REVIEW OF SEXUAL AND

REPRODUCTIVE HEALTH
AND RIGHTS IN THE
CONTEXT OF DISASTERS IN
ASIA

Ranjani Krishnamurthy
Independent Researcher & Programme Advisory
Committee (PAC) member, ARROW
Chennai, India

Citation Format: Murthy, R. K. (2009). Review of Sexual and

Reproductive Health and Rights in the Context of Disasters in Asia,
Kuala Lumpur, Malaysia: The Asian Pacific Resource and Research
Centre for Women (ARROW).

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TABLE OF CONTENTS

Sections Page no.

Abstract 2

Abbreviations 3

Acknowledgements 5

1.0: Introduction 6

2.0: Definitions 7

3.0: International standards, conventions and agreements: a review from a 9

disaster and SRHR lens

4.0: Impact of disasters on sexual and reproductive health and rights 12

5.0: Case studies on government, United Nations and donor interventions 17

on disaster from a SRHR lens

6.0: Good practices on addressing SRHR issues in the context of disasters 23

7.0: Conclusions and recommendations 25

Endnotes 30

Annex 1 31

Annex 2 33

References 34

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ABSTRACT

This study examines the impact of disasters in Asia on the sexual and reproductive health
and rights (SRHR) of women, adolescents and transgendered people; the strengths and
weakness of international standards on disasters and of disaster response of government
and other stakeholders; and good practices on addressing SRHR in disaster contexts.
Based on this analysis, it makes recommendations to strengthen integration of SRHR in
disaster risk reduction, response and recovery processes.

The study argues that disasters in the region have had an adverse impact on the SRHR of
women, adolescents and transgendered people (particularly the economically and socially
marginalised amongst them), though the extent and form of detrimental impact varies
with pre-existing gender and social relations, pre-existing SRH services and outcomes,
extent of loss to health infrastructure and personnel, attention to SRHR and social
determinants of SRHR in disaster policies, and the nature of the disaster itself. It argues
that the existing international standards, including the Minimum Initial Service Package
(MISP) for reproductive health in crisis situations, do not adequately address the SRHR
of above groups in disaster risk reduction, response and recovery. Based on case studies
from Bangladesh, China, India and Indonesia, the study observes that SRHR issues are
not institutionalised into disaster management plans of governments or of the Asian
Development Bank (ADB). While UNICEF, UNFPA and INGOs better respond to
SRHR issues in disaster contexts, their response is far from adequate. Amongst others,
the study calls for an international Convention on disasters that is SRHR-aware; a
revamped Minimum Standards in SRHR through the disaster risk reduction, response and
recovery stages; integration of SRHR into disaster management laws and plans of the
government; building institutional capacity of government to implement SRHR-aware
disaster plans; and attention to the revamped Minimum Standards in SRHR in immediate
response to disasters by the UN, ADB and INGO, as well as disaster mitigation,
preparedness and rehabilitation.

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This study is part of a larger regional collaboration of women NGOs, researchers and
activists, to monitor the implementation of the International Conference on Population
and Development (ICPD), in 12 Asia-Pacific countries. 1

1
Bangladesh, Cambodia, China, India, Indonesia, Laos, Malaysia, Nepal, Pakistan, the Philippines,
Thailand and Vietnam.

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 ABBREVIATIONS

AFC ARROWs For Change

AIDS Acquired Immunodeficiency Syndrome
ANC Ante-natal Care
ARROW Asian-Pacific Resource and Research Centre on Women
ARV Antiretroviral
CEDAW Convention on the Elimination of All forms of Discrimination Against Women
CEmOC Comprehensive Emergency Obstetric Care
CERF Central Emergency Revolving Fund
CRC Child Rights Convention
CRR Center for Reproductive Rights
EmOC Emergency Obstetric Care
ESEAOR East and South East Asia and Oceania Region
FPA Family Planning Association
FPAB Family Planning Association Bangladesh
FPAI Family Planning Association of India
GB Great Britain
GBV Gender-Based Violence
HIV Human Immunodeficiency Virus
IASC Inter-Agency Standing Committee
ICESCR International Covenant on Economic, Social and Cultural Rights
ICPD International Conference on Population and Development
IEC Information, Education and Communication
IEHK Inter-Agency Emergency Health Kit
IFRC International Federation of Red Cross and Red Crescent Societies
INGOs International Non-Governmental Organisations
IPPA Indonesian Planned Parenthood Association
IPPF International Planned Parenthood Foundation
IUCN International Union for the Conservation of Nature and Natural Resources
IUD Intra-Uterine Device
LHW Lady Health Worker
MCH Maternal and Child Health
MISP Minimum Initial Service Package
MOH Ministry of Health
NGO Non Government Organisation
NWFP North-West Frontier Province
OCHA Office for the Coordination of Humanitarian Affairs
OHCHR Office of the United Nations High Commission for Human Rights
PEP Post-Exposure Prophylaxis
PfA Platform for Action
PHCs Primary Health Care/ Public Health Centre
PoA Programme of Action
PNC Post-natal care
PRC Peoples Republic of China

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RH Reproductive Health
RTIs Reproductive Tract Infections
SHG Self -Help Group
SPRINT Sexual and Reproductive Health Programme in Crisis and Post-Crisis Situations
in East, Southeast Asia and the Pacific
SRH Sexual and Reproductive Health
SRHR Sexual and Reproductive Health and Rights
SRR Sexual and Reproductive Rights
STIs Sexually Transmitted Infection
TB Tuberculosis
TBAs Traditional Birth Attendant
UN United Nations
UNDAW United Nations Division for the Advancement of Women.
UNDMT United Nations Disaster Management Team
UNFPA United Nations Population Fund
UNHCR United Nations High Commissioner for Refugees
UNISDR United Nations International Standards for Disaster Reduction
UNICEF United Nations Childrens Fund
USAID United States Agency for International Development
UTIs Urinary Tract Infections
WCRWC Women's Commission for Refugee Women and Children
WHH Women-Headed Households
WHO World Health Organization

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ACKNOWLEDGEMENTS

The author is grateful to ARROW for commissioning this study.

Participants in the ICPD+15 planning meeting provided useful comments on the

proposed research methodology. The ARROW team and Chaman Pincha of India
provided constructive suggestions on the first draft of this paper.

Insights from being the Guest Editor of the ARROWs For Change bulletin, Vol. 14, No.
3, 2008 (Feminist and Rights-based Perspectives: SRHR in Disaster Contexts) were
valuable. The author is immensely grateful to the ARROW team who worked with me
on this bulletin, as well as the expert readers and other contributors to this bulletin.

Finally, she is grateful to Sheela Arul and Lakshmi Priya for research assistance.

Responsibility for any shortcomings is, however, mine.

Ranjani Krishnamurthy, 2009

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1.0 INTRODUCTION

According to the World Disaster Report 2009, the Asian continent accounted for 40.5%
of the disasters that occurred between 1999 and 2008 (International Federation of Red
Cross and Red Crescent Societies, 2009). Asia accounted for 82.3% of the disaster deaths
and 84.5% of the disaster-affected globally between 1999 and 2008 (ibid, 2009). The
number of disasters in Asia had decreased from 256 in 1999 to 226 in 2008, as the lowest
numbers of disasters in the decade were experienced globally during this year. A little
more than half (51.6%) of the disasters in Asia during this period were classified as
natural disasters with the remaining 48.4% being technological. 1 Natural disasters
nevertheless accounted for 95.4% of deaths in Asia. The important natural disasters in the
region between 1999 and 2009 in terms of frequency of occurrence were floods,
windstorms, earthquake/tsunami, avalanche/mudslides/landslides, droughts, extreme
temperatures, forest/scrub fire, volcanic eruptions and insect infestation (ibid, 2009).

The focus of this report is on natural disasters, though it recognises that the borderline is
thin between technological disasters and natural disasters, as human technologies and
interventions have increased the number and scale of natural disasters in Asia (UNDAW,
2004). Natural disasters discriminate against women/girls, adolescents and transgendered
people in general, particularly those who are poor, ethnic and religious minorities,
migrants without legal documents, dalits, indigenous groups, women heading
households, infirm and people with disability and elderly. Women and girls in Asia have
lesser access to disaster risk reduction measures than men, are less prepared to evacuate
before disasters occur, suffer post-disaster from higher fatality rates (with few
exceptions), 2 and have lesser access to response and recovery benefits. Issues of gender
discrimination against women and adolescent girls during disaster risk reduction,
response and recovery have been well-documented in the World Disaster Report 2007, as
well as by several United Nations (UN) agencies, regional non-government organisations
(NGOs) and international non-government organisations (INGOs) (Aryabandu and
Wickramasinghe, 2003; Enarson, 2004; Denis and Yunus, 2008; Gender and Disaster
Network, n.d). The scant literature on the impact of disasters on transgendered people

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suggest that they constitute an equally discriminated group in disaster response and
recovery (Pincha et al., 2007).

Given the scale of disasters in Asia, achieving the goals of the International Conference
on Population and Development (ICPD) and beyond (elaborated in section 2) is not
possible without addressing sexual and reproductive health and rights (SRHR) issues in
disaster contexts. Recognising this aspect, the Inter-agency Standing Committee in 1995
evolved the Minimum Initial Service Package (MISP) for Reproductive Health (RH) in
Crisis Situations, covering both conflicts and disaster-related emergencies (Womens
Commission for Refugee Women and Children, 2007). The 1994 ICPD Programme of
Action (ICPD PoA) also calls for ensuring that basic health servicesincluding
reproductive healthare available for internally displaced people. An important
research/advocacy question therefore is whether SRHR of women, adolescents and
transgendered people are being addressed in the disaster risk reduction, response and
recovery processes in Asia, and how best to strengthen the attention paid to SRHR
concerns of these groups. A related question is whether gains, if any, being made in
implementing the 1994 ICPD commitments during normal times are maintained in
disaster situations, and how best to ensure the same. Yet another issue for exploration is
whether the MISP for RH in Emergencies (1995), the ICPD commitments on disasters
(1994) and other international standards on health themselves reflect a strong SRHR
perspective.

The paper seeks to explore these questions and specifically examines:

The strengths and weaknesses of important international commitments and
standards related to disasters and health/sexual and reproductive health (SRH)
from an SRHR 3 lens with a focus on women, adolescents and transgendered
people;
The important SRH needs and sexual and reproductive rights (SRR) violations
against women, adolescents (females and males) and transgendered people in
disaster risk reduction, response and recovery;

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 Case studies from Bangladesh, China, India and Indonesia, on the strengths and
weaknesses of disaster risk reduction, response and recovery efforts of national
governments, selected United Nations (UN) agencies, and selected international
non-government organisations (INGOs) from an SRHR lens;
Good practices in Asia by any stakeholder in addressing SRHR of women,
adolescents and transgendered people in disaster risk reduction, response and
recovery; and
Recommendations to different stakeholders to strengthen SRHR sensitivity of
their disaster risk reduction, response and recovery measures.

Given constraints of time and budget, it was not possible to undertake field research or
hold phone/email interviews on the above themes with stakeholders. The main method
used for research was literature review. The author was constrained by the scarcity of
literature on the impact of disasters on SRHR and analysing SRHR sensitivity of disaster
risk reduction, recovery and response interventions. There was more literature on
conflicts and SRHR 4 than on disasters and SRHR (also an observation by Carballo et al.,
2005a). The materials on disasters and health often had very little coverage on SRHR. 5
Amongst the material available on disasters and SRHR, a majority pertained to the SRHR
of women and adolescent girls. There was little material on disasters and the SRHR of
adolescent boys or transgendered people. Further, there was scant literature in English on
SRHR and particular disasters like drought, windstorms, landslides and volcanic
eruptions; the quantum of information also varied across different Asian countries.

In spite of these limitations, the paper hopefully offers useful insights which are
presented in this report. The second section defines important terms used in the paper
related to disasters and SRHR. The third section reviews the strengths and weaknesses of
important international standards and commitments on disasters from an SRHR lens. The
fourth section, building upon a framework of six pathways of impacts, presents an
overview of impact (mainly adverse) of disasters on SRHR of women, adolescent girls
and transgendered people. The fifth section presents the findings from country case
studies on Bangladesh, China, India and Indonesia. The sixth section summarises some of

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the good practices on addressing SRHR issues in disaster risk reduction, response and
recovery, and illustrates how disasters could also be an opportunity to build back a better
and more equitable society. The seventh section outlines key recommendations to UN
agencies, national governments, INGOs and NGOs to strengthen attention to SRHR
issues within disaster risk reduction, response and recovery policies and practices.

2.0 DEFINITIONS

2.1 Disaster-related definitions 6

In the last few decades, there has been a paradigm shift in discourses around disaster
from disaster management to disaster risk reduction (DRR) as practitioners realised
the need to go beyond managing disaster events towards carefully addressing the risk
processes that drive these disasters in the first place (ARROWs For Change, Vol. 14. No
3, 2008). The definitions that follow on disaster, disaster risk reduction, response and
recovery are taken from the United Nations International Strategy for Disaster Reduction
(UNISDR), 2009. While response and recovery are discussed here as separate from DRR,
the ultimate aim is to integrate disaster risk reduction into response and recovery
strategies.

Disasters
Disasters refer to a serious disruption of the functioning of a community or a society
involving widespread human, material, economic or environmental losses and impacts,
which exceeds the ability of the affected community or society to cope using its own
resources. It is a result of the combination of: the exposure to a hazard; the conditions
of vulnerability that are present; and insufficient capacity or measures to reduce or cope
with the potential negative consequences (UNISDR, 2009).

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Disaster Risk Reduction
DRR refers to the concept and practice of reducing disaster risks through systematic
efforts to analyse and manage the causal factors of disasters, including through reduced
exposure to hazards, lessened vulnerability of people and property, wise management of
land and the environment, and improved preparedness for adverse events (UNISDR,
2009).

Response
Response refers to the provision of emergency services and public assistance during or
immediately after a disaster in order to save lives, reduce health impacts, ensure public
safety and meet the basic subsistence needs of the people affected (UNISDR, 2009).

Recovery
Recovery refers to the restoration, and improvement where appropriate, of facilities,
livelihoods and living conditions of disaster-affected communities, including efforts to
reduce disaster risk factors (UNISDR, 2009).

2.2 Sexual and reproductive health and rights

Reproductive health
The 1994 ICPD Programme of Action (PoA, chapter 7.5) defines reproductive health as
complete physical, mental and social well being in all matters related to the reproductive
system (UN, 1994a). The PoA elaborates that reproductive health implies the ability of
couples and individuals to decide if, when and how many children to have, and to access
to the following medical services to ensure reproductive health: family planning services;
antenatal, postnatal and delivery care; neonatal and infant care; treatment for sexually
transmitted infections and reproductive tract infections; safe abortion services where they
are legal and management of abortion related complications; prevention and appropriate
treatment for infertility; Information, Education and Communication (IEC) on human
sexuality, reproductive health, responsible parenting and discouragement of harmful
practices; treatment of cancer of reproductive systems; and treatment of HIV and AIDS

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(Human Immunodeficiency Virus/ Acquired Immunodeficiency Syndrome). This paper
extends the above definition to include other RH services like access to treatment for
reproductive health complications due to gender-based violence, treatment for
reproductive health conditions like uterine prolapse and access of adolescents,
transgendered people and women irrespective of marital status/occupation to the above
services (where relevant) without discrimination.

Reproductive rights
The 1994 ICPD PoA, Chapter 3, defines reproductive rights as the rights of couples and
individuals to decide freely and responsibly the number, spacing and timing of their
children, have the information and means to do so, attain the highest standards of
health, and make decisions on their reproductive health free of discrimination, coercion
and violence (United Nations, 1994a). This paper will extend the above definition to
include the right to decide freely and responsibly on abortion and extend all the elements
of reproductive rights to couples and individuals irrespective of their sexual/gender
identity and orientation.

Sexual health
The 1994 ICPD PoA, Chapter 7.36 defines sexual health as healthy sexual development,
equitable and responsible relations, sexual fulfilment and freedom from illness, disease,
disability, violence and other harmful practices related to sexuality (United Nations,
1994a). This definition could be extended to include prevention of unsafe castration
practices amongst male-to-female transgendered people and access to treatment for
transgendered people for sex-reassignment surgery and therapy. 7

Sexual rights
The ICPD PoA does not use the term sexual rights, but human rights. The human rights
of women, according to the PoA, include rights to have control over and decide freely
and responsibly on matters related to their sexuality and sexual health free of coercion,
discrimination and violence. This right will be interpreted in this paper as deciding
whether, when, with whom (of which sex/gender), how and why to have sexual relations.

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This right, one could argue, could be extended to women irrespective of their marital
status, and also to adolescents and people of diverse gender/sexual identities and
orientations, including transgendered people.

Exposure and vulnerability to SRH risk, conditions and diseases and SRR violations
Sen, Ostlin and George (2007) observe that understanding the roles that biological
differences and social bias play is important to understanding differential exposure and
vulnerability of women/girls and men/boys to SRH morbidity and SRR violations. They
note that while individuals have differential biological and social exposure to health
risks and conditions depending on both their sex Karyotype and their social position, their
vulnerability to health risks and conditions is determined socially and not biologically
(ibid, 2007: 62). This framework of biological/social exposure and social vulnerability is
used in this paper with particular reference to SRH risks, conditions and diseases and
SRR violations. Further, it is extended to transgendered people.

2.3 Feminist and human rights-based approach to development

A rights-based approach to development is a conceptual framework for the process of
human development that is normatively based on international human rights standards
and operationally directed to promoting and protecting human rights. A human rights-
based approach identifies rights holders and their entitlements and duty bearers and
their obligations, and works towards strengthening the capacity of rights holders to make
claims and duty bearers to fulfil their obligations (Office of the UN High Commissioner
for Human Rights, 2006).

A socialist feminist perspective sees women and marginalised groups as active agents
who are resilient and willing to assert their rights even in adverse situations. At the same
time, it recognises the diversity amongst women and the need for marginalised women to
mobilise around their multiple identities. It also recognises that women and marginalised
groups at times uphold dominant social constructs, and sees that a process of enabling
them to question these social constructs collectively as essential if they are to claim their
human rights, including SRHRs in disaster contexts (adapted from Pittaway et al., 2007).

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3.0 INTERNATIONAL STANDARDS, CONVENTIONS AND AGREEMENTS: A
REVIEW FROM A DISASTER AND SRHR LENS

3.1 United Nations Conventions/Covenants

As of now, there is no separate UN Convention on the protection of the rights of people

affected by disasters. 8 Neither is there a Security Council Resolution on Women and
Disasters along the lines of the 1325 Resolution on Women, Peace and Security. There is
a UN Convention to Combat Desertification (1994), a UN Framework Convention on
Climate Change (1992) and the Hyogo Framework for Action (2000-2015) which deals
with disaster risk reduction. However, these documents do not make any reference to
SRHR consequences in the context of desertification, climate change or risk reduction,
and of State Party obligations (UN, 1992; UN, 1994b; UNISDR, 2005).

In the absence of a separate Convention on the rights of people living in disaster-prone

areas or affected by disasters, this paper examines the Convention on the Elimination of
All Forms of Discrimination against Women (CEDAW), the Child Rights Convention
(CRC), and the International Covenant on Economic and Socio-cultural Rights (ICESCR)
from a disaster and SRHR lens.

CEDAW
The second Article of the CEDAW (1979) states that state parties to the Convention
condemn discrimination against women in all its forms, agree to pursue by all appropriate
means and without delay a policy of eliminating discrimination against women. There is
no separate Article on eliminating discrimination against women and girls in disaster
situations. Neither are such issues woven into other Articles of the Convention (UN,
1979).

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Child Rights Convention
The CRC (1989) asserts that State Parties shall take all appropriate measures to ensure
that the child 9 is protected against all forms of discrimination or punishment on the basis
of the status, activities, expressed opinions, or beliefs of the child's parents, legal
guardians, or family members. The CRC covers the rights of children in normal situations
and in situations of conflict, but not in disaster contexts (see UN, 1989).

The ICESCR
The ICESCR (1966) calls for State Parties to promote the rights of women and men to
work, rights to fair conditions of employment, rights to social security, rights to adequate
standing of living, rights to health (including maternal and reproductive health 10) and
rights to education. It does not specify that these rights apply in disaster situations or spell
specific economic and socio-cultural rights in disaster situations (UN, 1966, UN, 2000a).

None of the three Conventions/Covenants discussed above discuss the rights of

transgendered people, and currently, there is no separate Convention on their rights.
However, the Yogyakarta Principles, a non-legally binding document upholding the
rights of people of diverse sexual and gender identities, was formulated by human rights
actors in 2007. The term disaster does not appear in this document
(www.yogyakartaprinciples.org/principles_en.pdf).

3.2 The Fourth World Conference on Women, the ICPD, disasters and SRHR

The 1994 ICPD, disasters and SRHR

Reproductive health services in the context of internally displaced persons (through
conflict and disasters) are mentioned in Chapter IX, C of the ICPD PoA. The chapter
calls for measures to ensure that internally displaced persons receive basic education,
employment opportunities, vocational training and basic health care services, including
reproductive health services and family planning. The chapter does not spell out what
reproductive health and family planning services are to be provided in disaster situations,
to whom, and at which phase. The terms sexual health or reproductive and sexual

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rights do not find a place in this chapter. There is no reference to transgendered people
in the entire document (United Nations, 1994a).

The Beijing Platform for Action (PfA), 1995, disasters and SRHR
The Beijing PfA reached at the end of the Fourth World Conference on Women, 1995,
recognises that women suffer considerably due to disasters and often lose their
livelihoods. It calls for establishing gender-disaggregated data based on the impact of
disasters on women, expanding the role of women in disaster risk reduction and response,
and addressing the specific needs of women displaced by disasters. However, there is no
mention of SRHR issues in disaster contexts. The Beijing PFA uses the terms
reproductive and sexual health and reproductive rights, but not the term sexual rights
(UN, 1995).

3.3 International standards on disasters 11

Minimum Standards in Reproductive Health in Emergencies

The Minimum Initial Service Package (MISP) for Reproductive Health in Crisis
Situations was first articulated in 1996 in the field-tested version of the Reproductive
Health in Refugee Situation: An Inter-agency Field Manual (Womens Commission for
Refugee Women and Children, 2007). The MISP outlines priority RH activities in the
first three months of new emergencies and plans for comprehensive RH services as the
situation stabilises. The objectives of the MISP in RH are to prevent excess neonatal
mortality and morbidity, reduce HIV transmission, prevent and manage the consequences
of sexual violence, and plan for the provision of comprehensive RH services when the
situation improves. Women and girls are specific target groups. Ten kits (including kit
number 0) are to be used by in the first three months of emergency: the administrative kit,
condom kit (male and female), clean delivery kit (individual), post-rape kit, delivery kit
(health facility), management of complications of abortion kit, suture of tears and vaginal
examination kit, vacuum extraction of delivery kit, referral kit for RH and blood
transfusion kit. Three kits are to be used in the comprehensive phase: the oral and
injectable contraceptive kit, the sexually transmitted infection (STI) kit and the intra-

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uterine device (IUD) kit (Womens Commission for Refugee Women and Children,
2007).

Amongst the different standards that pertain to the first three months of disasters, MISP is
the most comprehensive one from an SRHR lens. Nevertheless, several SRHR services
necessary to address the interests and needs of women and adolescents are missing from
the minimum standards and the planning for comprehensive phase (see Box 1 of section
7). The term sexual and reproductive rights is not used in the manual at all, and the
manual does not make any reference to transgendered people (see Womens Commission
for Refugee Women and Children, 2007).

The Inter-Agency Emergency Health Kit (2006, 3rd ed.)

The Inter-Agency Emergency Health Kit (IEHK) specifies the medicines and medical
devices that are to be available in the first three months of an emergency. This kit was
first produced in 1990, and updated in 1998 and then in 2006. The medicines and medical
devices to be available at the basic unit level (for populations of 1,000) covers anaemia,
pain, diarrhoea, fever, respiratory tract infections, measles, falciparam malaria, red eye
condition, skin conditions, STIs, urinary tract infections (UTIs), preventive care in
pregnancy and worms. The medicines and supplies that are part of the supplementary unit
(for populations of 10,000) are intended for more advanced cases of the same health
conditions under the basic unit, for more dangerous forms of malaria and HIV Post-
Exposure prophylaxis (PEP). The IEKH is not designed for immunisation and nutritional
programmes nor does it include treatment for tuberculosis, HIV/AIDS and leprosy
(WHO, 2006). As the WHO itself admits, the IEHK does not focus comprehensively on
RH, as this is covered under MISP in RH (WHO, 2006). The IEHK does not use the
terms reproductive rights, sexual rights and sexual health. The IEHK does not have a
priority focus on particular groups. There is no mention of medicines and medical
supplies to be included in the risk reduction or recovery phase.

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The Inter-Agency Standing Committee (IASC) Guidelines for HIV/AIDS Interventions in
Emergency Settings (2003, but currently being revised)
At the preparedness stage, the above IASC guidelines call for the following: inclusion of
HIV/AIDS in emergency action plans; assessing prevalence rates; review of existing
policies and legislation on HIV/AIDS; training of uniformed forces, humanitarian
workers and government sectoral staff on HIV/AIDS and sexual violence; training of
health personnel on MISP for RH; and, preparing IEC strategy on HIV/AIDS in
emergency settings. At the minimum response phase, the guidelines advocate prevention
of, and immediate response to, sexual violence; ensuring access of humanitarian staff,
military personnel and public to condoms, including HIV/AIDS; consideration in
different sectoral relief programmes; targeting food aid and nutrition at people living with
HIV/AIDS; establishing syndromic management of STIs; ensuring safe blood
transfusions; and ensuring appropriate care of intravenous drug users. In the
comprehensive response phase, the guidelines call for a few additional interventions like
preventing mother-to-child transmission, linking HIV/AIDS with development activity,
institutionalising training of uniformed forces and health personnel on HIV/AIDS and
sexual violence, improving education and shelter of people living with HIV/AIDS,
providing anti-retroviral (ARV) treatment, controlling drug trafficking, promoting RH
services for young people and institutionalising HIV/AIDS education in schools. Women,
children (in particular orphans and adolescents), mobile populations and rural people are
to be given special priority, and amongst them, those living with HIV/AIDS. The
guidelines, however, do not mention continued availability of ARV for those undergoing
treatment before the emergency as part of the minimum response. Neither are
transgendered people perceived as biologically and socially at greater risk of contracting
HIV (see IASC, 2003).

The IASC Guidelines for Gender-based Violence Interventions in Humanitarian Settings

(2005)
In the preparedness phase, the above guidelines mention the need to assess the magnitude
of gender-based violence (GBV) in disaster-prone areas; assess adequacy of legislation,
policies and enforcement on GBV; assess ratification of and reporting on relevant

P a g e | 19
international treaties pertaining to GBV; and train government, UN staff and community
leaders from the sectors of water and sanitation, health, education, shelter and food
security regarding interventions on GBV. It also mentions the need to involve youth in
campaigns on GBV. In the minimum response phase, the guidelines recommend rapid
assessment of the situation with regard to GBV, recruitment of staff in a manner that will
prevent sexual exploitation and abuse, ensuring safe sectoral relief services, provision of
shelter and health care for survivors of GBV, and dissemination of information on
services available for GBV. It also mentions the need for adherence to MISP for RH in
emergencies. In the comprehensive response phase, additional interventions include
representation of women in various disaster-related committees, targeting income
generation programmes at women, involving men to prevent GBV, integrating GBV into
health and education systems, and training security forces, lawyers and judges on gender-
based violence. The guidelines are particularly concerned with interventions on GBV
against women and girls (including adolescents). It also recognises that men and boys
may be vulnerable to GBV in some situations. There is, however, no mention of
addressing GBV against transgendered people in disaster contexts. The terms
reproductive rights, sexual health and sexual rights are not used in the guidelines
(IASC, 2005).

The Sphere Project Handbook

The Sphere Project Handbook, the Humanitarian Charter and Minimum Standards in
Disaster Response, was first published in 2000, updated in 2004 and is currently being
updated again. It is a humanitarian charter and a set of minimum standards to be attained
in disaster and conflict response in the five sectors of water supply and sanitation, food
aid, nutrition, shelter and health services (The Sphere Project, 2004). The standards
mention that reaching women, children, older people, disabled, people with HIV/AIDS
and those who are ethnically, politically or religiously marginalised groups is a priority
(The Sphere Project, 2004). Related to SRH, the Sphere standards prioritise provision of
nutrient supplement for pregnant and lactating women, adolescent girls and boys,
appropriate material for absorbing menstrual blood, safe delivery kits, referral systems
for obstetric emergencies (including complications of unsafe abortion), and services to

P a g e | 20
prevent the transmission of HIV/AIDS. Measures to prevent and manage complications
due to gender-based violence are also a priority. In the long run, it recommends planning
for comprehensive RH services. The critique of MISP in RH well apply to the Sphere
Project handbook and will not be repeated here. Again, SRHR issues in risk reduction are
not outlined. Further, the Sphere standards do not mention the responsibility of
humanitarian NGOs to promote the availability of the RH kits under MISP (The Sphere
Project, 2004).

4.0 IMPACT OF DISASTERS ON SEXUAL AND REPRODUCTIVE HEALTH

AND RIGHTS

Buzsa and Lush propose a conceptual framework of three elements for examining
reproductive health and planning RH initiatives in conflict situations. Their framework
builds on the pre-existing reproductive health context, nature of displacement and conflict
and reproductive health outcomes (cited in Wayte et al, 2008). The framework adopted in
this section for examining impact of disasters on SRHR builds further on Buzsa and
Lushs thinking and identifies six pathways of impact of disasters on SRHR of women,
adolescents and transgendered people. These six pathways are outlined below with a few
examples from the Asian region. Due to limited space, not all evidence is presented in
this report.

Pathway 1: Biological exposure of females to SRH risks, conditions and diseases in

disasters
Women and girls social vulnerability has a greater bearing on the impact of disasters on
their SRHR than female biology. However, in a few instances, female biology has a role
to play on exposure to SRH risks and conditions during disasters. A study on the health
impact of the 1998 floods in Dhaka slums notes that flood waters mixed with waste and
faecal matter entered the vagina and urethra of women and adolescent girls and increased
the risk of urinary tract infections (UTIs) (Rashid, 2000). UTIs are known to be lower
amongst males than females as the urethra is longer amongst males and bacteria has to
travel a longer distance to reach the bladder.

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In Aceh, Indonesia, miscarriages increased in the immediate aftermath of the 2004 Indian
Ocean tsunami due to the disasters sheer physical impact, as well as physical and mental
shock (Carballo et al., 2005a). In India, there were reports of breast engorgement and
high fever among lactating women who had lost their breast-fed infants during the 2004
Indian Ocean tsunami (Murthy and Sagayam, 2006). In Thailand, some of the adolescent
girls and women in the reproductive age group reported that their menstruation stopped
suddenly in the immediate aftermath of 2004 Indian ocean tsunami due to sudden shock
and only resumed after a few/several months. As there was no counselling from health
providers that this is a normal phenomenon when faced with shocks, women and girls
reported being extremely worried about this (Dimitrjevics A., 2007).

Pathway 2: Social vulnerability to SRH risks, conditions and diseases and SRR
violations
Biological vulnerability to SRH risks and conditions is exacerbated by pre-existing social
norms that prevent women from expressing their SRH problems and from accessing SRH
services. In the Bangladesh 1998 floods, adolescents felt inhibited to discuss their urinary
tract infections with male relief workers (Rashid and Michaud, 2000). Women and girls
in temporary relief camps in Dhaka, Bangladesh also washed their menstrual cloth in
dirty water, found it difficult to dry during the day with men loitering around, and used
partially wet cloth (ibid, 2000). Given the norms restricting their mobility, pregnant
women, who were widowed by the 2005 earthquake in the North West Frontier Province
in Pakistan and who did not have a male relative, found it difficult to access antenatal
care, delivery care and post-natal care (Burki, 2006). An increase in workload of women
has been noted in instances of drought in Gujarat and Rajasthan of India, with women
having to walk longer distances carrying loads of water and fuel, even soon after delivery
(UNDAW, 2004; Pincha, 2008). Uterine prolapse is not uncommon in such situations.

Social norms glorifying motherhood also lead to specific kinds of SRHR issues in
disaster contexts. When women lose their children in the disaster, there is self-inflicted
and spousal pressure on them to re-conceive (through fertility assistance or re-

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canalisation surgery). Such pressure persists even if it is not safe given the age and health
condition of the women concerned. This was the case in earthquake-affected parts of
China where the one-child policy is strong, as well as in India when children or sons had
died during the 2004 tsunami (He et al., 2008; APWLD 2006b). Similarly, pre-existing
gender norms on masculinity have a bearing on SRHR of women and adolescent girls.
The social norm that widowers (in particular with young children) cannot live alone led
to an increase in tsunami marriages of widowers to adolescent girls and unmarried
sisters of their late wives (at times against their wishes). This was reported to be one of
the reasons for the increase in suicide amongst adolescent girls in one study, as well as in
low-birth weight children (Murthy and Sagayam, 2006).

Norms on masculinity also led to increase in violence and sexual violence in several
Asian countries affected by disaster. In the aftermath of the 2008 earthquake in Pakistan,
some of the affected population moved into cramped temporary shelters, leaving little
space for intimacy between couples, which lead to an increase in domestic violence
(Burki, 2006). In Rajasthan and Gujarat, high rates of male migration and abandonment
were noted after drought when men could not perform the expected role of being bread
winners. Incidence of tribal or Adivasi women engaging in sex work increased in such
contexts, where they are not always able to protect themselves from STIs (Sara Ahmed
cited in Enarson and Anderson, 2004).

Sexual violence is also perpetuated by community men on women and girls. Swasti, an
Indian NGO, observed instances of men exploiting women and girls in Tamil Nadu after
rescuing them post-2004 tsunami, particularly as the women and girls clothing were torn
or missing by the tsunami (Swasti and Oxfam International, 2007). In Aceh, Indonesia,
cases of sexual violence and abduction of women and girls in temporary camps where
strangers live together were reported (Womens Commission for Refugee Women and
Children, 2005). Women with disability were reported to be particularly vulnerable to
sexual exploitation (Oosters, 2005). Transgendered people (male-to-female) in Tamil
Nadu affected by the 2004 tsunami were not allowed to use toilets or bathing spaces for

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men and women in temporary camps by other community members (Pincha and
Harikrishna, 2008).

Pathway 3: SRH implications of the loss of women health personnel and women-
specific health infrastructure, as well as of gender biases in the health sector
In Pakistan, several of the government-sponsored Lady Health Workers (LHW) died in
the 2005 earthquake. Their roles included providing doorstep service delivery, including
basic preventive care and contraceptive supplies and referrals. The doctors in temporary
camps were often men, and when women doctors were present, there was not adequate
privacy. Where separate clinics existed for women and men, they were located next to
each other, with patient queues mingling. As a result of this lack of privacy, pregnant
women were not able to access skilled delivery care, and often delivered in their tents
with the help of family members or traditional birth attendants (Burki, 2006; APWLD,
2006a; Miller and Arquilla 2007). A few women developed sepsis from material retained
after delivery (Miller and Acquilla, 2007).

SRH services for women could also be disrupted by loss of women-specific health
infrastructure. To give a few examples, in Sri Lanka, four out of eight maternity clinics in
the east-coast were destroyed during the 2004 Indian Ocean tsunami, reducing womens
access to maternal and contraceptive services (Carballo et al, 2005b). In the remote
islands of Maldives, referral transport systems were disrupted during the first three days
after the 2004 Indian Ocean tsunami. Transporting pregnant women, who required
comprehensive emergency obstetric care (CEmOC) services on time by boats and then by
air taxi to the capital Male, was a major problem in this first three days (Carballo et al,
2005b).

In China, screening and treatment services for HIV/AIDS, which were available at local
units of the Centre for Disease Control and Prevention, were temporarily disrupted
because of the 2008 earthquake. People living with HIV/AIDS had to go to service
centres to the capital city of Sichuan located far away (UN HIV Emergency Task Team,
2008). However, the infrastructure and services were soon restored. NGOs SRH services

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also got disrupted. The Indonesian Planned Parenthood Associations office clinic in
Aceh was destroyed after the tsunami. The clinic provided delivery care, contraceptive
services, infertility advice, pap smear screening and sexual and reproductive health
education to youth and couples (Direct Relief International, 2005).

Occasionally, violation of sexual rights by the health providers is itself a problem. A case
in point is that of an unmarried girl with injuries who was evacuated by a helicopter to a
hospital in the Muzaffarabad district, Pakistan without accompaniment. She was raped by
a doctor, but the family was not keen on pursuing the case for fear of being ostracised by
their community (APWLD, 2006a).

Pathway 4: SRHR implications of SRHR and gender equity insensitivity of disaster

response

SRHR insensitivity of disaster response

A basic RH and safety need in relief stage is access to separate and safe toilets for men
and women in relief camps. Of 72 households who were living in tent camps interviewed
in earthquake-affected parts of Pakistan by APWLD, 36% reported that men and women
used the same toilets. In parts of the North West Frontier Province where purdah norms
are strong, the APWLD team observed that men prevented women from using public
toilets, and insisted that the women make a partition in the tent and use that space as a
toilet (APWLD, 2006a). In the 1998 Bangladesh floods, there were reports of cases of
adolescent girls in temporary shelters eating and drinking less so as not to use unsafe and
unclean toilets (Rashid and Michaud, 2000). Where the transgendered people live in
disaster-affected areas, they may require government efforts to ensure non-discrimination
in access to toilets and bathing spaces. This is rarely taken into account in disaster
response (Pincha and Harikrishna, 2008).

Another RH need of women is access to sanitary material for absorbing menstrual blood
as part of the relief package. This was not part of the government relief provisions in
Tamil Nadu in the aftermath of the 2004 tsunami (Government of Tamil Nadu, 2007).

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Several INGOs, however, included sanitary napkins in their relief kit. Older women often
suffer from urinary incontinence and at times faecal incontinence. They hence need to be
located near toilets, have access to extra clothing and bedding, and napkins/cloth for
absorbing urine in the night. However, these needs are rarely taken into account in relief
packages (Oosters, 2005).

Only one comprehensive study on the implementation of MISP in RH in disasters in Asia

could be found as of 2008 (see web page www.wcrc.org). Reviewing the implementation
of MISP in RH in Indonesia in 2005, the Womens Commission for Refugee Women
noted that only 52% of 32 representatives of UN agencies, INGOs and health personnel
met by the Commission had heard about MISP and only one in 25 knew the exact
content. Only three persons attended the first RH working group meeting, though
attendance improved later. RH supplies were not sufficient to respond immediately, and
delays were encountered due to problems with the UNFPA supplier. In particular, the
administration kits, clean delivery kits for traditional birth attendants (TBAs), kits for
STIs, and kits for referral services were limited. Emergency obstetric care (EmOC)
services in Aceh Utara were limited to intravenous infusions and medication for
haemorrhage, and there were no means for addressing seizures in case of complications
before women are transported to the next level of care. The Ministry of Health did not
report establishing a rape or sexual violence protocol to deal with clinical needs of
survivors of such violence. Midwives reported that emergency contraception would not
be provided to rape survivors due to religious restrictions. Contraception was not
available for unmarried couples (Womens Commission for Refugee Women, 2005).

Gender and equity insensitivity of disaster response and its bearing on SRHR
Gender blindness in disaster risk reduction can also have a bearing on SRHRs. Early
warning systems rarely reach women, particularly in the South Asian contexts, as they
are communicated in markets (over microphones) or through male leaders (Enarson and
Anderson, 2004). Preparedness training at community and service provider levels, until
recently, did not take into consideration the special needs of evacuating and preparing for

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the SRH needs of women, adolescents and transgendered people living with specific SRH
conditions (ibid, 2004).

Gender biases can also be seen in response and recovery interventions. Gender norms
prevented male relief workers in the North West Frontier Province Pakistan from
contacting poor women directly heading households, or such women from going to relief
points and collecting goods (APWLD, 2006a, 2006b). This has a bearing on womens
nutrition, and even pregnant women missed meals to feed their children. Ex-gratia relief
for compensation for loss of lives and livelihoods went to heads of households (mainly
men) in the 2004 tsunami in India, Indonesia and Sri Lanka and the 2005 earthquake in
Pakistan (APWLD, 2005, 2006b). In some parts of the 2005 earthquake-affected
Pakistan, the fathers-in-law or mothers-in-law got the compensation for the sons death
instead of the daughters-in-law (APWLD, 2006a). In India and Sri Lanka, sudden
increase in cash in the hands of men due to ex-gratia payments to heads of households led
to increase in male alcoholism and domestic violence (Murthy and Sagayam, 2006;
APWLD, 2006b; Pincha, 2008). In worst cases, husbands who had deserted their wives
came back to collect compensation for the death of their children and left after a few
months, at times leading to unwanted pregnancies (Murthy and Sagayam, 2006).
Meanwhile, transgendered people did not receive equal access to food rations, shelter and
ex-gratia compensation for loss as several did not have access to identity cards (Pincha
and Harikrishna, 2008). Identity cards are now being issued.

At times, male policymakers adopt a benevolent patriarchal attitude and issue orders
which may seem pro-women and girls but have adverse SRHR consequences for them. In
2005, the Government of Tamil Nadu stated that it would give Rs. 20,000 (about US$411
in current exchange rates) to tsunami-affected families who had cancelled the proposed
marriages of their children due to loss of assets, livelihood and cash during the tsunami.
This announcement led to a spate of (adolescent girl) marriages in the weeks that
followed, in combination with other social factors 12 (Murthy and Sagayam, 2006). The
Tamil Nadu government policy was subsequently withdrawn due to pressure from
womens groups.

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Lastly, class, caste, ethnic and other identity-based biases in disaster relief and recovery
measures interlock with gender biases, making women with marginalised identities
especially vulnerable to SRHR violations. Richer people, including richer women-headed
households, used their contacts to access disproportionate share of relief as well as access
to women-exclusive shelters in the 2005 earthquake-affected Pakistan 13 (APWLD,
2006a). In the tsunami-affected Thailand-Burma border, illegal migrants and the sea
gypsies who did not have government-recognised identity cards could not access
response and recovery measures (APWLD, www.apwld.org/tsunami_aftereffects.html,
APWLD, 2006b). In tsunami-affected parts of Tamil Nadu, dalits and Irula tribal
communities in coastal areas did not experience much loss of lives, but completely lost
their livelihoods. They did not have equal access to response and recovery measures as
those from the dominant fishing-castes. In the Andaman and Nicobar islands, migrants
from Bangladesh and non-tribal people were discriminated groups. Women and girls
from such communities were forced to adopt adverse coping strategies like cutting back
their food, nutrition, education and health expenditure (Murthy and Sagayam, 2006;
APWLD, 2005a, 2006b). Women with interlocking disadvantaged identities are also
more vulnerable to sexual exploitation. While slightly better off women and their
household members stayed with relatives, it was poor and socially marginalised women
who were left in relief camps in Sri Lanka. These women in camps were vulnerable to
sexual exploitation by military personnel (Fisher, 2005; APWLD, 2005a).

Pathway 5: Through pre-existing health/SRHR policy, service and outcome context

Assessing the impact of the 2004 Indian Ocean tsunami on health systems in Asia,
Carballo et al. (2005b) observe that the health systems in Sri Lanka and Thailand were
better prepared (including staff training) and equipped to meet a disaster and responded
more effectively than in India, Indonesia and the Maldives (Carballo et al, 2005b).
However, this may not necessarily mean that they were sensitive to all SRHR issues and
to all groups.

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In Pakistan, access to abortion was (and continues to be) restricted during the time of the
2005 earthquake, other than when the life of the mother is at risk (ARROW, 2005).
Pregnant women widowed by the 2005 earthquake in Pakistan could only access abortion
services clandestinely, as was the case with a 28-year-old pregnant widow with six
children in the North-West Frontier Province. She, however, managed to access safe
abortion services from a field clinic run by an NGO (Burki, 2006).

In China, SRH services are more comprehensive than in South Asia (but not reproductive
rights), and hence the 2008 earthquake-affected community could demand for restoration
of HIV/AIDS services, including availability of ARV therapy at nearby health centres
(UN HIV Emergency Task Team, 2008).
The contraceptive policy also has had a role to play in the RH needs post-disaster. In
India, the dominant method of contraception is sterilisation, though there is a move to
widen contraceptive choice. In Tamil Nadu, 44% of women under 27 years had been
sterilised before the 2004 Indian Ocean tsunami (Carballo et al 2005a). In contrast, in
Pakistan, IUDs and hormonal contraceptives were the dominant methods of contraception
used (ARROW, 2005). Varying contraceptive policies led to varying demands. In
tsunami-affected Tamil Nadu, the demand for re-canalisation surgery was high on the
part of couples who had lost their children, while in Pakistan there were demands by
post-earthquake widows for removal of IUDs. In China, the one-child family norm along
with adoption of sterilisation led to a similar situation to India (He et al., 2008).

Girls in much of South Asia are more likely to be underweight than boys due to gender
discrimination (UNICEF, 2006). Data from the 2004 tsunami in India suggest that levels
of malnutrition amongst children increased in the aftermath of disaster, with gender bias
persisting in post-disaster contexts as well (Murthy and Sagayam, 2006). 14 Combined
with increase in the incidence of early marriages of girls in tsunami-affected Cuddalore
and Nagapattinam districts in India, the incidence of high-risk pregnancies and low-birth
weight children may have increased in 2005 when compared to 2004 (ibid, 2006). The
HIV prevalence rate amongst population in the age group 15-49 years is higher than 1%
in Cambodia, India, Myanmar and Thailand (UNFPA, 2007). It becomes all the more

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essential to include condoms (female and male) and HIV prophylaxis in SRH relief
packages.

Pathway 6: Context and nature of disaster and SRHR impact of disasters

Different disasters may have different impact on SRHR. Sudden deaths arising out of
earthquakes, tsunamis, floods, and windstorms are more visible to the public eye, and
lead to greater flow of relief, ex-gratia compensation, and medical services (including
SRH services) (UNDAW, 2004). Droughts in Asia (unlike Sub-Saharan Africa) are much
less visible to the public eye, and it is poor people who live in drought-prone areas.

Droughts, as we have seen, lead to large-scale migration of men or of whole families,

mens desertion of their family, lesser ability of families to decide on emergency obstetric
care, and increase in sexual exploitation of women left behind (Bhatia, 2008). Floods and
tsunamis, on other hand, increase the risk of reproductive and urinary tract infections
amongst females. The sheer physical force and shock of experiencing earthquakes,
sudden floods and tsunami lead to increased miscarriages. Earthquakes are also known to
increase disability, in particular amongst women and girls in Asia who spend greater time
inside the house than men and boys (IUCN, 2006).

The SRHR concerns of women, adolescents and transgendered people flowing from the
analysis of this section and the groups amongst them who are particularly marginalised in
disasters are listed in Annex 1 and Annex 2 respectively. An insight that emerges is that
disasters enhance the exposure and vulnerability of marginalised women, adolescents (in
particular girls), and transgendered people to forms of SRH conditions and SRR
violations that existed before the disasters. To name a few, there is an increase in anaemia
amongst pregnant women and adolescent girls, breast engorgement, high-risk
pregnancies, miscarriages, unwanted pregnancies, uterine prolapse and UTIs/RTIs/STIs.
Domestic and sexual violence against women, girls and transgendered people and child
marriages increase post-disaster. At the same time, disasters lead to a few relatively new
SRH conditions and, hence, the need for services (e.g., services for re-fertility and
removal of IUDs). Further, new forms of SRR violations like ex-husbands returning to

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claim ex-gratia payment, and then abandoning the wives later (at times leaving them
pregnant), may be experienced.

5.0 CASE STUDIES ON GOVERNMENT, UNITED NATIONS AND DONOR

DISASTER INTERVENTIONS FROM AN SRHR LENS

This section presents country case studies analysing from an SRHR lens the response of
governments, UN agencies (the United Nations Childrens Fund or UNICEF, the United
Nations Population Fund or UNFPA, and the World Health Organisation or WHO) and
INGOs (Care, the International Planned Parenthood Federation or IPPF, and Oxfam
affiliates) to the 2004 tsunami in Indonesia, the 2008 earthquake in China, the 2007
floods in Bangladesh and the 2000 drought in India. 15 First, the interventions of the
stakeholders are described in each disaster context (5.1 to 5.4), and then the strengths and
weakness of their interventions are analysed (5.5).

5.1 China: Response to the 2008 earthquake

The earthquake
On 12 May 2008, an earthquake measuring 8.0 in the Richter scale stuck 92 km. of the
Sichuan provincial capital of Chengdu, affecting seven other provinces and a total of 46
million people. As of 10 July 2008, the death toll had reached 69,197; further, 374,176
were people injured and 18,377 were missing. Sex-disaggregated data on fatality was not
available. The Peoples Republic of China (PRC) estimates that 169 hospitals, 63 disease
prevention and control units, 52 maternal and child health (MCH) clinics, 1,263 township
health centres, 66 family planning centres, 348 central township family planning service
stations and 450 mobile service cars for family planning were damaged by the disaster,
with the maximum damage in Sichuan province (PRC, 2008).

Government response to earthquake from an SRHR lens

The State Planning Group on Earthquake Restoration and Reconstruction drafted a plan
for post-Wenchuan Earthquake Restoration and Reconstruction, which as of 11 August

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2008 was yet to be finalised (PRC, 2008). The Plan prioritises restoration of MCH and
family planning infrastructure and services destroyed by the earthquake in three
provinces and bringing them all under one common infrastructure along with public
health facilities. The Plan also envisages integration of health with other sectors through
one common infrastructure (PRC, 2008). Such integration would make services more
accessible to clients. At the response stage, the Plan proposes provision of temporary
shelter, water and sanitation, electricity, gas, medical services, cash for work, and
providing exception from income tax. Psycho-social care and health insurance for
construction staff are innovative features at the recovery stage (PRC, 2008). Though not
mentioned in the Plan, the PRC passed a government order to provide re-fertility services
for those who had lost children during the earthquake (which was a high number given
the one-child policy) (He et al., 2008).

UN agencies response to disaster and earthquake

A review of the UN China Appeal for Wenchuan Earthquake Early Recovery Support
(2008) process suggests that the WHOs focus was on strengthening health surveillance
in the aftermath of the earthquake, strengthening the Ministry of Health (MOH)s
institutional capacity, monitoring the health relief interventions of government,
reconstruction of damaged health facilities, strengthening long-term disaster risk
reduction capacity of MOH (UN in China, 2008, WHO, 2008b). Related to SRHR, the
Appeals focus has been on HIV/AIDS, maternal health and water and sanitation.
Following a rapid RH situation assessment, the United Nations Population Fund
(UNFPA) distributed hygiene kits for women, tailor-made hygiene kits for elderly
women, condom kits and post-HIV exposure prophylaxis kits. It also played the lead role
in translating MISP for RH into local languages, and has sought to restore RH services in
the long run. The UN Childrens Funds (UNICEF) has complemented these efforts by
focusing on the SRHR needs of pregnant and lactating women, girls and boys. Its efforts
in the response phase have included strengthening water and sanitation infrastructure,
MCH services, nutrition services for children and pregnant/lactating women, access to
mobile toilets in schools, access to hygiene kits for girls, disseminating information on
HIV/AIDS, and promoting condom and HIV prophylaxis availability.

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Oxfam Hong Kong and China Family Planning Association (FPA) response to
earthquake
Oxfam Hong Kongs response to the earthquake included provision of sanitary pads,
womens undergarments, portable toilets and public health messages, and restoring
womens livelihood and providing psycho-social support in the long run (likely to have
an indirect bearing on SRHR). Oxfam Hong Kongs post-earthquake interventions have
had a special focus on women, ethnic minorities, people with disability, elderly and the
worst-affected and remote areas (Oxfam Hong Kong, 2008a, 2008b). China FPA has
initiated a special project to provide psycho-social support to children in earthquake-
affected areas. In addition, some branches have provided sanitation, contraceptive
services, and implemented the post-earthquake government order on fertility services.
The primary target groups of China FPAs SRHR services have been couples,
adolescents and single parents (China Family Planning Association, n.d.).

5.2 Bangladesh: Response to 2007 floods

Floods in Bangladesh
The 2007 August monsoon floods affected 32,000 square kilometres in 39 out of 64
districts of Bangladesh, affecting over 16 million people in around 3 million households,
and resulting in 649 deaths (Government of Bangladesh, 2008a). Sex-disaggregated data
on deaths in flood were not available. Food stocks, crops and homestead gardens were
also destroyed, and live-stocks were killed by floods. 700,000 houses were damaged
(Asian Development Bank, 2007).

Government response
In the month of August 2007, the Government of Bangladesh started rescue operations
through boats and helicopters, opened a total of 1,515 shelters in different flood-affected
locations housing 360,000 of the affected people, and distributed pre-prepared and dry
food as well as rice. Around 62 government medical teams and a 6-member army
medical team began serving the flood-affected people. In the recovery stage, the

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government provided housing and livelihood recovery to affected families (Concern
Worldwide Bangladesh, 2007).

The Government of Bangladesh has recently drafted a National Plan of Disaster

Management 2008-2015 which has a small sub-section on cyclone and flood
management plan (Government of Bangladesh, 2008a). A strength of the draft Plan is
that it allows for decentralised flood/disaster management planning at the local level,
with participation of community women. At the response stage, the Plan envisages
provision of clothing, food, medicine, temporary shelter and toilets. In the long run, the
Plan seeks to mainstream disaster risk reduction in all development interventions. It also
seeks to map vulnerable women, children and the poor before disaster strikes; promote
womens representation in disaster preparedness committees; protect women (particularly
women with disability, women-headed household and elderly women) from death,
violence and desertion; and strengthen livelihood recovery of women and people with
disability (Government of Bangladesh, 2008a).

Response of UN agencies
The UN released US$6 million from the Central Emergency Response Fund (CERF) to
support UN agencies to effectively respond to the humanitarian consequences of the
floods in Bangladesh (UN, 2007). UNICEF and UNFPA were assisted through this grant
to provide supplementary feeding and micronutrient supplementation to children and
pregnant and lactating women to prevent further deterioration of their nutritional status
(UN, 2007). UNICEF, using other resources, also strengthened water and sanitation
services and other sectoral services 16 in the aftermath of the 2007 floods. Its long-term
focus was on strengthening the capacities at the community level for emergency
preparedness (UNICEF, 2007). The World Health Organisation (WHO) was assisted
through CERF to provide technical and logistical response to the health sector in order to
reduce the outbreak of water, food and vector-borne communicable diseases. In the long
run, WHO sought to build the capacity of the Ministry of Health and Family Welfare for
prevention and mitigation of adverse health effects of disasters (WHO, n.d).

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I/NGO response to the Bangladesh floods
Oxfam Great Britain (Oxfam GB) responded by providing essential water and sanitation,
vital relief items (not specified in document), and shelter kits (Oxfam GB, 2007). Local
volunteers were trained on carrying out hygiene awareness campaigns. In the recovery
stage, Oxfam GB provided seeds, tools and other support so that the flood-affected
population could grow crops for consumption and for sale. Oxfam GB provided cash-for-
work programmes to create employment; the income generated from these initiatives
helped in recovery. Works which protected people from flood in the future were
encouraged (Oxfam GB, 2007). Oxfam GB also initiated community level disaster
management plans, early warning systems, provided rescue boats and first aid kits, and
created flood shelters and raised foundation levels of houses in preparedness for coming
disasters. In Bangladesh, as in other parts of South Asia, the We Can campaign on
preventing violence against women was integrated into the disaster response. 17 Care
Bangladesh normally responds to floods by providing high-protein biscuits, food rations,
water purification systems and medical relief during the relief phase. In the long run, its
focus was on flood mitigation through embankments, promotion of flood-resistant crops
and tree plantation along embankments (Care, www.carebd.org/Water.htm).

5.3 Indonesia: Response to the 2004 tsunami

The earthquake/tsunami
On 26 December 2004, an extremely strong earthquake occurred below the Indian Ocean,
north-west of Sumatra. This earthquake caused a tsunami wave that ravaged most parts of
Aceh and the Nias islands of Indonesia, as well as parts of other Asian and East African
countries (Republic of Indonesia, 2005). The fatalities from the tsunami in Indonesia
reached a figure of 125,873 as of 6 March 2005. In addition, 94,494 persons were
missing, and 419,682 were displaced (United Nations, 2005). The majority of casualties
were in Aceh, and four times more females than males were estimated to have died 18
(Carballo and Heal, 2005). The tsunami destroyed 30 health clinics out of 240 and
seriously damaged 77. Moreover, 700 of 9,800 health workers and 30% of trained
midwives were dead or missing (Carballo et al, 2005b).

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Government response to tsunami
The Republic of Indonesia prepared a Master Plan for the Rehabilitation and
Reconstruction of the Regions and Communities of the province of Nanngre Aceh
Darussalam and the Islands of Nias in the Province of North Sumatra (Republic of
Indonesia, 2005). A special coordination unit for Aceh was established by the
government, 19 led by the Minister of Peoples Welfare in coordination with a team of
related Ministries. The response measures focused on all affected populations, with
special attention being paid to women and children. Concretely, during the response
stage, the government provided food, nutrition supplements (for pregnant women and
children), water and sanitation, shelter, medical aid, trauma counselling and family
planning services. Interestingly, the government set up an anti-trafficking task force
and cell for prevention of abuse, and started an integrated service centre for womens
empowerment. The long-term recovery plan includes restoring family planning and
maternal health infrastructure and providing livelihood support for female-headed
households and starting sports centres for youth (Republic of Indonesia, 2005). In 2006,
the government, in collaboration with the UNDP, framed a National Plan for Disaster
Reduction 2006-2009 which prioritises making hospitals disaster-proof and preparedness
with regard to health and nutrition. The document mentions adhering to minimum
standards on public health spelt out in the Sphere standards (Republic of Indonesia,
2006).

UN response to tsunami
A review of the Indonesian component of the UN Common Appeal for the 2004 Tsunami
suggests that the WHOs interventions focused on strengthening provision of early
warning systems on health threats, providing technical guidance on public health and
disease prevention, supply of emergency health kits, recovery of health infrastructure,
strengthening of midwifery services and strengthening the health component within the
government disaster policy (UN, 2005). UNFPA supplied hygiene kits, midwifery kits,
appropriate clothing and RH supplies (content not specified in document). It also
revitalised midwifery associations, strengthened EmOC services, prevented STIs and

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HIV/AIDS, and provided trauma counselling in tsunami affected areas. UNFPA targeted
women, men and adolescent girls in their response measures. UNICEFs interventions
focused on children of all age groups and pregnant and lactating women. Related to
SRHR, UNICEF strengthened water, sanitation and hygiene services, nutrition of
children and pregnant/lactating women, psychosocial counselling and child protection
services (UN, 2005).

I/NGO response to the tsunami

In the response phase, the Indonesian Planned Parenthood Association (IPPA) opened
additional health posts in tsunami-affected areas; operated mobile clinics; provided
medicines, supplies and medical equipments; and rendered medical services (IPPF,
2006). Care Indonesia intervened to restore government health infrastructure and to
provide water and sanitation services, public health and nutrition services, maternal
health services and other medical services through stationary and mobile centres
(www.careindonesia.or.id). In the area of health, Oxfam International provided sanitary
pads, head scarves for women, separate latrine and bathing areas in temporary camps and
medical equipments (Oxfam International, 2005).

In the recovery stage, the IPPA focused on restoring its own destroyed infrastructure and
its usual activities of family planning services, pap smear tests, delivery care, EmOC
services, and provision of information on reproductive health and rights to women and
youth (IPPF, 2006). Oxfam International and Care, in the recovery stage, promoted some
innovations like joint ownerships of housing and assets (www.careindonesia.or.id; Oxfam
International, 2005).

5.4 India: Response to the 2000 drought

Droughts in India
One of the worst droughts in India in the last ten years was in the year 2000 with the
states of Andhra Pradesh, Gujarat, Madhya Pradesh and Rajasthan being affected
(Government of India, 2000). Over 15% of the Indian population (130 million people)

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were affected by the 2000 drought. In the severely affected areas, an estimated 60 million
people, including 9 million children and 1.2 million pregnant women constituted a high-
risk group (UNICEF, 2000). The 2000 drought led to a situation of water scarcity, food
shortage, and loss of crops, fodder and livestock (UN, 2000b).

Government response to drought

The Government of India prepared a Contingency Plan Drought 2000 in response to
recurring drought (Government of India, 2000). The priorities in the response phase were
provision of drinking water, fodder, wage employment, food-grains, nutritional
supplements, human health services and livestock disease control services. Relief camps
for humans and cattle were to be set up as necessary. The Contingency Plan places
special attention on reaching out to women, children, old and infirm people. In the
recovery phase, the focus is on promoting drought-resistant crops, rainwater harvesting
structures, watershed development and aforestation. The nodal department for the
implementation of the drought action plan is the Department of Agriculture, which is
supposed to coordinate its implementation with relevant departments. The focus of the
Women and Child Development Department in drought situations is on strengthening the
nutrition of children under-6 years, pregnant and lactating women and vulnerable sections
of society (Government of India, 2000). NGOs are to be involved in implementation
(Government of India, 2000).

UN agency response to the 2000 drought

The UN Disaster Management Team, India responded immediately to the drought,
though not anywhere on a scale as in the case of 2004 tsunami. The UN Office for the
Coordination of Humanitarian Affairs (OCHA) provided an Emergency Grant of
US$30,000 for drought response to the Indian government. UNICEF responded
immediately by restoring water supply facilities, strengthening sanitation and personal
hygiene, improving primary health facilities, preventing dehydration, and strengthening
household and community water harvesting structures. UNICEFs long-term intervention
included construction of check dams with peoples participation. WHO provided
technical assistance in the setting-up of a functioning disease surveillance system to state

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governments and training of medical personnel on treatment of dehydration and heat
stroke (UN, 2000b, UNICEF, 2000). OCHAs situation report does not mention that
UNFPA responded to the drought, though it does mention that its office in Rajasthan
housed the drought interventions (UN, 2000b).

Response of Care, Oxfam and FPAI to the 2000 drought

Care India initiated cash-for-work programmes, and constructed water harvesting and
retention structures in drought-affected states with the financial support of USAID
(USAID, 2001). Oxfam GB intervened through its local partners to promote food-and-
cash-for-work programmes, provide subsidised fodder, create fodder banks and distribute
seeds in anticipation of the monsoon rains (Oxfam GB, 2000). The food-and-cash-for-
work programmes focused on strengthening community and household water harvesting
structures. Web searches do not suggest that the Family Planning Association of India
intervened during the 2000 drought.

5.5 Observations

Overall, the review of responses of government to disasters in the four countries suggests
that all the four governments have a policy framework on disaster risk reduction,
response and recovery. Women are recognised as a vulnerable group in disaster
contexts by all the four governments, along with people leaving with disabilities, the
elderly and the infirm. Amongst women, women heading households and pregnant and
lactating women are seen as needing special attention by some. Two of the four
governmentsChina and Indonesiahave focused on SRH services, apart from
sanitation services which are more widely addressed. Protecting sexual rightsin
particular freedom from violencehas been prioritised by two of the four governments,
with a thrust on violence against women in general in Bangladesh and on sexual
exploitation in Indonesia. Another positive feature is that over the yearsfrom the
drought in 2000 in India to the earthquake in 2008 in Chinaattention to SRHR issues of
women has improved.

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Nevertheless, from a feminist and human rights perspective to SRHR, there are a few
shortcomings. The agency of women is not recognised in disaster risk reduction, response
and recovery measures, and only one of four governments (Bangladesh) seeks to involve
women in disaster reduction/response/recovery committees. SRH needs of women
beyond family planning and MCH listed in Annex 1 have not been given the required
attention. China has also placed emphasis on re-fertility services, but the problem itself
was created by the one-child policy norm and emphasis on sterilisation as the main
method of contraception. The terms sexual and reproductive rights of women do not
figure in the documents, and there is no mention of adolescents and transgendered people
or the MISP for RH in emergencies. These findings are similar to the findings from a
review of disaster legislation in four Asian and two Pacific countries (Krishnamurthy,
2008).

The three UN agencies reviewedUNICEF, UNFPA and WHOhave had a much

greater focus on addressing health concerns in disaster contexts. The WHOs thrust is on
strengthening the Ministry of Healths institutional capacity in disaster risk reduction,
response and recovery. UNICEF and UNFPA have attempted to address SRHR of
women and adolescents in the response and recovery stages. UNFPA focused on women
and adolescent girls SRHR (condoms, delivery kits, HIV prophylaxis, hygiene kits and
addressing of sexual violence), while UNICEF concentrated on the health needs of
pregnant and lactating women and children (including delivery care, hygiene kits for
girls, nutrition and safe toilets in schools). In China, UNFPA has played a lead role in the
implementation of the MISP for RH in emergencies. Though the attention to SRHR of
UN agencies is far better than what is reflected in government disaster risk reduction,
response and recovery plans, they do not explicitly promote non-discrimination in access
of transgendered people to SRH services. Further, several SRHR issues affecting women
and adolescents listed in Annex 1 still need to be addressed. The terms sexual rights and
reproductive rights do not figure in UNs humanitarian appeal processes in the four
countries. Only the UN appeal process in China mentions MISP for RH, but this gives
hope that the attention to this standard is growing with time as the earthquake occurred in
2008.

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Three important strengths of non-SRHR specific humanitarian NGOs (Oxfam affiliates
and Care offices reviewed) response in the four countries have been their focus on social
determinants of SRHRs of women; on leadership of women in disaster risk reduction,
response and recovery; and emphasis on water, sanitation and hygiene kits for women.
Their efforts to strengthen womens ownership of livelihood assets and houses and
promote equal participation of women in cash-for-work programmes with provision of
equal wages may have reduced sexual exploitation of women and put income in their
hands to access SRH services where available. Additionally, CARE Indonesia provided
MCH and nutrition services to survivors of the tsunami in Aceh, while Oxfam GB sought
to mainstream campaign to reduce violence against women in its humanitarian response
in Bangladesh. However, the literature reviewed suggest that several SRHR needs and
interests of women and adolescents in disaster contexts listed in Annex 1 need to be
better addressed. Moreover, these two organisations attention to the SRHR of
transgendered people in disasters appears minimal. The terms sexual and reproductive
rights were not found in the documents related to disasters reviewed. In comparison, the
focus on SRHR by IPPF affiliates in disaster contexts was better, though it varied across
branches within a country and not all needs and interest listed in Annex 1 were addressed.
In Indonesia, SRH services were also extended to sexual/gender minorities by IPPA.

Linking back to the framework on pathways of impact on disasters on SRHR (section 4),
it is apparent that non-SRH specific humanitarian INGOs have a strong focus on
addressing social/economic vulnerability to SRR violations and SRH conditions. UN
agenciesin particular UNFPA and UNICEFhave paid attention to combating SRHR-
blind response and recovery policies. The WHO, along with national governments, has
sought to restore health and MCH/FP infrastructure and services and make them disaster-
proof. However, these efforts have not comprehensively addressed SRHR needs and
interests of women and adolescents and largely ignored those of transgendered persons in
disaster risk reduction, response and recovery (as listed in Annex 1). Further, the deeper
development policies and legislations that have led to disasters and marginalisation of

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particular groups of women, adolescents and transgendered people need to be better
addressed.

6.0 GOOD PRACTICES ON ADDRESSING SRHR ISSUES IN THE CONTEXT

OF DISASTERS

Good practices on addressing SRHR issues and their social determinants in disaster risk
reduction, response and recovery in the context of disasters are summarised in this
section. Those mentioned in section 5 are not repeated here. Observations are then made
on which SRHR needs and interests listed in Annex 1 are addressed in these practices, as
well as which pathways of impact of disasters on SRHR are taken into account.

6.1 Building institutional capacity on SRHR in disasters and thereby reducing the
risk of disaster

The SPRINT Initiative

The SPRINT Initiative (2007-10) of the IPPF East and South East Asia and Oceania
Region (ESEAOR), in partnership with UNFPA and the University of South Wales, aims
to increase access to SRH information and services for populations surviving disaster and
conflict situations in East, Southeast Asia and the Pacific. This goal is to be achieved by:
Increasing the regional capacity of key stakeholders with regard to SRH response
in disaster and conflict situations, including in meeting the MISP for RH;
Strengthening the coordination of SRH responses in disaster and conflict
situations;
Raising awareness on the importance of addressing SRH in disaster and conflict
situations at the national, regional and international levels;
Responding in a timely fashion to SRH needs in disaster and conflict situations;
and
Enhancing access to SRH information and services for persons surviving disaster
and conflict situations.

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While it is early to assess impact, this initiative will definitely strengthen the capacities to
implement MISP for RH in crisis situations in the region.

The module on RH and communicable diseases as part of the Public Health in Complex
Emergencies (PHCE) course of the Asian Disaster Preparedness Center (ADPC)
The module on Reproductive Health within the PHCE course of the ADPC describes the
rationale for providing RH services to affected populations as an essential component of
the emergency response, including the provision of the MISP for RH in emergency
situations. The module also identifies effective RH programme strategies to be used in
stable settings, including sessions on emergency obstetric care, family planning, safe
motherhood, prevention and care of STIs/HIV and sexual and gender-based violence. The
communicable disease module of the PHCE course focuses on the epidemiology and risk
factors specific to emergency setting and issues of surveillance and assessment of
HIV/AIDS (Lauza-Ugsang, 2008). Again, this course would contribute to strengthening
capacities for SRHR integration in disaster risk reduction, response and recovery.

6.2 Good practices in integrating SRHR in response and recovery

Creating demand for health services and SRH services from below: Swayam Shikshan
(SSP) Prayog and Shirkat Gah
In the aftermath of the 2004 Indian Ocean Tsunami, SSP, a network of NGOs and
community based organisations with experience in women-led disaster recovery in
Western India, mobilised women in tsunami-affected villages of two districts of Tamil
Nadu. SSP partnered with micro-finance self-help groups to assess whether response
processes were responsive to their needs. In the sphere of health, they found that post-
disaster stress and trauma was higher amongst women than men. Levels of anaemia and
miscarriages were higher than in pre-disaster times. Government emergency health
services did not serve womens unique health needs, and were being gradually withdrawn
since the emergency period is coming to an end (Gopalan and Sitaram, 2008).

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SSP responded by facilitating the creation of women-led local health governance groups
(HGGs) from amongst the SHG leaders. These groups approached the issue from two
angles: driving grassroots demand for better health and health services and collaborating
with public health service providers in improving service quality and delivery. The HGGs
in 41 villages were federated. They run a community health fund, collaborate with
government primary health centres and hospitals to organise health awareness talks and
village-level health camps, provide referral services, grow and distribute herbal
medicines, and link community members to government services. HGGs raise awareness
on womens and girls sexual and reproductive health (SRH), counsel those suffering
from post-traumatic stress disorder, address other critical health issues (such as anaemia)
and hold SRH camps where women and girls can undergo examinations for SRH and be
referred for specialised care. The groups have also worked with local governments to
close liquor business in the area and prevent early marriage. High liquor consumption is
cited as one of the reasons for loss of livelihoods, domestic violence and liver disorders
amongst men (Gopalan and Sitaram, 2008).

In response to the 2005 earthquake that struck northern Pakistan, Shirkat Gah focused on
addressing poor womens and adolescents immediate SRHR needs. The objective of
Shirkat Gah was to capitalise upon the opportunity that such situations provide to expand
womens space for action and decision making. Shirkat Gah worked with other like-
minded organisations to establish the immediate and medium-term needs of affected
women and adolescent girls. Immediate needs identified through these processes led to
relief measures such as provision of sanitary towels, contraceptives, safe toilets and
bathing areas and prevention of sexual violence and harassment by husbands and
outsiders. Medium-term strategies included training local organisations to address
identified needs, assisting local organisations to map available SRHR services and
organisations in the area and raising awareness amongst community women on issues of
sexuality and reproductive health, including abortion, contraception and choice in
marriage. Local organisations were trained on psycho-social counselling and skills of
traditional birth attendants were upgraded. Women have been mobilised in many places
for collective action (Mumtaz, 2008).

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Expanding access to family planning and EmOC post post-cyclone Nargis, 2008 by
Marie Stopes International (MSIM) Myanmar
Cyclone Nargis killed over 140,000 people and devastated Myanmar in early May 2008.
In the immediate aftermath, MSIM was on the ground providing primary care and
distributing vital goods, such as personal hygiene kits. It quickly established fixed centres
and regular mobile teams in order to provide contraceptive services. It supported
emergency obstetric care facilities and provided referral support to the women, thus
facilitating access to and utilisation of emergency obstetric services to over 600 pregnant
women. This measure would have saved the lives of mothers and infants. Further,
MSIMs cyclone response activities strengthened the organisation, which is now better
prepared for such events. Support teams for staff were established as team members
coped with new hardships. MSIM participated in a range of coordination work and
collaborated with various stakeholders to ensure that services reached the most
marginalised populations. In the recovery phase, SRH services were integrated with basic
medical and psycho-social support (Aung, 2008).

Building back more equitable and better systems: Addressing social determinants of
SRHR
In Aceh, Indonesia, Oxfam Internationals water and sanitation interventions promoted
access to water, bathing spaces and toilet within the permanent shelter. This was not the
case before the tsunami struck. Women reported that their work load had reduced
substantially and they were able to better adopt hygienic practices (Oxfam, 2007). In an
attempt to alter norms on responsibility for fetching water, in a drought situation in Sri
Lanka, men were given push cycles by INGOs to fetch water so that women did not have
to walk long distance, thus changing gender roles (UNDAW, 2004). In Tamil Nadu,
womens rights NGOs advocated for the repeal of the governments initial policy of
providing monetary assistance to tsunami-affected households for conducting marriages
as planned before the tsunami. As mentioned in section 4, this policy led to a spate of
early marriages. Womens rights NGOs also advocated for permanent house title deeds
on womens names or joint names of couples (Murthy and Sagayam, 2006).

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Assessment of adherence to MISP for RH protocols in disaster response and recovery
The Womens Commission for Refugee Women and Children conducts assessment of the
MISP for RH in emergencies. In Indonesia, they carried out an assessment of the
implementation of MISP for RH in Aceh province in February 2005. Specifically, the
assessment team visited the districts of Aceh Besar in northern Aceh and Aceh Utara on
the north-eastern coast. In addition, they conducted structured interviews and meetings
with 32 representatives and local and international NGOs, United Nations agencies,
donors and the Indonesian Ministry of Health. The assessment also included 10 focus
groups with local people who were displaced by the tsunami. In addition, the team visited
local health facilities and centres in districts of Aceh Besar and Aceh Utara. The findings
have already been highlighted in section 4 of this report. What is noteworthy is that the
findings led to identification of universal recommendations that humanitarian agencies
should prioritise MISP in response, preparedness training and recovery plans; raise
awareness on MISP for RH within their organisations and amongst different arms of
government (health, military and other departments); and that one nodal organisation
amongst humanitarian agencies should be made responsible for coordinating and
implementing the MISP for RH (Womens Commission for Refugee Women and
Children, 2005).

6.3 Observation

An overview of the good practices in addressing SRHR or its social determinants in

disaster risk reduction, response and recovery suggests that there are sound examples of
addressing womens SRHR needs, followed by those of adolescent girls. It is heartening
to see some attention to gender-based and sexual violence against women and girls.
However, there are few examples of addressing specific SRHR needs of adolescent boys
or transgendered people, or of ensuring there is no discrimination in their access to
common SRH services. SRH needs of pregnant and lactating women have been better
addressed than needs of women with uterine prolapse, UTIs, STIs, reproductive tract
infections (RTIs), disability or reproductive cancers. Issues such as rights of women to

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safe abortion services have been less addressed than access to contraception (albeit of
married women). The good practices, together, do not illustrate the actual meeting of
MISP for RH nor of the list of additional SRHR issues identified in Annex 1.

Going back to the framework of pathways of impact of SRHR on disasters, the good
practices highlight both top-down and bottom-up strategies that could be used to reduce
social vulnerability of women and adolescent girls to SRR violations and SRH conditions
and diseases, to restoring government health infrastructure and services and repealing
gender biases within government response and recovery measures. The SSP example
shows the potential of processes led by marginalised women to demand SRH services
and promote SRR in disaster contexts. However, there are few examples of disasters
being used as an opportunity to engender legislation and policies, to make them pro-
marginalised groups, or to promote SRH and SRR comprehensively for all in normal
times.

7.0 CONCLUSIONS AND RECOMMENDATIONS

7.1 Conclusions

The review of the impact of disasters in the region on SRHR in section 4, suggests that
disasters have a detrimental impact on SRHR of women and adolescent girls, particularly
on the marginalised politically, economically and socially amongst them. The scant
literature available on the impact of disasters on adolescent boys and transgendered
people suggests that the same hold true for these groups as well. The extent and form of
detrimental impact varies with pre-existing gender relations, extent of loss to health
infrastructure and personnel, attention to SRHR in disaster policies, attention to social
determinants of SRHR in disaster policies, pre-existing development/SRH services
(including contraceptive mix) and outcomes, and the nature of the disaster itself.
Disasters in the region have enhanced existing social vulnerabilities to SRH conditions
and SRR violations of marginalised women, adolescents and transgendered people, and
created new ones. Human rights enshrined in CEDAW, CRC and ICESCR have thus

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been violated, and further ignoring SRHR in disasters may delay recovery from disasters,
as in the case of women who due to changed circumstances need abortions but are unable
to access the same.

As yet, there is no legally binding international human rights agreement protecting the
rights of people affected by disasters and living in disaster prone areas. Though the
Hyogo Framework on Disaster Risk Reduction exists, it is not legally binding; nor does it
extend to the response and recovery phases and address SRHR issues. The international
standard that comes closest to addressing SRHR issues in disaster context is the
Minimum Initial Service Package for RH in emergencies evolved in 1996 by the IASC
working group. However, it does not extend to the risk reduction phase and does not
address the full SRHR concerns of women and adolescents in disaster contexts (see
Annex 1). Terms such as reproductive rights and sexual rights do not figure in the
MISP in RH in Emergencies; further, the Standard is silent on the SRHR concerns of
transgendered people. Some of these criticisms are true of government disaster risk
reduction, response and recovery plans in the four countries and contexts reviewed.
Further, the government sees women as passive victims who need to be saved by the
government and not holders of rights with resilience.

Against this background, the UN Humanitarian Appeals in the 2008 China earthquake,
the 2007 Bangladesh floods, the 2004 Indonesian tsunami and the 2000 Indian drought
have sought to strengthen attention to SRHR in response and recovery. UNFPAs and
UNICEFs interventions, in particular, have addressed several SRHR concerns of women
and adolescents, though not as comprehensively as demanded in Annex 2 of this
document. WHO, in these countries, has concentrated on strengthening institutional
capacity of health department on disaster interventions, but not necessarily with an SRHR
focus. While the terms sexual and reproductive rights and transgendered people do not
appear in the humanitarian appeals, what is heartening is the reference to MISP for RH in
the UN China Appeal for Wenchuan Earthquake Early Recovery Support. This points to
increasing attention to this international standard.

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The strength of humanitarian INGOs is their focus on social determinants of SRHR of
women and girls, such as water and sanitation services, nutritional services, land and
housing rights and equal wages. They have sought to strengthen the participation and
claim-making power of marginalised women and have not seen them as passive victims.
However, their focus on SRHR in disasters needs strengthening, and their disaster-related
documents (in the four countries and disasters studied) do not use terms such as sexual
and reproductive rights or transgendered people. IPPF affiliates in the four countries
do focus on SRHR in disaster situations and in Indonesia on SRHRs of transgendered
people as well. Nevertheless, SRHR concerns have not been addressed comprehensively,
and disaster issues need to be mainstreamed into their routine programming.

Against this mixed picture in addressing SRHR in disasters from a rights and feminist
lens, there have been several good practices. These good practices range from addressing
social determinants of SRHR in disasters to building institutional capacity of government
and other stakeholders on implementing MISP in RH, strengthening womens ability to
claim development/SRH services and rights in disaster contexts, demanding the
withdrawal of SRH-blind disaster policies and carrying out independent assessment of
implementation of MISP in RH. These good practices have by and large focused on
women and girls and rarely adolescent boys and transgendered people. Nevertheless,
they point to ways forward.

7.2 Recommendations

Recommendations to the Inter-Agency Standing Committee on Emergencies

1. Advocate to the UN for an international convention on the rights of people living
in disaster-prone areas and affected by disasters, with SRHR issues affecting
women, adolescents and transgendered people being integrated into the same.
2. SRHR issues may also be integrated into the Hyogo Framework (2000-2015) on
Disaster Risk Reduction, and this framework may be made legally binding.
3. It is suggested that the existing MISP in RH be reframed as the Minimum
Standards for SRHR in Emergencies in order to address SRHR issues in response

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 and recovery more comprehensively, and additionally in disaster risk reduction.
See Box 1 for concrete recommendations.
4. The broadened Minimum Standards in SRHR in Emergencies may be extended to
transgendered groups.

Box 1. Suggested Additional Standards for SRHR in Emergencies

Risk reduction
National identity cards for marginalised women and transgendered people
Advocacy for enactment/promulgation and enforcement of comprehensive SRHR policies and
legislation for women, adolescents and transgendered people
Participatory mapping of SRHR needs of marginalised women, adolescents and transgendered
people related to disaster risk reduction, response and recovery
Integration of health and SRHR issues in disaster risk reduction policies, plans and practices
Training of rescue, response and recovery personnel, community leaders, marginalised
women, adolescents and transgendered people, and the public on SRHR issues, and
institutionalisation of such training into curriculums
Increasing proportion of marginalised women and transgendered people in risk reduction
committees and rescue teams

Additional SRHR kits at the response stage

Culturally appropriate material for absorbing menstrual blood and urinary and faecal
incontinence
Non-discrimination in access to safe toilets and bathing areas for transgendered people and
other marginalised groups
Access to ante-natal care (ANC) and post-natal care (PNC), as well as contraceptive services
(including removal of contraception and emergency contraception) in the response stage
Access to safe abortion services, including medical abortion
Treating conditions like uterine prolapse, breast engorgement, miscarriages and irregular
menstrual cycles and infections like UTIs
Enforcing protocols for protection against child marriage and commercial sexual exploitation
of women, girls, boys and transgendered people in the aftermath of disaster
Continued access to treatment for those undergoing treatment for chronic SRH conditions and
catastrophic diseases
Providing minimum sexual and reproductive health services to women and men irrespective of
marital status, to adolescents and to transgendered people

SRHR at recovery stage

Restoration of health, family planning, maternal health and RTI/STI infrastructure, and
making them disaster-resilient
Provision of UTI/RTI prevention and treatment services in addition to STIs.
Provision of safe re-canalisation surgery and re-fertility services where demanded by women
and men and where advisable given their age and health conditions
Advocacy for comprehensive SRHR services and legislation for women, adolescents, and
LGBTI people

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Cross cutting:
Sensitisation of grassroots communities on SRHR entitlements as per international and
progressive national law

Recommendations to national governments

1. To review their national disaster bills/acts and disaster risk reduction, response
and recovery plans (at all levels), ensuring that these adhere to the revised
Minimum Standards for SRHR in Emergencies suggested in this paper as well as
address social determinants of SRHR.
2. To build institutional capacity of national, provincial and local governments on
SRHR issues in disasters through appropriate training; to ensure representation
from Womens/Health Ministries, rights-based NGOs and marginalised groups in
decision making forums; and to evolve protocols related to SRHRs in disasters.
3. To ensure that sex-disaggregated data on fatality, access to risk reduction,
response and recovery, and on SRH conditions/diseases and SRR violations post-
disaster are collected.
4. To promote a comprehensive SRHR and development legislation and policies for
women, adolescents and transgendered groups (particularly the marginalised
amongst them); and temporary methods of contraception in disaster-prone areas.

Recommendations to UN Agencies
1. Institutionalise addressing SRHR issues in disaster risk reduction into the country
and regional programme strategies.
2. The common UN humanitarian appeal following any major disaster should make
explicit its commitment to fulfil the suggested Minimum Standards for SRHR
pertaining to response and recovery; and allocate responsibility between different
UN agencies to fulfil this commitment.
3. Along with UNFPA, WHO, which invests considerably in building institutional
capacity of health ministries on disaster interventions, may strengthen their
capacity to address SRHR concerns in disaster risk reduction, response and
recovery.

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 4. UNFPA, which is presently the nodal agency on MISP in RH, may play the lead
role in disseminating and building capacity in the region on the suggested
Minimum Standards in SRHR in Emergencies, expand the SPRINT initiative to
South Asia, and support a regional SRHR organisation to monitor implementation
of Minimum Standards for SRHR in the region.

Recommendations to INGOs/NGOs
1. Regional NGOs which focus on SRHR may set up a wing to assess
implementation of the revised Minimum Standards in SRHR in disaster in the
Asia-Pacific Region.
2. The SPRINT Initiative of the IPPF East and South East Asia Regional Office may
broaden their focus and strengthen capacity of stakeholders to implement the
revised Minimum Standards for SRHR suggested in this document.
3. Humanitarian INGOs may prioritise working on SRHR along with their
pioneering work on promoting gender and social equity in disaster risk reduction,
response and recovery.
4. SRHR INGOs and their national affiliates may extend their SRHR services and
activities to disaster affected areas, and weave disaster risk reduction from an
SRHR lens into their strategic plans.
5. The revisions suggested to the existing MISP for RH may be incorporated into the
Sphere standards, and appropriate indicators may be evolved.

Although most of these recommendations pertain to SRHR in disaster contexts, they

cannot be implemented unless and until there is a broader commitment to gender, social
and economic equity before the disaster, and in the aftermath of disaster. This is the
critical challenge in a global-capitalist, patriarchal and hetero-sexual society. But as
shown in summary of good practices, disasters pose an opportunity to challenge these
hierarchies.

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ENDNOTES

1
The technological disasters in Asia during the period 1999 to 2009 were transport accidents, industrial
accidents and miscellaneous accidents (International Federation of Red Cross and Red Crescent
Societies, 2009).
2
Sex-disaggregated statistics on fatality is not provided by the World Disaster Report 2009. But fatality
figures from disasters in countries of the region support the global claim that more females than males
die in natural disasters. In North Aceh and Sri Lanka, four times more females than males were reported
to have died during the Indian Ocean 2004 tsunami. In India, three times more females than males died
during the tsunami (Carballo and Heal, 2005; also see, International Union for Conservation of Nature
and Natural Resources and Women, Environment and Development Organization, n.d). In the 1993
floods in Nepal, fatality was 6.1 per 1,000 population for females compared to 4.1 per 1,000 population
for males (Pradhan, 2007). In Pakistan, a study by the Asia Pacific Women Law and Development
(APWLD) of 137 people who died in 125 households during the earthquake notes that in the age group
10 to 21 years, more women than men died, but in other age groups, gender-differential was not seen
(APWLD, 2005).
3
Defined in section 2 of this paper.
4
See Harris and Smith, 2001; Reproductive Health Outlook, 2004; Disasters, 2004; Reproductive Health
Matters, 2008; Guy, 2002; Mc Guinn and Purdin, 2005.
5
See Asia Pacific Disaster Center, n.d; Chechhi et al, 2007.
6
The author is grateful to Maria Melinda Ando and Ambika Varma, ARROW, for their inputs into
disaster-related definitions. These definitions have also appeared in ARROWs For Change, Volume 14,
No. 3, 2008.
7
There were articulated as concerns and needs in focus group discussion by the author with male- to-
female transgendered people in Dhaka slums in Bangladesh in February, 2004 and in Chennai slums in
India on 1st August 2009.
8
Along the lines of the 1951 Convention on Status of Refugees and the 1974 Declaration on Protection
of Women and Children in Conflict-related Emergencies (UNHCR, 2007; UN, 1974).
9
The child is defined as up to the age of 18 years.
10
This was added through the General Comment of 2000 on the Right to Highest Standard of Health (UN,
2000).
11
For standards that are not specific to SRHR which are not reviewed here, refer to IFRC, 1994; IASC,
2006a; IASC, 2006b; IASC, 2007; IASC, 2008a; and IASC, 2008b.
12
The lack of safety of adolescent girls in temporary shelters, decline of dowry rates and increase in
widowers put added pressure on parents to get adolescent girls married off.
13
Occasionally, single women who had contacts gained access to exclusive shelters meant for single
women (and their children) (APWLD, 2006a).
14
However, in some countries, where gender discrimination in access to nutrition is not present, it is boys
who may be disadvantaged in the aftermath of disasters (Schwekendeik, 2008).
15
The three UN agencies have been selected as they play an important role in the health sector, with
UNFPA and UNICEF mandate extending to some of the elements of SRHR. IPPF affiliates have a
strong focus on SRHR, while Care and Oxfam are important actors in disaster with health as one of the
areas of focus.
16
UNICEF provided utensils and clothing, plastic sheets for temporary shelter and education and
recreation kits for children (UNICEF, 2007).
17
Discussion with the Regional Adviser, Gender and Humanitarian Assistance, Oxfam GB, February
2008.
18
The reasons for this imbalance in casualties include men being in the safer sea when tsunami struck
given the gender division of labour, gender norms on dresses, womens lesser knowledge of swimming,
and women being tied up with house work.
19
Bakomas PBP is the national government machinery for disaster management.

P a g e | 53
 Annex 1:
SRHR needs and interests of women, adolescents and transgendered people
in disaster contexts
SRHR NEEDS WOMEN ADOLESCENTS TRANSGENDERED
AND PERSONS
INTERESTS
Respect, Prevention of: Prevention of: Prevention of:
protection and Sexual violence Early marriage Sexual violence
fulfilling of Forced pregnancy Marriage to late elder Commercial sexual
SRR by spouse sisters husband exploitation
Commercial sexual Sexual violence
exploitation of Commercial sexual Non-discrimination in
women exploitation of women access to bathing and toilet
facilities
Access to safe abortion Access to contraceptive
services services to adolescents Non-discrimination in
access to response and
Access to contraceptive Non-discrimination in recovery in general
services to unmarried access to response and
women recovery measures in
general
Non-discrimination in
access to response and
recovery measures in
general
SRH concerns Advocacy for access of socially and economically marginalised women, adolescents
in disaster risk and transgendered people to identity cards and for comprehensive development
reduction policies

Disaster-proof health structures, including maternal, family planning and RTI/STI

clinics; and equipping these with adequate SRHR kits, supplies and equipments to
deal with emergencies

Training of health, military, risk reduction, response and recovery personnel on

SRHR of women, adolescents and transgendered people in disasters and their
familiarisation with international standards on SRHR and institutionalising the same
into the curriculum.

Annual mapping of the sexual and reproductive health needs and rights of
marginalised women, adolescents and all transgendered people at the community level

Training of community/religious leaders, women, adolescents and transgendered

people on disaster and SRHR- risk reduction, response and recovery

Training on disaster and SRHR of disaster risk reduction, response and recovery
committees from community to national levels

Integration of SRHR issues into disaster risk reduction, response and recovery plans
of government, donors and humanitarian NGOs

P a g e | 54
SRH issues in Safe, sex-disaggregated toilets and bathing areas, suitable for all age groups and
response people with disabilities; ensuring non-discrimination in access of transgendered
people to these facilities

Culturally appropriate clothing and underwear for women, adolescents, and

transgendered people distributed through the right channels

Easy access to condoms in places appropriate for women, adolescents, and

transgendered people

Separate mobile health clinics for women and men, with privacy and doctors of
appropriate sex; ensuring non-discrimination in access of transgendered people to
clinics

Access to separate breastfeeding areas in immediate shelters, before people move to

temporary camps
- Access to menstrual - Access to menstrual - Non-discrimination in
hygiene kits hygiene kits access to food, shelter,
- Counselling for - Counselling for health, ex-gratia relief
disruption of menstrual disruption of - Access to HIV
cycle menstrual cycle prophylaxis for
- Access to supplementary - Access to adequate survivors of sexual
nutrition for pregnant supplementary violence
and lactating women nutrition - Diagnosis and treatment
- Diagnosis and treatment - Treatment for RTIs, for RTIs, UTIs and
for RTIs/STIs/UTIs and UTIs and STIs and STIs and other SRH
other health SRH other SRH conditions conditions
conditions (e.g. - Access to abortion - Continued access to
prolapse, breast services treatment for those
engorgement) - Access to temporary being treated for SRH
- Napkins and extra cloth methods of conditions
for those with urinary contraception - Diagnosis and referral
incontinence - Access to HIV for sexual violence and
- Access to safe abortion prophylaxis and access to HIV
services emergency prophylaxis
- Diagnosis, and referral contraception
for sexual violence - Continued access to
- Access to HIV treatment for
prophylaxis and adolescents being
emergency contraception treated for SRH
for survivors of sexual conditions
violence - Diagnosis, and
- Access to contraception referral for sexual
at the primary violence
healthcare (PHC) level
- Access to delivery care
at PHC level, and
referrals for
EMoC/CEmOC
- Continued access to
treatment for women
being treated for SRH
conditions

P a g e | 55
SRH service in - Re-fertility services for Comprehensive SRHR Comprehensive SRHR
recovery those who desire to services under ICPD services under ICPD and
conceive and beyond listed in beyond listed in section 2
- Contraceptive removal section 2 as relevant to as relevant to
for those who have lost adolescents transgendered people
their sexual partners
- Comprehensive SRHR
services under ICPD and
beyond listed in section
2

P a g e | 56
 Annex 2:
Whose SRHR gets worst-affected in disasters?
WOMEN ADOLESCENTS TRANSGENDERED
PEOPLE
Common to all 1. Poor
three 2. From marginalised caste, ethnic/religious groups and nationalities
3. Migrants
4. Internally Displaced Persons (IDPs) and refugees (such as due to conflict)
5. Those with differential abilities/disabilities
6. HIV-positive
7. From marginalised geographical locations
8. Sick
9. Facing sexual violence before disaster
10. Those not following traditional gender and sexual norms
11. In marginal occupations (including sex work)
Marginalised 1. Women heading 1. Adolescent-headed 1. Those disowned by
groups households/single households their natal family
particular to women 2. Adolescents who are 2. Those disowned by
women, 2. Women in polygamous orphans/with single their community
adolescents, or live-in relationships parents/ leaders
and 3. Pregnant women 3. Girls who are dressed in
transgendered 4. Women with urinary clothing that violate
people illness or foetal cultural and gender
incontinence norms during disaster
5. Women who have lost situations (these girls are
children harassed and
6. Women who are dressed discriminated against
in clothing that violate when rescued by
cultural and gender men/youth)
norms during disaster 4. Married adolescents
situations (these women
get harassed and
discriminated against
when rescued by men
because of their
clothing)
7. Women living with
HIV/AIDS

P a g e | 57
REFERENCES

Aryabandu, M.; Wickramasinghe, M. 2003. Gender Dimensions in Disaster

Management: A Guide for South Asia. Sri Lanka: ITDG South Asia Publication.

Asian Development Bank (ADB). 2007b. September 2007 South Asia Flood Update.
Thailand: Asian Development Bank.

Asian Disaster Preparedness Centre (ADPC). Public Health in Complex Emergencies.

Available at www.adpc.net/v2007/Programs/PHE/Default.asp Accessed 16 August
2008.

Asia Pacific Women Law and Development (APWLD). 2005. Survey of Womens
Human Rights Violations in the Aftermath of the Tsunami in India, Indonesia,
Thailand and Sri Lanka, and the October 8th 2008 Earthquake in Pakistan. Thailand:
APWLD.

_______. n.d. Tsunami Aftermath, What is the Reality of the Tsunami Tragedy for
Migrant Workers from Burma? Available at
www.apwld.org/tsunami_aftereffects.html Accessed 10 November 2008

_______. 2006a. Earthquake Aftermath: Violations of Womens Human Rights in

Pakistan, Report of the Survey of Womens Human Rights Violations in the Aftermath
of the October 8, 2005 Earthquake in Pakistan. Pakistan: APWLD.

_______. 2006b. Guidelines for Gender-Sensitive Disaster Development. Thailand:

APWLD.

Asian-Pacific Resource and Research Centre on Women (ARROW). 2005. Monitoring

Ten Years of ICPD Implementation, Asian Country Reports. Malaysia: ARROW.

_______. 2008. Definitions. ARROWs For Change. Vol.14, No. 3, p. 11.

Aung, M.M. 2008. Monitoring country activities: Myanmar. ARROWs For Change.
Vol.14, No. 3, pp. 6-7.

Bhatia, K. 2008. Making a difference: Addressing gender and social vulnerabilities in

emergencies: ppt. Nepal: UNFPA-CST. (mimeo)

Burki, E. 2006. The Pakistan earthquake and the health needs of women.
Humanitarian Practice Network. Issue 34.

Carballo, M.; Heal, B. 2005. The public health response to the tsunami: What have we
learned? Forced Migration. Special Issue, pp. 12-14.

P a g e | 58
Carballo, M.; Hernandez, M.; Schneider, K; Welle, E. 2005a. The impact of tsunami on
reproductive health. Journal of Royal Society of Medicine. Vol. 98, pp.400-403.

Carballo, M; Daita, S.; Hernandez, M. 2005b. Impact of the tsunami on the healthcare
systems. Journal Social Science Medicine. Vol. 98, pp. 390-395.

Care Bangladesh. n.d. Water, water everywhere but News Archive, Care. Available
at www.carebd.org/Water.html Accessed 20 November 2008.

_______. n.d. Projects of Care. Available at www.carebd.org/project_list.php

Accessed 20 November 2008.

Care Indonesia. n.d. Disaster Risk Reduction. Available at www.careindonesia.or.id

Accessed 15 October 2008.

_______. n.d. Emergency Response. Available at www.careindonesia.or.id Accessed

15 October 2008.

_______. n.d. Humanitarian Accountability. Available at www.careindonesia.or.id

Accessed 15th October 2008.

Care India. 2006a. CAREs Disaster Response Actions in India. Available at

www.careindia.org Accessed 20 November 2008.

_______. 2006b. CAREs Disaster Management Expertise and Approach. Available at

www.careindia.org Accessed 20 November 2008.

_______. n.d. CARE in India. Available at www.careindia.org Accessed 20 November

2008.

Chechhi, F; et al. 2007. Public health in crisis-affected population : A practical guide for
decision makers. Humanitarian Practice Network Paper 61.

China Family Planning Association. n.d. www.chinafpa.org.cn

Concern World Wide- Bangladesh. 2007. Bangladesh Flood Response Update- 12th
August 2007. Available at http://concernbd.blogspot.com/2007/08/bangladesh-flood-
response-update-12th.html Accessed 20 November 2007.

Dennis, S.; Yunus, W. 2008. Empty Promises: Gender Scorecard of World Bank-
Managed Post-Tsunami Reconstruction in Indonesia. USA: Gender Action.

Dimitrijevics, A. 2007. Mainstreaming Gender into Disaster Recovery and

Reconstruction. USA: The World Bank Institute.

P a g e | 59
Direct Relief International. 2005. Tsunami response one year later. Available at
www.directrelief.org/uploadedFiles/Press_Center/Publications/Other_Publications/tsu
nami_oneyear.pdf Accessed 20 November 20 2008.

Disasters. 2004. Vol. 20, No. 3: Reproductive Health in Conflict.

Enarson, E. 2004. Gender Matters: Talking Points on Gender Equality and Disaster Risk
Reduction. www.gdnonline.org/wot_cases.php Accessed 25 August 2009

Enarson, E.; Andreson, C. 2004. Gender Equality and Disaster Risk Reduction
Workshop: Participant Commentaries, 10-12 August, 2004 at HONOLULU, HAWAI.

Family Planning Association Bangladesh (FPAB). 2005. FPAB Strategic Plan 2005-
2009. Bangladesh.

Family Planning Association India. 2005. Strategic Plan 2005-2009.

Fisher, S. 2005. Gender-Based Violence in Sri Lanka in the after-math of the 2004
Tsunami Crisis: The Role of International Organisations and International NGOs in
Prevention and Response to Gender Based Violence. Dissertation submitted to the
University of Leeds for Masters of Arts.

Gender and Disaster Network. n.d. Gender Equality in disasters: Six Principles for
Engendering Disaster relief and Reconstruction, Available at
http://unisdr.org/wcdr/preparatory-process/inputs/gender-broadsheet.pdf Accessed 20
November 2008.

Gopalan, P.; Sitaram, A. 2008. Indian grassroots women create sustainable change in
post-tsunami health service provision. ARROWs For Change. Vol. 14, No. 3, p.3.

Government of India. 2000. Contingency Plan Drought 2000. National Disaster

Management Division, Department of Agriculture and Cooperation, Ministry of
Agriculture, Government of India.

Government of the Peoples Republic of Bangladesh. 2008a. National Plan of Disaster

Management: 2008-2015. Disaster Management Bureau, Ministry of Food and
Disaster Management, Bangladesh.

Government of Tamil Nadu. 2007. Update on tsunami related activities (as of 30-6-
07). Available at www.tn.gov.in/tsunami/tsunami-relief.htm Accessed 23 August
2007.

Guy, S. 2002. Reproductive health during conflict and displacement. Issue 20:
Humanitarian Exchange.

P a g e | 60
Hannan, C. Mainstreaming gender perspectives in environmental management and
mitigation of natural disasters. Paper presented at the Roundtable Panel and
Discussion on the Disproportionate Impact of Natural Disasters on Women. Organised
by The United Nations Division for the Advancement of Women,
17 January 2002, United Nations Conference Room 5.

Hariss, C. and Smith, I. 2001. The reproductive health of refugees. Gender and
Development. Vol. 9, No. 2.

He, H., et al. 2008. The Wenchuan earthquake and government policies: Impact on
pregnancy rates, complications and outcomes. ARROWs For Change. Vol. 14, No. 3,
pp.4-5.

Inter-Agency Standing Committee (IASC). 2003. Guidelines for HIV/AIDS Interventions

in Emergency Settings. Switzerland: IASC.

_______. 2005. Guidelines for Gender-based Violence Interventions in Humanitarian

Settings: Focusing on Prevention
of and Response to Sexual Violence in Emergencies. Switzerland: IASC.

_______. 2006a. Women, Girls, Boys and Men: Different Needs Equal Opportunities,
Gender Handbook in Humanitarian Action.

_______. 2006b. Operational Guidelines on Protecting Persons in Natural Disasters.

_______. 2007. Guidelines on Mental Health and Psychosocial Support in Emergency

Settings.

_______. 2008a. Human Rights and Natural Disasters: Operational Guidelines and
Field Manual on Human Rights Protection in Situations of Natural Disaster. USA:
Booking-Berns Project on Internal Displacement.

_______. 2008. Policy Statement: Gender Equality in Humanitarian Response: 20th June
2008.

International Federation of Red Cross and Red Crescent Movement (IFRC). 1994. Code
of Conduct for the International Red Cross and Red Crescent Movement and NGOs in
Disaster Relief. Switzerland: IFRC.

_______. 2007. World Disaster Report 2007. USA/UK: Kumarian Press/Eurospan.

_______. 2009. World Disaster Report 2009. USA/UK: Kumarian Press/Eurospan.

International Planned Parenthood Federation (IPPF). 2006. Tsunami: Supporting

Communities and Rebuilding Lives. UK: IPPF.

P a g e | 61
International Union for Conservation of Nature and Natural Resources (IUCN). 2006.
Hearing Their Voices: Women and Children in Earthquake- Affected Areas of
Pakistan. Switzerland: IUCN.

_______ and Women Environment Development Organisation (WEDO). 2008. Gender

Equality and Adaptation. WEDO Available at www.genderandenvrionment.org
Accessed 20 November 2008.

Lauza-Ugsang, J. 2008. Monitoring country activities: Regional. ARROWs For

Change. Vol. 14, No. 3, p.6.

McGinn, T. and Purdin, S. 2005. Editorial: Reproductive Health and Conflict: Looking
Back and Moving Ahead. Disasters. Vol. 28, Issue 3, pp.235-238.

Miller, A.C.; Arquillo, B. 2007. Disasters, womens health and conservative societies:
Working in Pakistan with the Turkish Red Crescent following the South Asian
Earthquake. Prehospital and Disaster Medicine, July-August. Available at
http://pdm.medicine.wisc.edu/22-4%20PDFs/miller.pdf Accessed 26 August 2009.

Mumtaz, K. 2008. Monitoring Country Activities: Pakistan. ARROWs For Change.

Vol. 14 No. 3.

Murthy, R.K.; Sagayam, J. 2006. A study on non-discrimination in the tsunami

rehabilitation programme in India. India: Save the Children Tsunami Rehabilitation
Programme in India.

Murthy, R.K. 2008. Fact File: Disaster Legislations in Six Asia-Pacific Countries: A
Review from an SRHR and Feminist Lens. ARROWs For Change. Vol. 14, No. 3,
p.12.

Oosters, Barbara. 2005. Looking with a disability lens at the disaster caused by tsunami
in South East Asia. Chrisoffel Blind Mission-Christian Blind Mission.

Oxfam Hong Kong. 2008a. One month on: Oxfam Hong Kong review of relief work
and five-year plan in Siachen and Gansu after 12 May earthquake.

_______. 2008b. Three Months on: A report on Oxfam Hong Kongs response to the
China Earthquake of 12 May.

Oxfam GB. 2000. Oxfam GB Response to the South Asia Drought - Update 24 Jul
2000. Available at www.reliefweb.int/r Accessed 20 November 2008.

P a g e | 62
_______. 2006. Oxfam's work in Bangladesh: In-depth humanitarian work. Available
at www.oxfam.org.uk/resources/countries/bangladesh_humanitarian.htm Accessed 20
November 2005.

_______. 2007a. Concept Paper (V2) on Early Recovery in Bangladesh Flood 2007.
Bangladesh: Oxfam GB. (mimeo)

Oxfam International. 2005. Indonesia in Oxfam tsunami accountability report:

December 2005. UK: Oxfam International.

Peoples Republic of China (PRC). 2008. The State Overall Planning for Post-
Wenchuan Earthquake Restoration and Reconstruction (Public Opinion Soliciting
Draft). China: State Planning Group of Post-Wenchuan Earthquake Restoration and
Reconstruction, PRC.

Pincha, C., et al. 2007. Understanding Gender Differential Impacts of Tsunami and
Gender Mainstreaming Strategies in Tsunami Response in Tamil Nadu. India: Oxfam
America and Anawim Trust.

Pincha, C. 2008. Gender Sensitive Disaster Management: A Toolkit for Practitioners.

India: Earthworm Books.

_______ and Harikrishna. 2008. Aravanis: the Voiceless Victims of Tsunami.

Humanitarian Practice Network. Vol. 41.

Pittaway, E.; Bartolomei, L. ; Rees, S. 2007. Gender dimensions of the 2004 tsunami
and a potential social work response in post-disaster situation. International Social
Work. Vol. 50, No. 3, pp.307-319.

Pradhan, E.K., et al. 2007. Risk of flood-related mortality in Nepal. Disasters. Vol. 31,
No. 1, pp. 57-70.

Rashid, R.F. 2000. The urban poor in Dhaka City: Their struggles and coping strategies
during the floods of 1998. Disasters. Vol. 24, Issue 3, pp. 240-253.

Rashid, S.F. ; Michaud, S. 2000. Female adolescents and their sexuality: Notions of
honour, shame, purity and pollution during the floods. Disasters. Vol. 24, Issue 1,
pp. 54-70.

Reproductive Health Matters. 2008. Vol. 16, Issue 31: Conflict and Crisis Settings:
Promoting Sexual and Reproductive Rights.

Reproductive Health Outlook. 2004. Refugee Reproductive Health. Available at

www.rho.org Accessed 15 August 2008.

P a g e | 63
Republic of Indonesia. 2005. Master Plan for the Rehabilitation and Reconstruction of
the Regions and Communities of the Province of Nanngre Aceh Darussalam and the
Islands of Nias, Province of North Sumatra.

_______. 2006. National Action Plan for Disaster Reduction 2006-2009. Indonesia:
Republic of Indonesia/UNDP.

Schwekendeik, D. 2008. The North Korean standard of living during famine. Social
Science and Medicine. Vol. 66, pp.596-608.

Swasti and Oxfam International. 2007. Understanding the Vulnerability of Coastal

Communities to HIV/AIDS in Tsunami-Hit Areas of India. India: Oxfam America.

Taylor, A.W.J. 2003. Cross-cultural appraisal of disaster trauma in three Pacific Island
Countries. Asia-Pacific Viewpoint. Vol. 44, No. 2, pp.177-193.

The Sphere Project. 2004. Humanitarian Charter and Minimum Standards in Disaster
Response. Switzerland: IFRC.

United Nations (UN). 1966. International Covenant on Economic, Social and Cultural
Rights. Adopted and opened for signature, ratification and accession by General
Assembly resolution 2200A (XXI) of 16 December 1966, United Nations, New York.

_______. 1974. Declaration on the Protection of Women and Children in Emergency

and Armed Conflict. Proclaimed by General Assembly resolution 3318(XXIX) of 14
December 1974, United Nations, New York.

_______. 1979. Convention on the Elimination of all Forms of Discrimination Against

Women. General Assembly Resolution of 18 December, 1979.

_______. 1989. Child Rights Convention. Adopted and opened for signature, ratification
and accession by General Assembly resolution 44/25 of 20 November 1989.

_______. 1992. United Nations Framework Convention on Climate Change.

FCCC/INFORMAL/84/GE.05-62220 (E) 200705, United Nations, New York.

_______. 1994a. Programme of Action of the International Conference on Population

and Development. Report of the International Conference on Population and
Development, 5-13 September, 1994, UN Doc. A/CONF.171/13

_______. 1994b. Elaboration of an International Convention To Combat Desertification

in Countries Experiencing Serious Drought and or Desertification, Particularly in
Africa, A/AC.241.27

P a g e | 64
_______. 1995. Beijing Declaration and Platform for Action. Fourth World Conference
on Women, 15 September 1995, A/CONF.177/20 (1995) and A/CONF.177/20/Add.1
(1995).

_______. 2000a. The Right to the Highest Attainable Standards of Health. 11/08/2000,
E/C.12/2000/4 (General Comments) Committee on the Economic and Social Cultural
Rights, Twenty Second Session, Geneva, 25th April- 12 May, 2000.

_______. 2000b. OCHA Situation Report No. 1 India Drought, 18 May 2000. New
York/Switzerland: Office of the Coordination of Humanitarian Affairs.

_______. 2000c. UN's Rapid Response to Drought in Rajasthan and Gujarat, 18 May
2000.

_______. 2003. Secretary Generals Bulletin: Special Measures for Protection from
Sexual Exploitation and Sexual Abuse. ST/SGB/2003/13, 9th October, 2003.

_______. 2005. Indian Ocean Earthquake Tsunami 2005 Mid-Term Review,

Consolidated Appeal Process. New York/Switzerland: Office of the Coordination of
Humanitarian Affairs.

_______. 2007. CERF allocates US$ 6 million to support the humanitarian response to
floods. New York/Switzerland: Central Emergency Response Fund, Office of the
Coordination of Humanitarian Affairs.

United Nations Childrens Fund (UNICEF). 2000. UNICEF Report on the Drought and
Floods in India. Available at www.unicef.org/emerg

_______. 2005. Revised Country Programme Document Indonesia (2006-2010).

E/ICEF/2005/P/L.35/Rev1
United Nations Childrens Fund, 2006, Revised Country Programme Document China
(2006-2010). New York: UNICEF.

_______. 2007. UNICEF situation report Bangladesh floods - external 06 August

2007. Available at www.reliefweb.int/rw/rwb.nsf/db900SID/LSGZ-
75WDP9?OpenDocument

United Nations Division for Advancement of Women. 2004. Women 2000 and Beyond:
Making risky environment safer, women building sustainable and disaster resilient
communities.

P a g e | 65
United Nations High Commissioner for Refugees (UNHCR). 1999. Chapter 2:
Minimum Initial Service Package. Reproductive Health in Refugee Situations: An
Inter-Agency Field Manual. Switzerland: UNHCR. Available at
www.unfpa.org/emergencies/manual/ Accessed 20 November 2008.

_______. 2007. Convention and Protocol Related to Status of Refugees. Switzerland:

UNHCR. Available at www.unhcr.org/protect/PROTECTION/3b66c2aa10.pdf

_______. 2008. UNHCR Handbook for the Protection of Women and Girls. Switzerland:
UNHCR.

United Nations HIV Emergency Task Team. 2008. Newsletter. Vol. 3.

United Nations in China. 2008. UN China Appeal for Wenchuan Earthquake Early
Recovery Support: July 2008. China: United Nations in China.

United Nations International Strategy for Disaster Risk Reduction (UNISDR). 2005.
Hyogo Framework for Action 2005-2015, Building the Resilience of Nations and
Communities to Disasters. Switzerland: UNISDR.

USAID. 2001. USAID India: Drought Fact Sheet #1, FY 2001. Available at
www.reliefweb.int/r Accessed 20 November 2008.

Wayte, K., et al. 2008. Conflict and development: Challenges in responding to sexual
and reproductive health needs in Timor Leste. Reproductive Health Matters. Vol. 16,
No. 31, pp. 83-92.

World Health Organisation. 2006. The Inter-Agency Emergency Health Kit.

_______. 2008b. 2008-2009 Programme Budget China. Switzerland: WHO.

_______. n.d. Emergency and Humanitarian Action: Country Report Indonesia EHA in
the WHO South-East Asia Region. Available at
www.searo.who.int/LinkFiles/EHA_CP_Indonesia.pdf Accessed 13 August 2009.

_______. n.d. Emergency and Humanitarian Action: Country Report Bangladesh EHA in
the WHO South-East Asia Region. Available at
www.searo.who.int/LinkFiles/EHA_CP_Bangladesh.pdf Accessed 13 August 2009.

_______. n.d. Emergency and Humanitarian Action: Country Report India EHA in the
WHO South-East Asia Region. http://www.searo.who.int/linkfiles/eha_cp_india.pdf
Accessed 13 August 2009/

Womens Commission for Refugee Women and Children. 2003. MISP Fact Sheet.

P a g e | 66
_______. 2005. Reproductive Health Priorities in Emergencies: An Assessment of the
Minimum Initial Service Package in Tsunami Affected Areas in Indonesia: February-
March, 2005.

P a g e | 67