Reproductive Health, Refugee Style
by Austin Ruse
Sometime in the next few weeks the World Health Organization, in conjunction with the United Nations High Commissioner on Refugees (UNHCR) and several other UN agencies, is expected to release its new Inter-agency field Manual Reproductive Health in Refugee Situations.
This document will be a permanent follow up to the first working manual published in 1995, a document which has concerned pro-life advocates for its overt promotion of not just contraception, but also chemical and surgical abortion.
In late September rumors swirled around the international community that the new document, in closed preparation for over a year in Geneva, would go even further than the first. Sources on the inside of the Geneva planning meetings claimed the new document would make mandatory the promotion of all kinds of family planning methods including abortion. The document was said not to allow any conscience considerations on the part of relief workers. Moreover, this promotion of abortion would occur in refugee camps, among the most dangerous places in the world.
In late October a staff member of the House Sub-Committee on International Affairs warned WHO officials in Geneva of the domestic American consequences to these new guidelines. Based on this meeting, and increasing pressure from international pro-life community, WHO and UNHCR signaled they were backing off the mandatory abortion directives in the new field manual, and would allow conscience clauses for relief workers.
Clues to the new manual can be found in the old one. The 1995 manual includes chapters on safe-motherhood with medical recommendations on the detection and management of complications, guidelines on optimal feeding practices of newborns, and includes a chapter on the prevention and treatment of sexual violence, and another on the prevention and care of sexually transmitted diseases. It is the sixth chapter on family planning that has raised red flags in the pro-life community, which to some seems to make explicit the use of abortifacients like Depo-Provera. Additionally, the manual promotes the use of a kit that includes an inter-uterine vacuum aspirator which the manual claims would only ever be used to complete life threatening botched abortions.
What some pro-lifers find alarming is the large number of UN agencies and prominent non-governmental organizations (NGOs) who have participated in the writing of the manual. In addition to WHO and UNHCR other participants include Save the Children Fund, UK, International Federation of the Red Cross and Red Crescent Societies, OXFAM, the United Nations Children's Fund (UNICEF) and many others. This effort at a coordinated approach at family planning in refugee situations seems to have begun with UNFPA, the UN agency most concerned with population control questions, who, in June 1994, UNFPA commissioned itself to "assist Rwandese refugees and displaced persons." Moreover, in November, 1994, UNFPA opened their Geneva-based Emergency Relief Operations office to further "identify reproductive health needs, develop projects, and promote a coordinated response in refugee situations. ... giving special attention to [reproductive health] needs of adolescents, mostly girls."
The question also arises as to why refugees, who spend their days concerned with basic survival, would ever been concerned with population control. A US Congressional staff member close to this situation lends insight, "I have been to half a dozen refugee camps in recent years. At each one I have inquired about family planning. The relief workers inevitably say they have some contraceptives around but that the refugee families never want them. These people want their children. This effort comes not from necessity or from popular appeal but is purely political."
The idea of codifying family planning in refugee situations was given great impetus in November, 1995 when Dr. Sadako Ogata, United Nations High Commissioner for Refugees (UNHCR) called for a greater emphasis on long-term development saying that her agency should play a pro-active role through a more "home-land-oriented, holistic approach." The number of refugees globally totals something over 22 million, although the Holy See Observer Mission at the United Nations places the number of refugees, including those who have not crossed a border, closer to 50 million displaced persons. Pro-lifers were surprised, however, that Dr. Sadako's "holistic approach" as expressed in the field manual, would include surgical abortions performed in refugee camps.
The effort advanced markedly in June 1995 when UNFPA organized an "Inter-Agency Symposium on Reproductive Health in Refugee Situations"along with UNHCR, WHO and UNICEF. Dr. Nafis Sadik, UNFPA Executive Director, addressed the Symposium, "UNFPA will work with UN agencies and organizations to make resources available to meet the reproductive health needs of refugee and internally displaced women, men and adolescents ... in the next few years, reproductive health will be systematically and comprehensively implemented ... ." A joint memorandum was signed at the Symposium's conclusion wherein UNHCR and UNFPA each committed "... to advocate for, coordinate, monitor, and evaluate reproductive health activities focusing on refugees."
Essential to the success of the UN inter-agency effort was not just participation of many agencies, but also the refugees themselves. Peter Poore, Senior Health Adviser for Save the Children Fund-UK, said that "The failure of governments, UN agencies and NGOs to address adequately the reproductive health needs of refugees is not technical, but organizational. ... [The] uncoordinated, inappropriate imposition of any ‘service' on an uninformed, unwilling and uncooperative community will always fail." Poore recommended an international code of conduct that could be equally applied to UN agencies and NGOs and which would ensure coordination, accountability and avoid agency competition for the fund-raising dollar.
By 1996 a coordinated partnership had been realized among UN agencies and aligned NGOs and emergency relief groups, thereby moving closer to an international code of conduct. By that time UNFPA had already implemented reproductive health projects for refugees in 12 countries, at a total cost of $3,296,000 USD. In supporting roles were IPPF, AMREF, CARE, and Marie Stopes International (MSI). So it was in Bosnia and Herzegovina, for example, that UNFPA and MSI provided 250,000 condoms, 76,000 cycles of contraceptive pills and 32,000 IUDs for its returnees and internally displaced peoples.
UNFPA's Sadik announced at the November 1996 World Food Summit held in Rome, the signing of an agreement between UNHCR, the Federation of Red Cross and Red Crescent Societies and other NGOs to bring "reproductive health care to refugees in the Great Lakes region of Africa," and said that they will offer similar assistance in all future refugee situations. Mr. Hirofumi Ando, UNFPA's Deputy Executive Director, explained that reproductive health would not include abortion, although he showed the gathering of press the black "medical kit" provided to refugees which contains IUDs and vials of Depo Provera, both known to act as abortifacients.
As rumors advanced that the new manual would go even further than the old, Congressman Chris Smith (R-NJ) met with UN Secretary General Kofi Annan. Smith told Annan that refugees do not need or want contraceptive devices or abortions. He said what they need most is better food, safer water, shelter, and the resources to provide proper resettlement. Smith also warned Annan that Congress would not approve of US funding going to programs that support abortion overseas.
In mid November the US Congress voted to suspend payments of American dues to the United Nations saying they could not support international bodies that promote abortion. The new Inter-agency Manual for Reproductive Health in Refugee Situations has yet to be released.
This item 529 digitally provided courtesy of CatholicCulture.org
