Acil Durum ve Afetlerde Cinsel Sağlık Ve Üreme Sağlığı “Minimum Başlangıç Hizmet Paketi (MISP)” ve Ebelik

Abstract

Kriz ortalamalarında cinsel sağlık ve üreme sağlığı (CSÜS) sorunlarına bağlı olarak önlenebilir nedenlerle oluşan mortalite ve morbidite riskini azaltmak amacıyla hızlı, organize ve erişilebilir sağlık bakımı sunulmalıdır. Bu amaç doğrultusunda; yeterli sayıda nitelikli sağlık personeline, yeteri düzeyde tıbbi ekipmanın sağlanması ve ulaştırılmasına, eşgüdümlü hizmet sunumunun sürdürülmesine ihtiyaç vardır. Bu ihtiyacı karşılayabilmek amacıyla uluslararası kuruluşlar tarafından çeşitli girişimlerde bulunulmuş olup, en önemlisi Kriz Durumunda Üreme Sağlığı için Kurumlar Arası Çalışma Grubu (IAWG) tarafından geliştirilen Minimum Başlangıç Hizmet Paketi (MISP)’dir. MISP, afet ve acil durum koşullarında CSÜS hizmetlerinin kesintisiz bir şekilde sunulmasını sağlayan acil müdahale paketidir. MISP’in temel amacı, kriz ortamlarında kadınlar ve kız çocukları başta olmak üzere tüm etkilenen topluluklarda önlenebilir hastalık ve ölümleri azaltmak, cinsel şiddet ve HIV gibi acil riskleri önlemek ve kapsamlı üreme sağlığı hizmetlerine geçiş için zemin hazırlamaktır. Minimum Başlangıç Hizmet Paketi (MISP), riskleri azaltmak amacıyla geliştirilen ve kriz koşullarında anne ve yenidoğan sağlığının korunması, cinsel sağlığın sürdürülmesi ve HIV dahil bulaşıcı enfeksiyonların önlenmesi için hızlı, koordineli ve kaliteli hizmet sunumunu hedefleyen kapsamlı bir stratejik çerçevedir. Bu paket, insani müdahalelerde sağlık sisteminin temel unsurlarını güçlendirerek sürdürülebilir bir iyileşme süreci için temel oluşturmaktadır. MISP, acil ve afet durumlarında uluslararası bakım standardı oluşturmak amacıyla geliştirilmiş olup, olağanüstü durumlarda CSÜS hizmetlerinin sürdürülmesinde acil bir gerekliliktir. Bu derlemede; MISP’in acil ve afet durumlarında önemi, işleyişi, içeriği, uygulama basamakları, hizmet sunumu sırasında yaşanan olası durumlar, ebelerin olağanüstü durumlarda rolleri ve MISP açısından önemini değerlendirmek amaçlanmaktadır.

Keywords

• Minimum Hizmet Paketi
• İnsani Yardım
• Üreme Sağlığı
• Ebelik
• Kadın Sağlığı

Sexual and Reproductive Health in Emergencies and Disasters: Minimum Initial Service Package (MISP) and Midwifery

Abstract

In crisis settings, rapid, organized, and accessible healthcare services should be provided to reduce the risk of mortality and morbidity associated with preventable causes related to sexual and reproductive health (SRH) issues. To achieve this goal, it is essential to ensure the availability of a sufficient number of qualified health professionals, adequate medical equipment and supplies, and the maintenance of coordinated service delivery. To address these needs, various initiatives have been launched by international organizations, the most significant of which is the Minimum Initial Service Package (MISP) developed by the Inter-Agency Working Group on Reproductive Health in Crises (IAWG). The MISP is an emergency response package designed to ensure the continuity of SRH services during disasters and humanitarian emergencies. Its primary objective is to reduce preventable morbidity and mortality among all affected populations—particularly women and girls—by preventing urgent risks such as sexual violence and HIV infection and by laying the groundwork for the transition to comprehensive reproductive health services. The MISP serves as a comprehensive strategic framework developed to mitigate risks and to ensure the provision of rapid, coordinated, and high-quality health services that protect maternal and newborn health, maintain sexual health, and prevent infectious diseases, including HIV, during crises. This package strengthens the essential components of the health system within humanitarian interventions and forms the foundation for a sustainable recovery process. Developed as an international standard of care for emergencies and disaster situations, the MISP represents a critical necessity for maintaining SRH services under extraordinary circumstances. This review aims to evaluate the importance, functioning, content, and implementation steps of the MISP during emergencies and disasters, as well as the potential challenges encountered during service delivery and the vital roles and significance of midwives in relation to the MISP in crisis contexts. The MISP serves as a comprehensive strategic framework developed to mitigate risks and to ensure the provision of rapid, coordinated, and high-quality health services that protect maternal and newborn health, maintain sexual health, and prevent infectious diseases, including HIV, during crises. This package strengthens the essential components of the health system within humanitarian interventions and forms the foundation for a sustainable recovery process. Developed as an international standard of care for emergencies and disaster situations, the MISP represents a critical necessity for maintaining SRH services under extraordinary circumstances. This review aims to evaluate the importance, functioning, content, and implementation steps of the MISP during emergencies and disasters, as well as the potential challenges encountered during service delivery and the vital roles and significance of midwives in relation to the MISP in crisis contexts.

Keywords

• Minimum Initial Service Package
• Humanitarian Emergencies Reproductive Health
• Midwifery
• Women Health

References

1. UNFPA. Minimum Initial Service Package (MISP) for SRH in crisis situations [Internet]. Available from: https://www.unfpa.org/resources/minimum-initial-service-package-misp-srh-crisis-situations. Accessed 2023 Jun 1.
2. Davidson N, Hammarberg K, Romero L, Fisher J. Access to preventive sexual and reproductive health care for women from refugee-like backgrounds: a systematic review. BMC Public Health. 2022;22(1):403.
3. Foster AM, Evans DP, Garcia M, Knaster S, Krause S, McGinn T, et al. The 2018 Inter-agency field manual on reproductive health in humanitarian settings: revising the global standards. Reprod Health Matters. 2017;25(51):18–24.
4. Inter-Agency Working Group on Reproductive Health in Crises (IAWG). Inter-agency field manual on reproductive health in humanitarian settings: 2010 revision for field review [Internet]. Inter-Agency Working Group on Reproductive Health in Crises; 2010. Available from: http://iawg.net/resource/inter-agency-field-manual-on-reproductive-health-inhumanitarian-settings-2010
5. The Sphere Handbook [Internet]. Available from: https://spherestandards.org/wp-content/uploads/Sphere-Handbook-2018-EN.pdf. Accessed 2023 Jun 1.
6. IAWG. Minimum Initial Service Package (MISP) Advocacy Sheet [Internet]. Available from: https://iawg.net/resources/minimum-initial-service-package-advocacy-sheet. Accessed 2023 May 30.
7. UNFPA. The Minimum Initial Service Package (MISP) for Sexual and Reproductive Health (SRH) in crisis situations [Internet]. Available from: https://www.unfpa.org/resources/minimum-initial-service-package-misp-srh-crisis-situations. Accessed 2023 May 28.
8. IAWG. Minimum Initial Service Package (MISP) Process Evaluation Tools (Revised 2022) [Internet]. Available from: https://iawg.net/resources/minimum-initial-service-package-misp-process-evaluation-tools-revised-2022. Accessed 2023 May 28.

9. Starrs AM, Ezeh AC, Barker G, Basu A, Bertrand JT, Blum R, et al. Accelerate progress—sexual and reproductive health and rights for all: report of the Guttmacher–Lancet Commission. Lancet. 2018;391(10140):2642–92.
10. World Health Organization. Promoting sexual and reproductive health for persons with disabilities: WHO/UNFPA guidance note. Geneva: World Health Organization; 2009.
11. Tran NT, Greer A, Kini B, Abdi H, Rajeh K, Cortier H, Boboeva M. Integrating sexual and reproductive health into health system strengthening in humanitarian settings: a planning workshop toolkit to transition from minimum to comprehensive services in the Democratic Republic of Congo, Bangladesh, and Yemen. Confl Health. 2020;14(1):1–12.
12. Myers A, Sami S, Onyango MA, Karki H, Anggraini R, Krause S. Facilitators and barriers in implementing the Minimum Initial Services Package (MISP) for reproductive health in Nepal post-earthquake. Confl Health. 2018;12(1):1–9.
13. Fouad FM, Hashoush M, Diab JL, Nabulsi D, Bahr S, Ibrahim S, et al. Perceived facilitators and barriers to the provision of sexual and reproductive health services in response to the Syrian refugee crisis in Lebanon. Women’s Health. 2023;19:17455057231171486.
14. Çöl M, Bilgili Aykut N, Usturalı Mut AN, Koçak C, Uzun SU, Akın A, et al. Sexual and reproductive health of Syrian refugee women in Turkey: a scoping review within the framework of the MISP objectives. Reprod Health. 2020;17:1–12.
15. Module ADL. Minimum Initial Service Package (MISP) for Reproductive Health in Crisis Situations. 2006.
16. Nove A, ten Hoope-Bender P, Boyce M, Bar-Zeev S, de Bernis L, Lal G, et al. The State of the World’s Midwifery 2021 report: findings to drive global policy and practice. Hum Resour Health. 2021;19:1–7.
17. Beek K, McFadden A, Dawson A. The role and scope of practice of midwives in humanitarian settings: a systematic review and content analysis. Hum Resour Health. 2019;17(1):1–16.
18. World Health Organization. Sexual and reproductive health during protracted crises and recovery (No. WHO/HAC/BRO/2011.2). Geneva: World Health Organization; 2011.
19. Inter-Agency Working Group on Reproductive Health in Crises (IAWG). Inter-Agency Field Manual on Reproductive Health in Humanitarian Settings. 2018.
20. Vu A, Adam A, Wirtz A, Pham K, Rubenstein L, Glass N, et al. The prevalence of sexual violence among female refugees in complex humanitarian emergencies: a systematic review and meta-analysis. PLoS Curr. 2014;6. Available from: https://doi.org/10.1371/currents.dis.835f10778fd80ae031aac12d3b533ca7.
21. International Confederation of Midwives (ICM). Position statement: Role of the midwife in disaster/emergency preparedness (PS2014_003). The Hague: International Confederation of Midwives; 2014. Available from: https://www.nurse.or.jp/nursing/international/icm/basic/statement/pdf/Role_of_the_Midwife_in_DisasterEmergency_Preparedness_en.pdf
22. White Ribbon Alliance. Respectful maternity care charter: the universal rights of women and newborns. Washington (DC): White Ribbon Alliance; 2019.