As Humanitarian Crises Grow, So Do Risks for Women and Newborns

During humanitarian emergencies, women and newborns face severe disparities and heightened vulnerabilities, increasing their risk of illness and death. Humanitarian crises—caused by conflict, climate-related disasters, or forced displacement—disrupt health systems, limit access to essential services, and increase the likelihood of preventable deaths. In 2023, 58% of global maternal deaths, 50% of newborn deaths, and 51% of stillbirths worldwide occurred in the 29 countries with a UN humanitarian response plan or regional response plan. In humanitarian emergencies, a lack of skilled health personnel, inadequate infrastructure, and shortages of essential medicines are common—resulting in limited access to both basic and emergency maternal and newborn care. A fight for humanitarian aid is also a challenge, as maternal and newborn health are often under-prioritized or neglected in humanitarian response.

For many women, the absence of skilled birth attendants during delivery—combined with limited emergency obstetric care—means that life-threatening complications (such as postpartum hemorrhage, sepsis, and obstructed labor) are often left untreated, leading to tragic outcomes. Additionally, routine antenatal and postnatal care is frequently disrupted—contributing to undiagnosed complications like preeclampsia and gestational diabetes—while newborns are at heightened risk of conditions such as asphyxia, prematurity, and infections.

Family planning services are also insufficient during many humanitarian crises, contributing to unintended pregnancies and exacerbating maternal health risks. Adolescent pregnancy, a serious concern, is further compounded by early marriage and gender-based violence, typically more prevalent during crises. Additionally, many women and girls are subjected to sexual and gender-based violence, leading to severe reproductive health complications and limited access to essential care, including mental health support. The mental health impact on pregnant women and new mothers during crises is profound—with high levels of stress, anxiety, and depression affecting both maternal and newborn health outcomes. Breastfeeding and infant nutrition are also compromised due to food insecurity, displacement, and lack of proper support, often resulting in suboptimal feeding practices that threaten infant health.

With the number and complexity of humanitarian crises on the rise, it’s even more important to ensure that the most vulnerable groups—women and newborns—receive the best possible care.  I turned to maternal and newborn health practitioners, implementers, and researchers, and asked seven experts with different backgrounds and experiences what is the one thing they feel needs more attention or policy or funding or understanding related to humanitarian aid and response. They responded with incredible insights into the challenges women and newborns face during humanitarian crises.

-Sarah B. Barnes

Dr. Claudia Donkor, Sexual and Reproductive Health in Emergencies Specialist, UNFPA Somalia on the underutilization and under-funding of the Minimum Initial Service Package (MISP):

The Minimum Initial Service Package for Sexual and Reproductive Health (MISP for SRH) was first introduced in 1996 to address the disruption of access to basic SRH services during humanitarian emergencies. MISP for SRH is a set of essential (often life-saving) activities and services needed to appropriately respond to the urgent needs of women, girls, and vulnerable populations in the first 48 hours of emergencies.

Somalia is a nation grappling with protracted conflict, recurrent climatic shocks, poor maternal and newborn health outcomes, and pervasive gender-based violence. Women and girls, particularly those in humanitarian crises, face limited access to sexual and reproductive health services and information. The MISP for SRH, a crucial framework for addressing these urgent needs, is often underutilized due to lack of understanding and prioritization. MISP for SRH provides a holistic approach to safeguarding the health and rights of women and girls in emergencies, encompassing six key areas: leadership/coordination, prevention and response to sexual violence, HIV and sexually transmitted infection prevention, maternal and newborn health, family planning, and planning for comprehensive SRH services.

A recent UNFPA-supported MISP Readiness Assessment in Somalia revealed critical gaps in implementation, including limited awareness and prioritization of MISP for SRH as a comprehensive package. This lack of understanding hinders effective response efforts, leaving vulnerable women and girls at risk of preventable maternal and newborn deaths and other SRH complications. It is imperative to inform program implementers, humanitarian response teams, and donor organizations that MISP for SRH is an essential part of every humanitarian response. The sexual and reproductive health needs of women and girls should not be overlooked in times of crisis.

Deborah Denis, Strategic Partnerships Research Manager, National African Students Association, New York University on the deprioritization of maternal and newborn health services and education:

The Boko Haram insurgency in Northeast Nigeria displaced more than 2.4 million people. This decade-long crisis and recent flooding have further strained an already fragile healthcare system and low literacy rates. With thousands of people resettled in camps and host communities, livelihood and healthcare needs remain urgent—especially for maternal health. Most internally displaced individuals come from rural areas, with limited understanding of the importance of maternal healthcare, particularly preventative measures like antenatal care. It is common for healthcare to be sought only when visible illness or childbirth complications occur. Unfortunately, due to limited funding, comprehensive sexual and reproductive health (SRH) and maternal and newborn health (MNH) services are often lacking.

Research shows that maternal health tends to be reactive rather than proactive in emergency preparedness and response. The assumption that pregnant women know how to manage their pregnancies—combined with the belief that general healthcare covers maternal needs—results in higher rates of preventable pregnancy complications and maternal deaths among displaced communities. In regions with low literacy levels, such as northeast Nigeria, general awareness of maternal health needs is lower than should be anticipated. In my experience, myths and misconceptions about “Western” medicine exist in these regions and health education on culturally sensitive issues such as maternal health must be intentional. To address this, emergency interventions must integrate educational efforts to raise awareness about maternal health care and design programs that specifically address MNH needs in humanitarian settings.

As humanitarian crises are expected to increase, policymakers must proactively plan maternal healthcare intervention responses. This involves incorporating educational activities and clinical care for pregnant women into emergency intervention strategies and adopting long-term policies that prioritize training skilled healthcare workers.

Mushtaq Khan, Health and Nutrition Senior Advisor, International Rescue Committee Afghanistan on the need for more attention on long-term care for women and newborns:

In Afghanistan, women and newborns face serious health challenges due to a combination of cultural, political, socio-economic, and infrastructure factors. For example, cultural barriers restrict women’s mobility and require male consent to access healthcare services, particularly in remote areas. When it comes to maternal and newborn health in Afghanistan, the priority is mainly emergency healthcare, with less attention on equally important long-term care needs, like postpartum care, follow-up newborn care, and perinatal mental health services. In Afghanistan—which at times faces both acute and protracted crises—there must be attention to both the emergency needs and persisting health needs to avoid long-term negative health outcomes.

Since the Taliban took over three years ago, there are multiple factors that lead to high rates of maternal and newborn mortality: poorly resourced and unskilled birth attendants, poor nutrition and mental health for mothers, and lack of credible data on maternal and newborn health outcomes. In addition, newborn care is typically overshadowed by maternal health care leading to high rates of neonatal mortality.

Micronutrient deficiencies among women and newborns are common in Afghanistan’s rural communities, leading to pre-term births, nutritional deficiency complications among mothers, and low-birth weight babies. Mothers have faced multiple compounding traumas from displacement due to conflict and recurring natural disasters—but have no perinatal mental health support. Due to the incredible challenges women and mothers face, immediate and long-term health needs of newborns are often forgotten. Lastly, the current lack of credible data on maternal and newborn health outcomes makes advocacy for prioritizing maternal and newborn health services—particularly their long-term care—very challenging. 

Jihan Salad, Program Specialist, Sexual and Reproductive Health, UNFPA; AlignMNH Steering Committee Member on the health of adolescent girls:

The health of adolescent girls, including adolescent mothers, is often overlooked— especially during crises. This is a significant issue and requires urgent attention. In Malawi, where I  worked as a health systems specialist for UNFPA, existing policies support adolescent access to essential health services. Yet Malawi continues to be among the countries with one of the highest adolescent birth rates regionally and globally, largely due to early marriages and limited educational opportunities. During crises, adolescent birth rates increase as access to education and healthcare services is often disrupted. This leaves adolescent girls vulnerable, as the lack of basic services exposes them to unplanned pregnancies. The collapse of social structures also magnifies inequities—making it harder for girls to avoid early pregnancies.

This highlights the importance of ensuring adolescents have access to healthcare and education (including outside of the formal health system), to promote health and safety and reduce early pregnancies. It also underscores the need to address inequalities that hinder access to services. For example, establishing safe spaces for adolescents where they can access health services, mental health support, and protection from violence is crucial. In addition, humanitarian policymakers and funding organizations can help by prioritizing resources for mobile clinics and outreach programs to deliver health information and services to adolescents. If we fail to provide these necessary services to adolescents, including adolescent mothers, during crises, the consequences will affect not just the young mothers, but entire communities and future generations.

Harriet Ruysen, Midwife; Research Fellow, London School of Hygiene & Tropical Medicine on not forgetting the newborn:

The number of people trapped in humanitarian settings continues to increase. This year, 311 million people in 32 countries are affected by conflicts, disease outbreaks, and climate disasters including women, babies, and children. Global estimates show that newborn deaths (babies aged 0- 28 days) account for nearly half (47%) of all child deaths globally. Most of these deaths are happening in countries with ongoing humanitarian crises which exacerbate poverty and malnutrition, cause displacement and trauma, and erode support systems that protect the most vulnerable. Health services are disrupted by depleted human resources, fractured supply chains, intermittent power and water supplies, and damage to buildings, equipment, and infrastructure. Hospitals are increasingly targeted in war—and it can be impossible for women to reach healthcare safely due to lack of transport, active fighting, shelling, unexploded ordinance, or the threat of sexual violence.

A disproportionate number of newborns die (or are stillborn) for entirely preventable reasons during humanitarian disasters and conflicts. Women are more at risk of anemia and other exposures that contribute to prematurity, low birth weight babies, and congenital conditions. Stress, insecurity, and malnutrition are known to affect long-term childhood development with potential consequences for future generations. Babies born too soon, too small, or who become sick are particularly vulnerable to health system shocks, power and stock outages, and human resource gaps. However, preterm babies can and do survive with the right care: in high-income countries, 9 in 10 extremely preterm babies (<28 weeks) survive, compared with just 1 in 10 in low-income countries. It doesn’t have to be this way. The Newborn Health in Humanitarian Settings Field Guide and the Roadmap to Accelerate Progress for Every Newborn in Humanitarian Settings are resources that can be used to strengthen country programs for newborn care and expand access to dignified and high quality care during pregnancy, birth, and the postpartum period. Innovative and affordable technologies—like those delivered by NEST360 in parts of Sub-Saharan Africa—have untapped potential to save newborns in humanitarian settings. To ensure that every child can survive and thrive in a world where conflicts are increasingly protracted—and the impacts of humanitarian crises on health systems are long-lasting—we need to protect newborn lives.

Rondi Anderson, PhD; Midwife; Senior Reproductive, Maternal, Newborn, and Child Health Advisor, Project Hope on gaps in 24/7 response for maternal and newborn health:

My experience includes humanitarian response in Africa, Asia, and the Middle East; I’ve worked amidst chronic conflict in Somalia, with Rohingya refugees, and for cyclone and flood response in Bangladesh. I’ve responded to earthquakes and chronic conflict in Syria, tropical storms in South and East Africa, and the current humanitarian crisis in Gaza. Causes of maternal deaths cannot be predicted or prevented, so to save women’s lives, response to obstetric emergencies must be available 24 hours a day, 7 days a week.

There are global standards for the minimum health care package for preventing maternal death in humanitarian settings (MISP for SRH). Alarmingly these standards are often selectively implemented with many outpatient health clinics and mobile teams, and significant gaps in accessible, 24/7 obstetric and newborn emergency response persist. To save women’s lives, all women experiencing obstetric emergencies must have access to initial stabilization, transport, and ready health facilities. These are difficult goals to attain but are essential for preventing maternal and newborn mortality. Literature finds that 58% of preventable maternal deaths and 50% of neonatal deaths occur in humanitarian settings, and access to services is the leading contributor.

In Bangladesh, although the number of midwives were expanded to serve 24/7 in health facilities, emergency transport was weak, resulting in camp births with high maternal and newborn mortality rates. In the northern region of Syria, with more than 2 million people affected, humanitarian response was exclusively mobile teams and static outpatient clinics—with no initial stabilization or transport—and overall, very limited options; maternal deaths were reported regularly by communities and receiving hospitals. In Gaza, inpatient facilities are few and overwhelmed, and many communities are reached only by mobile teams without emergency capacity. A similar situation was reported to me from a Madagascar tropical storm response, where there were mobile teams only; health facilities were damaged and evacuated. Meeting the needs of pregnant women and newborns requires more resources; mobile clinics alone will not solve the problem.

Hani Rukh-E-Qamar, Executive Director and Founder, Canadian Advisory of Women Immigrants; MSc Epidemiology Student, McGill University on the need for sustainable and ethical exit strategies:

During many global humanitarian crises, maternal and newborn health (MNH) is often neglected, and the needs of the affected communities after a crisis are not taken into consideration. While working at McGill University in collaboration with the Canadian Red Cross, I studied the ethics of developing exit strategies in humanitarian settings through a qualitative research project. I analyzed exit strategies in low- and middle-income countries (including Kenya and Liberia), pointing to the need to consider ethical factors—such as sustainability, collaboration, and transparency—in implementing diverse programming, including for maternal and newborn health. For project closure, maternal and newborn health requires particular attention.

The unique nature of maternal and newborn health care means that abrupt closure could have severe and long-lasting consequences on health outcomes. This is especially concerning in humanitarian settings as programs tend to focus on the reduction of maternal and newborn mortality—often lacking ways to support communities in improving other MNH outcomes, such as postpartum care linkages, sustainably. Therefore, MNH programs need to be designed with sustainability at the forefront, ensuring that communities can continue to support these essential services after humanitarian organizations have left.

For example, creating postpartum care interventions that workers who are trained for a variety of roles can handle, and integrating them within local non-governmental organizations (NGOs) may increase sustainability. Mothers need ethical exit strategies that focus on community-identified investments and resources to serve the community’s short and long-term MNH needs—without having to continuously rely on donors and humanitarian aid—while collaborating with local leaders and being transparent. However, it is important to consider aspects that pull in the opposite direction—such as the pressure to maximize efficiency—or the short-term focus of many humanitarian efforts. Overall, having an ethical exit strategy will allow a community to plan responsibly and allow them to transition from an emergency state to a sustainable one.

Cover photo: Bangladesh. Rohingya women in refugee camps share stories of loss and hopes of recovery. Photo courtesy UN Women. https://creativecommons.org/licenses/by-nc-nd/2.0/