Comprehensive contraceptive service delivery in a crisis setting

Location:

Introduction:

The Syrian civil war has triggered the largest, most complex humanitarian response since the United Nations Office for the Coordination of Humanitarian Affairs declared it an emergency in September 2012. One of the biggest challenges for humanitarian agencies has been accessing affected populations in areas controlled by armed opposition groups. Much of the response for this crisis has focused on trauma care and primary health care, with little attention to sexual and reproductive health (SRH). In northern Syria, CARE has provided a wide range of sexual and reproductive health services like family planning and contraceptive services, referrals to emergency obstetric care, and management of sexual violence. Contraceptive services included short-acting methods as well as long acting reversible contraception, specifically IUDIntrauterine devices. This has been possible because of a collaboration to provide integrated SRHSexual and reproductive health services between CARE, Syria Relief and Development, and UNFPAUnited Nations Population Fund. Contraceptive services were integrated into primary health care services provided in static health facilities (supported by another donor) as well as mobile SRHSexual and reproductive health clinics to take services to the communities.

Project Description:

At the primary health care level, both at static and mobile SRHSexual and reproductive health clinics, midwives and nurses provided contraceptive services, including counseling, pregnancy testing, and a range of contraceptive methods (IUDIntrauterine devices, injectables, oral contraceptive pills, progestin-only emergency contraception, and condoms). Additionally, they provided clean delivery kits (for those who could not or would not deliver in a facility), antenatal care, safe delivery services, postnatal care, syndromic management of STISexually transmitted infections, health education, and referrals for safe delivery and emergency obstetric care.

Results:

These interventions have proven to be successful, as this partnership has created 10 primary health clinics, 10 mobile clinics serving 60 communities and accounting for 61% of all family planning service delivery, and 1 “Women and Girls’ Safe Space.” Overall, the partnership has reached an estimated 388,660 people, including 97,165 women of reproductive age. Between April 2016 and July 2017, the partnership provided 60,876 family planning services including 9,726 IUDIntrauterine device insertions, 7,156 injections with Depo-Provera, 22,611 cycles of oral contraceptives and 10,711 condoms.

Lessons Learned:

Pre-crisis, oral contraceptive pills dominated the method mix and now the preferred method is IUDIntrauterine devices due to increased access to contraceptive services and supplies.