated into emergency and relief response (FPOP) • Of the 14.4 million affected people, 25% are women who are of reproductive age, which is equivalent to 3.6 million (IPPF) • This serves to indicate the large number of women who could get pregnant by their spouses as people still have sexual intercourse even in times of crisis. There are also cases of unplanned pregnancies especially when contraception is not used, or when a girl or woman is raped.” (IPPF)
Repro Health An estimated 900 babies are born daily in the typhoon-hit regions. But with limited access to medical facilities and aid, newborns are exposed to the risk of respiratory complications and infections, and mothers to childbirth complications and obstructed labor that can result in death. • Yet these deaths are mostly preventable if a basic and sterile delivery kit is available. A simple cloth can help warm the baby against developing cold or hypothermia, while clean gloves can be used to contract a mother’s uterus to prevent excessive bleeding post delivery.
Minimum Package • These life-saving items are often taken for granted until times of emergency, amid chaos and ruins, when we realize they are not readily accessible. Even a clean blade makes a difference in ensuring the umbilical cord is cut without an infection hazard. • Under the internationally approved Minimum Initial Service Package (MISP) for reproductive health, certain activities must be implemented at the onset of every emergency, including distributing emergency delivery kits to displaced pregnant women in their last trimester. The emergency kits for women and traditional birth attendants to aid safe delivery may contain a plastic sheet, a razor blade and a bar of soap.
Ongoing challenge • Sexual and reproductive health service is one area that hasn’t been adequately recognized by humanitarian responders and communities on the ground. In the Philippines, it remains an ongoing challenge, as access to reproductive health rights is often faced with opposition due to religious and cultural sensitivities. • The 2011 Family Planning Survey noted that the country’s maternal mortality ratio jumped by 35 percent, from 162 deaths per 100,000 live births in 2006, to 221 in 2011. And still, the Responsible Parenthood and Reproductive Health Law is still undergoing deliberations in the Supreme Court
VAW and trafficking • In emergencies, desperation drives families to seek alternative sources of income, and adolescent girls and women may have to engage in transactional sex or fall prey to human trafficking (Save the Children) • Domestic violence is also likely to increase as frustration grows within the family unit and women and girls bear the brunt. • Of the millions of people affected by the typhoon, an estimated 56,400 women between 15 and 49 years old are at risk of sexual violence. In the evacuation centers, around 2,500 women are at risk.
Facilities for women • UNFPA-organized reproductive health medical missions • Creation of at least 17 ‘women-friendly’ spaces, providing information sessions on the prevention of gender-based violence and psychological counseling • “Women’s gardens” in Samar
Disadvantages • On top of the increased risk for gender-based violence, women who lost their husbands to disasters may find it difficult to retrieve property, receive compensation for destroyed homes or gain access to loans because family property is usually in their husband’s name. There is also a consensus that women are less likely to survive disasters, and that planning and warning systems need to be responsive to this reality. Women and girls are less likely to know how to swim and have less upper body strength required to hold on to trees or other anchors (Ferris)
Trafficking • Currently, local government units and social workers have been alerted regarding the possibility of trafficking of children in Yolanda areas, whether for sex trafficking or forced labor, and are coordinating with national agencies • Need for better coordination regarding policies, programs and actions on the welfare of Yolanda orphans (New York Times story)
What needs to be done • For the Philippine government: • Ensure that services to protect vulnerable groups, such as women and children (and elderly), are rapidly expanded. These should include access to trained protection staff and domestic violence telephone hotlines; increased deployment of female police; and women-friendly spaces in displaced communities. • All of these steps should be supported as a crucial part of the crisis response and not as a secondary issue (alongside of course measures to ensure ‘safe programming’, so that no part of the response increases risks for women, girls or other vulnerable groups).
What needs to be done • By the Philippine government • Deliver a pro-poor reconstruction strategy that spearheads a major economic development of the worst affected regions and tackles inequalities, including gender, that make people vulnerable. • The strategy should involve communities (including women’s groups) in the design and implementation of structures, especially residences
For UN and Int’l NGOs • Continue to increase support to the Philippine government and state institutions, as well as civil society organizations,in order to accelerate the response and ensure sustainability of the recovery and reconstruction efforts. • International actors should integrate their activities with those of domestic actors, avoiding the establishment of parallel service provision and uncoordinated investments.
UN and int’l NGO’s • Strengthen gender analysis across all programs and implement projects accountablyand on the basis of the needs and priorities of different groups. • This should include actively supporting women’s leadership and women’s organizations, and looking for other opportunities to ensure that relief and recovery programs help to promote gender equality in the long-term. (Source: Oxfam assessment)
