Refugee and internally displaced women have a right to and a need for emergency contraception. For women forcibly displaced by conflict, access to emergency contraception (EC) is not only a right, but also a critical need that can help to maintain and improve their reproductive health. Refugee and IDP women who are not granted access to EC are deprived of their right to reproductive health, as they may be forced to experience an unwanted pregnancy and may, as a result, suffer or die from childbirth or abortion complications. While maternal mortality is a common cause of death among women living in resource-poor settings, the stressful living conditions of displaced women make delivering a child even more difficult and life threatening. By offering a “second chance” to those whose regular contraceptive method has failed, EC provides a woman or adolescent girl with the opportunity to avoid an unplanned or forced pregnancy and can reduce her risk of death or illness due to complications from childbirth or unsafe abortion. War and conflict increase incidents of rape and other forms of gender-based violence (GBV); this dire reality is reflected in an increasing number of documented reports and research. Women and adolescents are especially vulnerable to sexual abuse committed by combatants. The use of rape as a weapon of war has been documented during the conflicts in Bosnia and Herzegovina, Rwanda and Sierra Leone. According to a recent study in Sierra Leone, war-related sexual violence was widespread among women who were internally displaced by the conflict. The prevalence of sexual violence, including rape, committed by combatants was found to be 9 percent during the past 10 years of war, equaling Sierra Leone’s lifetime prevalence of non-war-related sexual assaults. Research in Tanzania in 1997 found that almost 28 percent of Burundian refugee women of reproductive age had been raped since becoming refugees. A 1982 study of Guatemalan refugee women found that their most overwhelming fear was of being raped. Displaced women are also victims of another type of gender-based abuse – sexual exploitation – when men wielding power in the refugee, host and even humanitarian communities demand sex in exchange for safety, food or other commodities. As a consequence of war, women may be required to exchange sex for resources to support themselves and their families. To make matters worse, women in conflict settings often do not have access to regular family planning methods for protection against unwanted pregnancies. Such circumstances underscore the importance of making EC available for refugee and IDP women. To address the reproductive health needs and rights of refugee women, EC should be made available from the beginning of a response to a humanitarian crisis. The Minimum Initial Service Package (MISP), which outlines the series of priority actions needed to respond to the reproductive health needs of populations in the early phase of humanitarian crises, includes EC as a component of the services to be provided to survivors of GBV. The MISP is included as a standard of humanitarian response in the new SPHERE guidelines, which were published in 2004. Staff training is especially critical in these settings and clear information on available services must be communicated immediately to newly arriving refugees, IDPs and others affected by conflict who may be unaware of EC as an option.

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