By any measure, the global humanitarian system has become faster, more sophisticated and better funded over the past three decades. Yet, when crises strike – whether through war, climate disaster, famine or disease outbreak, one of the most predictable failures remains the same: the systematic neglect of women’s sexual and reproductive health.
From policy corridors to field hospitals, the pattern is depressingly familiar. Relief operations mobilise swiftly with food, water and shelter. But sexual and reproductive health despite being central to survival, barely registers in the initial response. It is only when preventable deaths mount and long-term damage becomes impossible to ignore that attention arrives, often too late.
A recent analysis by the United Nations Population Fund (UNFPA), reviewing Minimum Initial Service Package (MISP) readiness across dozens of countries between 2021 and 2024, lays this failure bare. Drawing on assessments from 77 countries, it confirms what practitioners have long known: despite rhetoric around gender-sensitive aid, women and girls remain dangerously exposed in emergencies.
The Minimum That Is Rarely Met
The irony is stark. The MISP, developed in the mid-1990s by the Inter-Agency Working Group on Reproductive Health in Crises, was never intended to be ambitious. It outlines a basic, non-negotiable set of life-saving interventions to be activated within hours of a crisis.
These include preventing sexual violence, reducing HIV transmission, ensuring safe childbirth, providing contraception, and where legal, offering safe abortion care. This is not an aspirational framework; it is the bare minimum standard for any credible humanitarian response.
And yet, the study shows that even this floor is frequently missing.
Policy Without Priority
Most countries today can point to national disaster management frameworks and health preparedness plans. On paper, the architecture exists. In practice, however, sexual and reproductive health is either absent or treated as an afterthought.
In nearly three-quarters of the countries surveyed, emergency frameworks make no meaningful reference to MISP. Even more concerning, long-term development strategies, where resilience should be built, rarely address reproductive health preparedness at all.
This is not merely bureaucratic oversight. It reflects a deeper discomfort with recognising that women’s bodies and reproductive needs are central to crisis response, not peripheral to it.
Fragmented Systems, Familiar Failures
Coordination failures further compound the problem. While national disaster committees exist, few countries maintain active sexual and reproductive health working groups that function before emergencies occur. Responsibilities are diffused across ministries, agencies and technical bodies, leading to predictable confusion when crises hit.
The consequences are operationally severe. Supply chain managers and logistics teams, those controlling warehouses, rarely coordinate effectively with clinicians who understand reproductive health needs. At sub-national levels, where most crises are actually experienced, systems are even weaker.
Flying Blind on Critical Data
The absence of reliable data is another critical gap. Without robust information, effective response becomes guesswork.
National health systems often fail to track key sexual and reproductive health indicators. Risk assessments rarely disaggregate data by gender, age or displacement status. Rapid needs assessments seldom include questions on gender-based violence or unintended pregnancies.
In an era capable of tracking infectious disease outbreaks in near real-time, the inability to monitor maternal deaths or sexual violence in crisis zones is not just a technical lapse, it is a moral one.
Chronic Underfunding of Essential Care
Even where intent exists, resources do not follow. Emergency stockpiles are typically geared towards visible relief – food, tents, basic medicines, while critical reproductive health supplies remain scarce.
Essential items such as emergency obstetric kits, post-exposure prophylaxis and rape-management supplies are often missing. Funding mechanisms are slow and unreliable, and when funds do arrive, they are frequently earmarked for more “visible” interventions.
With global aid budgets tightening, programmes related to contraception, sexual violence care and safe abortion services are among the first to be cut, largely due to lingering social and political sensitivities.
Service Delivery: The Weakest Link
At the point of care, the gaps become starkly human.
Facilities often lack trained personnel, clear protocols or even basic privacy for survivors of sexual violence. Maternal health services struggle with shortages of skilled staff, unreliable blood supplies and fragile referral systems. Contraceptive access is inconsistent, and safe abortion care (where legal) is frequently marginalised.
For refugees and internally displaced populations, the situation is even worse. Despite being at heightened risk, their needs are often inadequately integrated into national planning.
A Crisis of Priorities
None of these findings are new. Similar patterns have been observed for decades. What has changed is the scale and complexity of global crises.
Climate change, protracted conflicts and pandemics now intersect, creating layered emergencies. With over 100 million people forcibly displaced worldwide, women and girls form the majority of those affected. Yet their health needs continue to be sidelined.
The Way Forward Is Clear
This report does more than diagnose the problem, it offers a roadmap.
Governments must embed sexual and reproductive health firmly within national emergency frameworks. Coordination mechanisms must be established and tested before crises occur. Dedicated budgets should be ring-fenced, not left vulnerable to shifting donor priorities.
Health systems need trained personnel, resilient supply chains and modernised data systems. Crucially, reproductive health must be integrated across the humanitarian-development-peace continuum, ensuring preparedness is continuous rather than reactive.
For UN agencies, the challenge runs deeper than coordination rhetoric and demands structural correction in how mandates are interpreted and executed on the ground.
The Cost of Inaction
Critics may argue that resources are limited and priorities must be chosen carefully. But this is a false economy.
Sexual and reproductive health interventions are among the most cost-effective in crisis settings. Preventing maternal deaths, treating infections, and addressing sexual violence not only save lives but stabilise families and communities.
The alternative, rising maternal mortality, unsafe abortions, increased HIV transmission and cycles of violence, imposes far greater long-term costs.
A Question of Humanity
Ultimately, the issue is not technical capacity or financial feasibility. It is political will.
The evidence is overwhelming. The tools are available. The costs are modest relative to the stakes. What remains lacking is the resolve to act.
As the next crisis looms, whether in the Pacific, Africa or West Asia, the question is not whether the world can respond better. It is whether it chooses to.
Failing to prioritise sexual and reproductive health in emergencies is not just poor policy. It is a profound failure of basic humanity.
