Women facing crises

This IJGO special section assembles articles on the idea of “Women facing crisis: contagion, climate, conflict”. Like climate change, war, and pandemics, the effects of the suffering of women and girls is something that cannot be geopolitically contained. Crisis puts health services under strain, and simultaneously sexual and reproductive health and rights (SRHR) violations are exacerbated by crisis. Pregnancy, childbirth, and unplanned pregnancy are common occurrences in a woman's life – even small reductions in access will result in huge numbers of additional maternal deaths, unsafe abortions, or unmet needs for contraception. Globally, the situation remains that essential SRHR services and SRHR education are often missing.1 Perhaps this is because obstetrics and gynecology is uniquely politicized. There is no other field of medicine that is as regulated by law or subject to sudden changes depending on who holds political power. In this intersection between politics and SRHR, we see the consequences of a failed SRHR policy. Lack of essential services translates into victims of domestic violence, trafficking, rape, teenage pregnancy, unsafe abortions, and maternal deaths turning up at our clinics. Since at least the mid-1990s we have recognized that protecting SRHR is a prerequisite to poverty reduction and societal development. Child marriage – often driven by poverty – results in early births, too many births, and births that are too closely spaced, cementing a continuing cycle of poverty. This cycle deprives a girl of the education, professional skills, and reproductive choice that she would otherwise have had. It also deprives her children and community of her education, her professional skills, and her reproductive choices. Comprehensive services, especially if they are embedded in the community, will help to break the cycle of poverty through child spacing, smaller and more resourceful families, higher literacy rates, higher employment rates, and viable communities. Reflecting the global scope of the problem, this issue contains, among others, reports from South Korea, Pakistan, India, Afghanistan, Mexico, Colombia, Palestine, and Turkey on SRHR outcomes, mitigation and response strategies to crisis.2-11 Included articles highlight the vulnerability of refugees12 and the disastrous impact regime change can have on access to services and maternal outcomes.5 Several papers highlight the individual resources of disadvantaged populations, showing that sometimes vulnerable groups fare better than expected because of systems that rise to the occasion, or because of a resilience we are unable to measure.13, 14 Reflecting this idea is the report from the Mukwege foundation on their holistic and person-centered approach to rehabilitation after sexual violence.15 Willful blindness to the health and rights of women and girls may relate to local crises, but these will ripple over time to impact the stability and sustainability of the world. Drawing on the articles in this issue, we suggest in response curiosity, compassionate care, and cooperation along the road ahead to ensure respect for human rights in the field of obstetrics and gynecology.