The emerging international policy agenda for reproductive health services in conflict settings

Over the past 20 years, shifts in the nature of conflict and the sheer numb ers of civilians affected have given rise to increasing concern about provi ding appropriate health services in unstable settings. Concurrently, intern ational health policy attention has focused on sexual and reproductive heal th issues and finding effective methods of addressing them. This article re views the background to the promotion and development of reproductive healt h services for conflict-affected populations. It employs qualitative method s to analyse the development of policy at international level. First we exa mine the extent to which reproductive health is on the policy agendas of or ganisations active in humanitarian contexts. We then discuss why and how th is has come about, and whether the issue has sufficient support to ensure e ffective implementation. Our findings demonstrate that reproductive health is clearly on the agenda for agencies working in these settings, as measure d by a range of established criteria including the amount of new resources being attracted to this area and the number of meetings and publications de voted to this issue. There are, however, barriers to the full and effective implementation of reproductive health services. These barriers include the hesitation of some field-workers to prioritise reproductive health and the number and diversity of the organisations involved in implementation. The reasons for these barriers are discussed in order to highlight areas for ac tion before effective reproductive health service provision to these popula tions can be ensured. (C) 1999 Elsevier Science Ltd. All rights reserved.