Abstract
MISP for SRH operates on a six-point agenda that is to identify the lead SRH implementor, GBV mitigation, emergency humanitarian response, HIV and STIs prevention and management, reduction of maternal and infant mortality and morbidity, prevent early and unintended pregnancies and integration of SRH into primary care. On the contrary, IAF Manual recommends a comprehensive and integrated reproductive health care approach in humanitarian settings. Furthermore, it holistically addresses reproductive health issues and underscores the need to incorporate reproductive health services in humanitarian crisis action plans. The manual advocates for a coordinated and comprehensive response, capacity building, a dignified service delivery model, specificity of needs and challenges, family planning and STIs integration, and GBV prevention. The two differ in scope, focus, depth, and implementation duration. These differences ensure comprehensive delivery of reproductive healthcare in the short and long-term while necessitating long-term capacity building. The upcoming edition should incorporate guidelines on post-abortion care, mental healthcare, LGBTQ+ inclusivity, improved community participation, and increased multi-sector integration and collaboration. Finally, the next MISP for the SRH edition should incorporate emerging best practices and evidence-based findings.
Keywords: IAF Manual, MISP for SRH, GBV mitigation, HIV and STIs prevention, LGBTQ+ inclusivity, comprehensive and coordinated, integrated reproductive health, emergency humanitarian response, humanitarian settings, maternal and infant mortality, and morbidity
Sexual and Reproductive Health in Humanitarian Settings
Overview of Inter-Agency Manual (IAFM)
Inter-Agency Field Manual 2018 serves as a blueprint providing practical recommendations while emphasizing the need for a comprehensive and integrated reproductive health care approach in a humanitarian setting. The Manual is a critical reference point for reproductive health professionals during emergencies. It holistically addresses reproductive health issues that encompass family planning, prevention and management of STIS, and maternal and infant health (IAWG-MISP, 2010). The IAF Manual underscores the need to incorporate reproductive health services in humanitarian crisis action plans. Most importantly, the Manual emphasizes victims’ right to reproductive health services. Emergency and humanitarian field workers use the Manual as a basis to provide reproductive health services in humanitarian crises in a more dignified manner (IAWG-MISP, 2010).
The Manual addresses women’s and children’s critical needs and vulnerability, suggests approaches ideal for humanitarian settings and underscores the need for humanitarian actors to understand specific reproductive healthcare needs and challenges (IAWG-MISP, 2010). It proposes an integrated healthcare model incorporating family planning, maternal health, STI prevention and management, infant health, gender-based violence prevention, and adolescent reproductive health. Furthermore, it recommends the need for a coordinated and comprehensive humanitarian response. It helps in capacity building, ensuring the provision of reproductive health services in a dignified and culturally sensitive manner (IAWG-MISP, 2010). Furthermore, it emphasizes the need to address different aspects of reproductive health, including physical, emotional, and psychosocial.
MISP for SRH 2010 LDM Overview
MISP for SRH underscores the need for a comprehensive, well-coordinated humanitarian response effort and a coordination group (IAWG-MISP, 2018). Secondly, it emphasizes the need for the prevention of STIs, GBV. Clinical care for GBV victims while ensuring the psychosocial and emotional well-being of the affected individuals and communities. Thirdly, it highlights the need for integrated and comprehensive emergency obstetric care (CEmOC) while ensuring timely, effective, and responsive delivery of emergency obstetric healthcare (IAWG-MISP, 2018). It also highlights the importance of reproductive health and Family planning and the need for effective communication between emergency healthcare providers and the affected individuals and communities. The MISP for SRH Manual provides guidelines for emergency healthcare professionals to ensure the dignified treatment of the affected individuals and responsive delivery of SRH services (IAWG-MISP, 2018).
Inter-Agency Field Manual (IAFM) vs. MISP for SRH: Differences
The IAF 2018 Manual and MISP for SRH 2010 have more similarities than differences. First and foremost, the two differ in scope and focus. IAF Manual 2018 has a broader scope and focus and provides comprehensive guidelines and practical recommendations regarding reproductive healthcare in humanitarian crises (Dawson et al., 2022). It underscores needs assessment, STIs, GBV, maternal and infant health, and adolescent health. On the contrary, MISP for SRH has a narrow scope and focus as it addresses a subset of critical healthcare, SRH, in a humanitarian setting (IAWG-MISP, 2018). While MISP for SRH focuses on SRH, IAF Manual provides broad-based guidelines for reproductive health that encompass SRH. However, MISP for SRH is a standardized model for the delivery of effective, timely, and well-coordinated SRH healthcare needs and covers narrower aspects of reproductive health such as emergency obstetric care, GBV response, family planning, STI, and care of sexual violence victims. Despite their minor differences, the two intersect on matters of reproductive health.
The two also differ in detail since IAF Manual provides detailed guidelines on reproductive healthcare in humanitarian crises (Dawson et al., 2022). On the contrary, MISP for SRH provides minimal recommendations on SRH services in humanitarian settings. Unlike IAF Manual, MISP for SRH outlines necessary actions to be undertaken at the onset of a humanitarian crisis. Though it is less detailed than IAF Manual, MISP for SRH is simple for ease of implementation in emergencies. Still, the two also differ on the mandate. IAF MISP offers detailed guidelines for delivering reproductive health throughout humanitarian crises and promotes a holistic reproductive health model. On the contrary, MISP for SRH underscores the delivery of immediate SRH needs only in the preliminary stages of a humanitarian crisis. Hence its primary focus is delivering immediate SRH needs rather than holistic reproductive healthcare needs.
The Impact of the Differences on vulnerable populations
The differences between Inter-Agency Field Manual (IAF Manual) and MISP for SRH can impact the lives and health of pregnant capable people in diverse ways. (IAWG.-MISP, 2018). In humanitarian settings, IAF Manual provides a holistic reproductive healthcare framework for use throughout the humanitarian crisis. This comprehensive approach ensures that women and girls receive effective reproductive healthcare services beyond the initial stages of a humanitarian crisis. On the other hand, MISP’s focus on immediate needs ensures the delivery of critical services at the onset of a crisis, helping address immediate health risks (IAWG-MISP, 2010).
IAF Manual promotes a comprehensive reproductive healthcare approach that considers the multifaceted aspects of reproductive healthcare, whereas MISP for SRH focuses (Dawson et al., 2022). The approach ensures effective reproductive healthcare service delivery. On the other hand, MISP’s emphasis on immediate delivery of minimum essential services ensures that critical reproductive healthcare needs are addressed. Still, IAF Manual promotes capacity building as opposed to immediate humanitarian needs. Long-term capacity building is essential for sustainability, long-term reproductive health, and the well-being of the affected populations (Rose et al., 2023). However, MISP for SRH’s focus on immediate SRH needs is also crucial as it ensures timely delivery of emergency healthcare needs in the short term. Still, the IAF Manual framework provides customized interventions focused on essential needs, necessitating the adaptation of reproductive healthcare strategies to diverse humanitarian settings (Ireland et al., 2021).
On the other hand, MISP’s standardized model promotes short-term consistency in the delivery of reproductive healthcare. The differences between IAF Manual and MISP for SRH ensure that immediate and longer-term reproductive healthcare needs are addressed in the initial stages and throughout the humanitarian crisis (IAWG-MISP, 2018). These differences contribute to improved reproductive health and context-specific interventions throughout a humanitarian crisis.
What is missing in MISP for SRH
MISP for SRH has shortfalls that should be addressed in the next edition. Firstly, the current edition does not prescribe comprehensive post-abortion care. The provision of safe and legal post-abortion treatment and care should be prioritized in the next edition (Nguyen et al., 2021). The current edition of MISP lacks comprehensive Mental Health and Psychosocial Support (MHPSS). The next edition should strongly emphasize mental health and psychosocial interventions (Dawson et al., 2022). Other areas MISP must prioritize menstrual health management, LGBTQ+ inclusivity, improved community participation and engagement, and increased multi-sector integration and collaboration (Ireland et al., 2021). MISP must ensure relevance and effectiveness (Nguyen et al., 2021). Guidelines that are inconsistent with modern evidence-based practice should be eliminated and replaced. The next edition should incorporate emerging best practices and evidence-based findings to enhance clarity and ease of implementation in humanitarian settings.
Conclusion
Inter-Agency Field Manual (IAFM) offers comprehensive reproductive health service delivery recommendations throughout a humanitarian crisis. In contrast, MISP for SRH offers a focused framework for delivering immediate SRH essential services only at the onset of a humanitarian crisis. The two differ in scope, focus, depth, and implementation duration. The differences ensure comprehensive delivery of reproductive healthcare in the short and long-term while necessitating long-term capacity building. The next edition should incorporate guidelines on post-abortion care, mental healthcare, LGBTQ+ inclusivity, improved community participation, and increased multi-sector integration and collaboration. Finally, the next MISP for the SRH edition should incorporate emerging best practices and evidence-based findings.
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