No Flood of U.S. Support for Sexual and Reproductive Health for Cyclone Idai Victims

Two weeks ago, Cyclone Idai battered the southeastern coast of Africa with high winds and heavy rain. The storms and subsequent flooding devastated Mozambique and parts of Malawi and Zimbabwe, sending death tolls soaring to 750 people—a number that is expected to increase—and affecting over one million more across the region. Nearly 130,000 people in Mozambique alone have sought shelter after being displaced from damaged or destroyed homes and flood waters that have yet to recede. Although the storm has passed, these three countries have a long road to recovery ahead and still face considerable risks in its aftermath.

Despite significant improvements in recent years, access to health care in many of these countries was strained before the storm. In a context where health care facilities and providers were already limited, now several health care facilities are badly damaged and unable to operate. This comes at a time when the World Health Organization and others have raised the alarm about the increased risk of outbreaks of water-borne infections, including cholera (the first case of which was confirmed Wednesday), malaria and typhoid, resulting from a lack of sanitation facilities, contaminated water supplies and standing water where mosquitos can breed.

However, this is only one element in a broad spectrum of risks facing hundreds of thousands of women and girls of reproductive age affected by the storm—all of whom have their own unique health needs in the aftermath of this disaster. Research has shown that women are often disproportionately impacted by natural disasters, with some studies suggesting that women are more than 14 times more likely to die during or following a disaster.

It is estimated that nearly 75,000 women in Mozambique impacted by the cyclone are pregnant, with an additional 20,000 pregnant women living in affected areas of Malawi. Maternal mortality rates in these regions were already among the highest in the world before the cyclone. Now these women face even greater challenges accessing the maternal health care they need. Not only have health care facilities been damaged or destroyed, supplies vital for maternal health care, including oxytocin for treating post-partum hemorrhage, which requires electricity to be kept cool, treatments for HIV and malaria in pregnant women, and even access to clean water during deliveries is now difficult to come by. Meanwhile, contraceptives and menstrual hygiene products remain just as necessary as they had been before the disaster.

Mass displacement, inadequate shelter and sanitation facilities, the separation of families and economic hardship resulting from the storm heightens the risk of gender-based violence (GBV), including rape, sexual harassment and exploitation, domestic and intimate partner violence and early marriage. Ensuring that prevention efforts and services to address GBV—including reproductive health and psychosocial services—are available to survivors from the onset of a natural disaster is critical.

The United States, like many donor governments, has come forward to assist with various aspects of the relief and recovery efforts in Mozambique, Malawi and Zimbabwe. The U.S. government has long worked with a coalition of diverse and effective nongovernmental organizations (NGOs) and United Nations (UN) agencies to respond in crises like this. However, one organization the United States will not be funding is UNFPA—the UN agency mandated to provide reproductive health care and coordinate GBV prevention and response in humanitarian emergencies. This isn’t because UNFPA has willfully shirked its mandate in this crisis or is otherwise unable to provide the health and protection services necessary to respond the needs of those affected by Cyclone Idai. On the contrary, UNFPA mobilized immediately following the disaster.

As a central player in the international community’s response, UNFPA chairs the “protection cluster,” which coordinates UN agencies and international NGOs working on GBV prevention and response in addition to other protection concerns, and co-chairs the “health cluster” with the World Health Organization, which coordinates the emergency health care response. UNFPA has been busy setting up mobile health clinics in hard-to-reach areas, deploying reproductive health kits with much-needed sexual and reproductive health supplies—including post-rape kits—to communities and hospitals, and distributing dignity kits to women and girls.

No, the United States cannot fund UNFPA even if U.S. embassies and humanitarian responders view the agency as well-positioned to provide life-saving care in this crisis. That option was taken off the table two years ago when the Trump administration announced their unfounded and politically motivated Kemp-Kasten determination, which continues to bar any U.S. funds from going to UNFPA to support either their core budget or irreplaceable humanitarian work.

Trump administration policies like their expansive Global Gag Rule and the decision to defund UNFPA prevent the U.S. from having comprehensive discussions and making fully informed decisions about which entities we should fund in our development work and during humanitarian emergencies. These decisions, particularly in a crisis, should be based on the needs on the ground and which organizations are well-positioned to respond quickly and effectively, not arbitrarily determined by an administration’s ideological agenda.