“In any new emergency setting,” writes the RHRC Consortium, “15% of pregnant women can be expected to develop complications during pregnancy or delivery and will require emergency obstetric care.”
This sobering number drove the creation of the RHRC--that is, the [Reproductive Health Response in Crises](http://www.rhrc.org/)--Consortium,* a humanitarian group focused on ensuring that reproductive care is never overlooked in relief efforts for refugees. In 2005, the Consortium released the [“Field Friendly Guide to Integrate Emergency Obstetric Care in Humanitarian Programs”](http://www.rhrc.org/resources/emoc/EmOC_ffg.pdf), a step-by-step instruction manual for incorporating obstetric-specific facilities and resources into every refugee camp that springs up in response to crisis.
The RHRC Consortium is made up of [seven members](http://www.rhrc.org/about/who.html) whose focuses span reproductive health, academic research, women’s advocacy, and humanitarian aid. The aim of the Consortium is to explicitly outline the minimum requirements for obstetric emergency preparedness, even amidst conflict, crisis, and the limited resources of a refugee camp.
According to the guide, “emergency preparedness for safe motherhood should include planning for the rapid distribution of clean delivery supplies, essential medicines, and equipment for obstetric care at health facilities as well as the presence of personnel qualified to provide [emergency obstetric care] to existing or new temporary health facilities.”
The guide uses [criteria jointly established](http://www.childinfo.org/files/maternal_mortality_finalgui.pdf) by the WHO, [UNICEF](http://www.unicef.org/sowc09/docs/SOWC09-Figure-4.1-EN.pdf), and [UNFPA (the UN Population Fund](http://www.unfpa.org/webdav/site/global/shared/documents/publications/2009/obstetric_monitoring.pdf) to determine the minimum level of emergency obstetric care considered humane in a refugee camp setting. They determine that at least four “basic” and one “comprehensive” center for every 500,000 people--that’s equivalent to five obstetric facilities serving a population larger than the city of Atlanta!
A basic obstetric facility is expected to be able to assist delivery of a child, remove placenta and retained products from the uterus, and deliver medication using a needle. A comprehensive facility performs these functions, as well as emergency blood transfusions and Cesarean sections.
The Consortium simplifies the major culprits of maternal and infant death in crisis situations to the widely accepted [“Three-Delays Model” of maternal mortality](http://www.maternityworldwide.org/what-we-do/three-delays-model/). In a refugee camp, a mother who runs into complications during pregnancy suffer delays in three critical stages, any one of which greatly reduces her and her child’s chances of survival.
The First Delay is her decision to seek health care. Indeed, this delay is due in large part to the Second Delay: the gap between deciding care is necessary and reaching a health facility in time, due to poor access and lengthy traveling time, makes obtaining treatment that much more difficult. The Third Delay occurs in the health facility itself, where often a mother must wait too long to receive adequate emergency care, putting both hers and her child’s life in jeopardy.
Each Delay serves as a key intervention point for public health and women’s advocates striving to reduce maternal and children’s mortality, and to improve obstetric conditions in refugee camps. Areas of the world in crisis prove especially dangerous for women, and all the more so for expectant mothers. The RHRC Consortium seeks to educate on the basic requirements for the health and survival of these women and children, and demonstrates precisely how to go about improving conditions even in areas of the world most stricken by conflict and crisis. In short, they provide a field guide to helping pregnant mothers navigate--and survive--the most bewildering and dangerous of camp environments.
By: Lizi Jones
*Formerly the Reproductive Health Response in Conflict Consortium
UN Photo: Martine Perret refugee camp Timor-Leste