Revisiting Humanitarian Action Early: Planting the Seeds for a New Generation

June 2021 – Twenty-six-year-old Ana was seven months pregnant without access to critical prenatal health care. Like many pregnant women living in Venezuela, she faced a horrific choice: remain in her home country, placing her unborn child and her own life at risk, or leave her family, including two daughters to take the dangerous journey across the border to seek health care for herself and her unborn baby in Colombia. “The situation in Venezuela has hit us all really hard. We’ve all cried. Leaving your family is not easy. I migrated during my pregnancy because I didn’t have the resources nor the care as a result of the problems in Venezuela.”

The political and economic crisis and subsequent violence have caused tremendous challenges for Venezuelans to obtain food, access health care, education, employment opportunities and much more. The COVID-19 pandemic has worsened the situation as the border with Colombia closed in March 2020. Despite the border closure, Venezuelans like Ana, faced with this horrific choice, are still making the even more treacherous journey across the border at unsafe entry points, where people are subject to extortion demands by border gangs, violence, exploitation and more.

Ana is one of the few who made it across the border before it closed and was able to access Save the Children Colombia’s Emergency Health Clinic at the Colombian border. She said, “At the time when I came here, I had an at-risk pregnancy and was hospitalized as a result. I had kidney stones…and I had very low haemoglobin levels. But thank God I went to a doctor, and I received excellent care and a (blood) transfusion.”

Unfortunately, Ana’s story is not unusual. UNICEF estimated that in 2018, 29 million babies (approximately 1 in 5) were born into conflict affected areas. Among the displaced, 30-34 million are children, which is the entire populations of Australia, Denmark and Mongolia combined. Women account for about 16 million of those displaced.

Pregnant women, nursing mothers and women with young children face additional challenges when they are displaced. The United Nations Population Fund (UNFPA) estimates that in 2018, 3.6% of those affected by humanitarian emergencies were pregnant women and girls (5 million out of 136 million). Pregnant women and girls in humanitarian situations are at a higher likelihood to experience unsafe deliveries as skilled birth attendants and emergency obstetric care can be limited or unavailable.

According to the 2021 Lancet Series, women of reproductive ages living near heavy conflict are three times more likely to lose their lives than women in peaceful settings, and in the span of 20 years (1995- 2015), the death of 10 million children under the age of 5 can be attributed to conflict. Current research indicates the impacts of conflict on women and children can result in malnutrition, physical injuries, infectious diseases, poor mental health, and poor sexual and reproductive health. Women and girls are also at a higher risk of early pregnancy loss, birth defects, low birth weight and pre-term births in emergencies as they would not have the same access to ante-natal and nutrition support. Evidence of research conducted up to 2015 found that 15% of pregnant women and girls in humanitarian crises could experience an obstetric complication, which often results in maternal death or preventable long-term health consequences.

The Nurturing Care Framework illustrates 5 key areas that young children need to survive and thrive: good health, adequate nutrition, responsive caregiving, security and safety and opportunities for early learning. Additionally, the Nurturing Care Framework outlines that critical role of supporting children’s caregivers.

Thus, support to both children and their families (including supporting pregnant women and new mothers) is crucial for all children to survive and thrive. A 2018 analysis of Humanitarian and Refugee Response Plans revealed that only a small fraction of the key recommendations from the Nurturing Care Framework were included. This analysis showed that 58% of humanitarian response plans considered the nutrition needs of young children and their families (including nursing mothers and pregnant women), 22% included maternal and child health, 24% included safety and security, 10% included responsive caregiving and 9% included early learning.

There is clearly much to be done to put children in humanitarian crises on the right track to survive and thrive. But it is not too late; strong evidence exists on what to do to support pregnant women and their young children.

We, therefore, call on health and humanitarian donors, implementing agencies and other actors to take these 4 key actions.

  1. Increase investments focused on pregnant women and their children in humanitarian contexts. The investments should look at the holistic needs of pregnant women and children including caregiver mental health, socio-emotional support, safety and security of the home environment, breastfeeding support, and economic support, especially during a child’s first 1,000 days.Every humanitarian setting must assess the needs of pregnant women and families with young children and must develop a coordinated cross-sectoral plan of action to address these needs.
  2. All phases of an emergency response plan must include critical maternal and newborn health actions as laid out in the Nurturing Care Framework.
  3. Build front line work force and health services to support safe and healthy births.

This year, on World Refugee Day, we would like to highlight the plight of pregnant women like Ana, who need to leave home and cross borders to protect themselves, their children and families.

Given the critical needs of pregnant women and families with young children, we call upon the world to focus on the earliest years of life to create a next generation where all children SURVIVE and THRIVE.

Blog written by Sweta Shah, Joan Lombardi, Nada Elattar, and Katie Murphy