Humanitarian Response Plans and the Global Maternal and Newborn Health Agenda
Every year the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) publishes the Global Humanitarian Overview (GHO) detailing the current state and future trends in humanitarian action. With 2023’s GHO just released on 1 December, the tragic reality is that the number of people in need continues to increase year over year, with a record 339 million people – one in every 23 – expected to need humanitarian assistance in 2023.
‘Humanitarian and fragile settings’ include a breadth of situations – forced displacement, violent conflicts, food insecurity, such as the current largest global food crisis in modern history, and climate change related disasters, as well as global pandemics that have seen healthcare access shrink for many. And the cycle is a vicious one – the average humanitarian crisis with a UN coordinated response lasts nine years. As crises continue and new ones emerge, countries, in collaboration with the UN, develop humanitarian response plans (HRPs) – and associated funding appeals – to seek assistance and direct limited humanitarian assistance to top priorities.
To measure the global need and summarize the current trends, OCHA summarizes each Humanitarian Response Plan (HRP) and Regional Refugee Response Plan in a Global Humanitarian Overview. HRPs are prepared for crises – both acute and protracted – that require international assistance. HRPs are made up of two components; 1) a country strategy with strategic objectives and indicators, 2) and cluster plans with activities, accompanying projects and financing details. HRPs set clear priorities, identify indicators and activities, request funding and a budget and overall articulate a shared vision for how to alleviate suffering and save lives in a specific humanitarian response.
Why is this important for the global maternal and newborn health (MNH) community?
To truly understand the mortality and morbidity burden in countries with humanitarian settings, data systems must improve to reflect the realities of sub-national crises and areas of fragility. The Mortality in Humanitarian Settings Dashboard was recently developed to show the extent to which affected populations are or are not considered in global mortality estimates and highlight that tracking progress toward global and national development goals is not accurate unless context specific data is included. The recent update to the dashboard confirmed that countries with HRPs continue to account for a significant proportion of global maternal and newborn deaths. The 29 countries with HRPs in 2023 contribute 58% of global maternal deaths, 50% of newborn deaths, and 51% of stillbirths worldwide. Meeting SDG, EPMM, and ENAP targets is only possible if we address these settings with the highest burden. To do this we must understand if and how MNH needs and services are being prioritized in humanitarian settings by evaluating HRPs in each context and seeking to influence them if MNH is not prioritized.
Women do not stop getting pregnant during crises, and babies do not stop being born. In the Democratic Republic of the Congo, four women die during labor or due to pregnancy-related complications every hour (UNOCHA). In Venezuela, teenage pregnancy is more than double the regional rate, with the estimated adolescent fertility rate to reach 82 expected births per 1,000 by the end of 2022 (UNOCHA). Regardless of the type or length of the crisis, essential, comprehensive, quality MNH services must be provided, and therefore must be prioritized in HRPs.
- 17.6 million people need humanitarian assistance in 2023
- Start of recent conflict: 24 February, 2022
- 2017 Maternal mortality ratio (per 100,000 live births): 19
- 2021 Neonatal mortality rate (per 1000 live births): 5
- 2021 Stillbirth tate (per 1000 live births): 5
- MNH prioritized in the most recent Flash Appeal Health Objectives: No. While there are broad objectives to protect health infrastructure and access to health services, there are no MNH specific indicators or objectives.
- Percentage of requested appeal funded: 76%
- Consecutive years of humanitarian appeals: 9
- The MNH indicators above were captured before the recent conflict in Ukraine and therefore outcomes are likely far worse as continuing conflict and insecurity makes accessing health facilities, even maternity hospitals, Attacks on critical energy infrastructure mean lack of proper heat in the winter and clean water, this can lead to increased risk of virus and disease for pregnant women and infants.
* While Ukraine has had an HRP for 9 consecutive years, the most recent conflict and rapid influx of migrants and refugees has led to a regional refugee response plan which highlights additional needs and funding requirements for Ukraine and bordering countries.
- 28.3 million people need humanitarian assistance in 2023
- 2017 Maternal mortality ratio (per 100,000 live births): 638
- 2021 Neonatal mortality rate (per 1000 live births): 34
- 2021 Stillbirth rate (per 1000 live births): 26
- MNH prioritized in 2022 HRP Health Objectives: Yes. For example, increased and equitable access to healthcare for pregnant and lactating women is a specific outcome under Objective 1 and number of pregnant women attending their first ANC visit is an indicator in Objective 1.
- Percentage of requested appeal funded: 56%
- Consecutive years of humanitarian appeals: 15
- Similar to Ukraine, the mortality data does not properly capture the current situation and MNH outcomes are likely worse. Restrictions on women’s participation in society is crippling the health workforce; limited resources and insecurity force women to delay accessing necessary MNH care and high levels of food insecurity, coupled with a growing climate crisis make access to proper food and nutrition for pregnant women and their infants nearly
- 5.2 million people need humanitarian assistance in 2023
- 2017 Maternal mortality ratio (per 100,000 live births): 480
- 2021 Neonatal mortality rate (per 1000 live births): 24
- 2021 Stillbirth rate (per 1000 live births): 18
- MNH prioritized in 2022 HRP Health Objectives: No, there are no MNH specific indicators or objectives.
- Percentage of requested appeal funded: 43%
- Consecutive years of humanitarian appeals: 13
- 2023 Global Humanitarian Overview takeaway: “Women, children, persons with disabilities and other vulnerable groups have been disproportionately affected by the ongoing crisis. They have limited access to health and WASH services, with women giving birth with no medical assistance in makeshift displacement sites…”
- 1.5 million people need humanitarian assistance in 2023
- 2017 Maternal mortality ratio (per 100,000 live births): 289
- 2021 Neonatal mortality rate (per 1000 live births): 28
- 2021 Stillbirth rate (per 1000 live births): 17
- MNH prioritized in 2022 HRP Health Objectives: Yes. For example, preventive and curative services targeting children under age 5 and pregnant and lactating women, and trauma care are named in the list of items covered by the first 25% of funding from the HRP. Additionally, pregnant and lactating women are mentioned in HRP nutrition and health objectives as well.
- Percentage of requested appeal funded: 65%
- Consecutive years of humanitarian appeals: 4
- 2023 Global Humanitarian Overview takeaway: The number of people in need has increased by one-third in the past year. The conflict in Cabo Delgado is driving forced displacement, which combined with irregular rainfall is leading to dire food shortages and high rates of malnutrition for both children and pregnant and lactating women.
*While Mozambique has a country wide HRP, there was also a recent Emergency Response Plan put in place to address the effects of Cyclone Gombe. This emergency response plan is only 29% funded.
While the Global Humanitarian Overview successfully conveys broad public health trends in these contexts, it does not thoroughly detail the state of MNH in humanitarian settings. More collective attention and action is needed from the entire global community to prioritize MNH in these settings, support providers and responders to deliver context-adapted services, and further advocate for more recognition and funding at all levels. Some specific actions we can take to increase prioritization and investment for MNH in humanitarian appeals include:
- Urging OCHA and the humanitarian community writ-large to prioritize MNH in each country’s ‘Humanitarian Needs Overview’ and subsequently HRPs and other humanitarian appeals.
- Work with Global Health Cluster, country specific health clusters, and humanitarian responders in assessing, advocating for, and providing MNH services.
- Providing resources to partners who are delivering MNH services in these settings; and,
- Advocating for initiatives and donors to include humanitarian and fragile settings in research studies and project plans so as to improve availability of data to reflect the realities of MNH in these contexts.
The upcoming International Maternal and Newborn Health Conference in May 2023 in Cape Town, South Africa will focus on the urgent and collective action needed to meet global targets, which cannot be met without investment in and consideration of MNH in humanitarian and fragile settings. It is therefore imperative that conference organizers, donors, country delegations, and participants alike all consider how to design a future agenda for MNH that appropriately reflects the needs in these settings, from preparedness and response to resilience, both identified in current HRPs and not.
Andrea Edman is the SRHR Advocacy & Communication Specialist at the International Rescue Committee (IRC) and a member of the Maternal and Newborn Health Sub-Working group for the Inter-Agency Working Group on Reproductive Health in Crises (IAWG).