Reproductive health during conﬂict Benjamin O Black MBBS MSc MRCOG, a, * Paul A Bouanchaud BSc MSc, b Jenine K Bignall BSc MBBS DRCOG DFSRH, c Emma Simpson BSc MSc, d Manish Gupta BSc MB ChB, MRCP MRCOG e a Specialist Trainee Obstetrics & Gynaecology, The Whittington Hospital, Magadala Avenue, London N19 5NF, UK b LSE Fellow in the Department of International Development, London School of Economics and Political Science, Department of Social Policy, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK c Specialist Trainee Community Sexual and Reproductive Health, Margaret Pyke Centre, Wicklow Street, London WC1X 9HL, UK d Global Health Consultant, London, UK e Consultant Obstetrician and Subspecialist in Maternal and Fetal Medicine, Whipps Cross University Hospital, London E11 1NR, UK *Correspondence: Benjamin O. Black. Email: drbenjaminblack@gmail.com Accepted on 12 April 2014 Key content  Reproductive health (RH) outcomes worsen during conﬂict and displacement, the causes of which are considered multi-factorial.  In conﬂict and displacement settings, there are unique challenges in providing emergency obstetric care.  There has been increased recognition of the need to provide adequate RH in emergency responses.  Providing appropriate assistance to populations affected by conﬂict requires continued monitoring and evaluation, and the further development of life-saving interventions. Learning objectives  To understand the effect of conﬂict on RH.  To discuss the reasons why RH outcomes worsen during conﬂict and displacement.  To consider the ways in which responses can be made during an emergency. Ethical issues  Should RH be considered a priority during an emergency response to conﬂict and disasters?  Does offering RH assistance to conﬂict-affected populations put other local groups at a disadvantage?  Will greater knowledge of how conﬂict and displacement affect RH help in understanding and treating refugees and asylum seekers in the UK? Keywords: conﬂict / emergency / humanitarian / refugees / reproductive health Please cite this paper as: Black BO, Bouanchaud PA, Bignall JK, Simpson E, Gupta M. Reproductive health during conﬂict. The Obstetrician & Gynaecologist 2014; DOI: 10.1111/tog.12114. Introduction The act of war and its associated societal effects pose speciﬁc challenges to ensuring that the reproductive health (RH; Box 1) needs of the affected population are met. It is estimated that approximately 1.5 billion people are currently living in countries affected by conﬂict, fragility, or large-scale violence. 1 Conﬂict can negatively impact all aspects of RH, 2 directly through damage to services, gender-based violence (GBV), and forced displacement of populations, and indirectly through reductions in the availability of basic health care and breakdown of normal social institutions. This article takes a broad deﬁnition of conﬂict, encompassing any armed violence between groups, including state or non-state actors, either within or between existing states. Whereas the focus is on conﬂict, the issues raised are applicable to most crisis settings, such as following natural disasters or economic collapse. The primary purpose of this broad review is to raise awareness among obstetric and gynaecological clinicians of the wide implications that conﬂict has on the RH of affected populations. The literature used in this review will also serve as an excellent resource for those who wish to read further around these topics. Reproductive health A universal human right For 20 years, RH has been formally recognised as a human right; in 1994, the Women’s Commission for Refugee Women and Children called for greater recognition of unmet RH needs among displaced populations, something largely ignored until then. 3 The International Conference on Population and Development, 4 held in Cairo the same year, widened the international community’s deﬁnition of RH and identiﬁed it as a basic human right, recognised in law and ª 2014 Royal College of Obstetricians and Gynaecologists 1 DOI: 10.1111/tog.12114 The Obstetrician & Gynaecologist http://onlinetog.org Review