How Women & Girls in Somalia Are Navigating Complex and Intersecting Threats to Sexual and Reproductive Health, Rights and Justice
By Dilly Severin, Executive Director, Universal Access Project, in conversation with Ummy Dubow, Country Director for CARE in Somalia.
Somalia has faced numerous and intersecting crises over the span of decades, from record-breaking drought to devastating flooding to political instability and conflict. As of February this year, one in five Somalis has no access to adequate food, and 1.7 million children face acute malnutrition. At the same time, the 2024 Somalia Humanitarian Response Plan is only 10% funded.
The disconnect between the needs in Somalia and financing for humanitarian response is staggering; but sadly, it is not unusual. As the world continues to face a “crisis of crises,” public and policymaker attention, as well as resources – including financial resources – are spread thin. Even further diluted is the focus on and prioritization of the specific sexual and reproductive health and rights needs of women and girls in humanitarian crisis.
In Somalia, multiple climate disruptions and intersecting crises compound on one another and further marginalize girls and women who already navigate challenges due to limited health care access and long-held societal norms and beliefs, including around harmful practices and gender-based violence. To learn more, I spoke with Ummy Dubow, Country Director for CARE in Somalia on what women and girls in Somalia are facing, and how CARE is working at a community level to support crisis response. CARE is a Universal Access Project partner and has been working in Somalia since 1981:
What are the unique sexual and reproductive health and rights needs and experiences of women in Somalia, and in humanitarian crises more broadly?
Ummy Dubow: Specific to the sexual and reproductive health and rights experiences of women in Somalia, we have a high maternal mortality rate – 692 out of 100,000 live births. This reflects a complex array of challenges that hinder access to essential health care services for women during pregnancy and childbirth, including:
Lack of access to basic health services. The collapse of the government and health care infrastructure has resulted in limited access to basic health care services for pregnant women. So many women, especially those in rural areas, cannot afford private hospitals and thus deliver outside of health facilities. This increases the risk of complication and maternal mortality.
Inadequate water, sanitation and hygiene services. Limited access to clean and safe water, inadequate sanitation facilities and unsafe latrines exacerbate health risks faced by pregnant women, particularly in internally displaced people camps where sanitation infrastructure is lacking. The need to travel outside of compounds, especially at night, further exposes women to risks of violence and health hazards.
The high rate of gender-based violence and harmful practices. Prevalent practices such as female genital mutilation, which is almost 99% practiced in Somalia; as well as early and forced marriages and rape are all part of violence perpetrated against women. The lack of justice for survivors, and impunity for perpetrators, perpetuates a culture of violence against women and girls, further increasing sexual and reproductive health risks.
Limited access to family planning information and services. This is coupled with taboos and negative stereotypes around sexual and reproductive health and family planning, as well as with limited decision-making power around contraceptive use – decisions are often controlled by male partners.
Low availability of medical supplies. This includes insufficient availability of menstrual hygiene management materials, medical supplies for pregnancy and childbirth, and hygiene kits – further impeding women’s ability to maintain their health and hygiene during and after pregnancy, and increasing the risk of maternal morbidity and mortality.
Addressing these challenges requires a comprehensive approach that addresses the underlying factors contributing to maternal mortality in Somalia. This includes rebuilding and strengthening health care infrastructure, improving access to clean water and sanitation facilities, combatting gender-based violence and harmful practices, promoting sexual and reproductive health education and women’s empowerment, and ensuring the availability of essential medical supplies and dignity materials. By addressing these factors holistically, progress can be made toward reducing maternal mortality and improving the health and well-being of women in Somalia.
How is CARE responding? What has been successful?
Ummy: CARE’s work in Somalia demonstrates a commitment to community-driven approaches and holistic interventions to address the reproductive health needs of women and girls.
One of the initiatives that CARE is leading on is called the AMAL Initiative. Through this initiative, CARE has mobilized community leaders and health workers to support young mothers in accessing reproductive health and rights services. This program also identifies and provides social support to schoolgirls who have been forced into marriage, ensuring they have access to essential health services.
CARE also provides emergency ambulance services to women in rural communities with limited access to maternity services. This vital service ensures that mothers with delivery complications receive timely and comprehensive health care at hospitals, resulting in successful treatment and delivery outcomes.
Our work conducting assessments and studies, including gender analysis, gender-based service mapping, and conflict mitigation assessments, has also been successful. These studies provide valuable insight into the needs, coping mechanisms, and gaps in sexual and reproductive health and rights programming, guiding the design and implementation of effective intervention.
Social and behavioral norms changes are also a factor, for example, sensitizing communities on the importance of breastfeeding to prevent malnutrition and advocating for the eradication of harmful traditional practices. Additionally, CARE raises awareness about the importance of antenatal and postnatal care for mothers and promotes safe dietary practices during pregnancy. We also engage men and boys in the community, which has supported them as champions of social change. By involving husbands in encouraging breastfeeding, promoting family planning options, and advocating for healthy dietary practices during pregnancy, for example, CARE fosters supportive environments for women’s reproductive health and well-being.
We also support the provision of sexual and reproductive health products including menstruation and sanitary kits, hygiene kits, and dignity kits. These ensure that women and girls have access to essential hygiene and reproductive health supplies, promoting their dignity and well-being. CARE also constructs accessible and safe latrines connected to water sources, addressing hygiene needs and ensuring the dignity and safety of women and girls while also reducing the risk of waterborne diseases and promoting overall health.
Through these comprehensive initiatives, CARE is making significant strides in improving the reproductive health outcomes of women and girls in Somalia, empowering communities to address their unique needs and challenges.
What are gaps or challenges that remain?
Ummy: The multitude of challenges in providing reproductive health services and addressing gender-based violence in Somalia underscores the urgent need for comprehensive action and support. Here are a few factors that need to be considered:
The lack of skilled female health staff. There is a shortage of skilled female health workers, which poses a significant barrier to the provision of reproductive health services.
Inadequate equipment. The lack of essential equipment and supplies further hinders the ability to deliver life-saving services to women in need.
Weak leadership and governance. The absence of a strong, committed leadership, particularly within the Ministries of Health, can impede efforts to prioritize women’s health and address gender-based violence.
Insufficient funding. Inadequate funding for sexual and reproductive health and gender-based violence programs of course limits the effectiveness of interventions.
Policy and implementation gaps. The lack of comprehensive policies to protect women against gender-based violence and the challenges in implementing existing policies further compound the problem. Strengthening the legal framework and enhancing enforcement mechanisms and building institutional capacity are necessary to address this.
Broken health care infrastructure. Somalia’s health care infrastructure is fragmented and under-resourced, making it difficult to provide basic health services to the population.
Cultural barriers and norms. Gender-based violence is pervasive in Somali society, and cultural barriers often prevent survivors from seeking help or accessing support services. Therefore, addressing cultural norms and attitudes toward gender-based violence, within both communities and health care facilities, is critical to breaking the silence surrounding this issue and promoting gender equality and women’s rights.
Addressing these challenges requires a holistic approach that addresses the root causes of gender inequality and violence, which strengthens health care systems and infrastructure, and which fosters a strong leadership and political commitment to prioritize women’s health and rights.
How do these crises intersect with, or how are they amplified by, other issues like climate change?
Ummy: The vulnerabilities faced by women and girls during crisis, particularly in relation to loss of shelter and access to water, sanitation and hygiene facilities, are profound and multifaceted. When climate crises such as droughts occur, families often lose their main sources of livelihood, such as livestock, forcing them to abandon their homes and seek refuge in overcrowded, internally displaced camps. At these camps and other makeshift settlements, there is a lack of water, sanitation and hygiene facilities, such as latrines with doors and locks. This lack of basic sanitation infrastructure not only compromises the dignity and well-being of women and girls, but also exposes them to heightened risk of sexual and gender-based violence, including rape; as does the overcrowded and insecure living conditions in such camps. The absence of adequate shelter, privacy, and security measures leave women and girls vulnerable to exploitation, harassment, and assault by gangs, militias, even fellow camp residents. Addressing these vulnerabilities faced by women and girls in crisis situations requires a comprehensive approach that prioritizes their safety, dignity and well-being, ensuring access to safe and secure shelter, adequate water, sanitation, hygiene facilities and protection services, as well as addressing the underlying drivers of gender-based violence and discrimination.
There is also the compounding effect on caregiving. Women and girls are at particular risk due to the increased workload and caring responsibilities. In Somali culture, women traditionally assume the role of homemakers and caretakers. They are primarily responsible for tasks such as food provision, caregiving, tending to the needs of the sick and elderly. Meanwhile, men are typically tasked with income generation, providing for the family financially. However, during times of crisis such as conflict or natural disasters, the caregiving responsibility is placed on women and it's often magnified as their capacities become stretched or rather overstretched. Women and girls in these circumstances face what can be described as a triple burden: Not only must they find ways to ensure the survival of their families, but they also bear the responsibilities of caregiving and protecting themselves and their loved ones from sexual violence and other dangers that may arise in such situations. For example, in crisis, the destruction and loss of water sources exacerbates the challenges faced by women in accessing water for their households. With water points destroyed or diminished, women are forced to travel longer distances, often spending more time and efforts collecting water. Moreover, the extended journeys to fetch water exposes women to heightened risks of sexual and gender-based violence. Addressing these challenges requires a multifaceted approach that includes not only rebuilding or restoring water infrastructure, but also implementing measures to ensure safety and security of women during their journeys for water and firewood.
Also during crisis, the education system often faces significant disruption as teachers and communities prioritize survival over academic pursuits. One of the most profound effects of this disruption is the increased likelihood of children, particularly girls, dropping out of school. Families struggling to support themselves may prioritize the education of male children over female children, leading to the withdrawal of girls from school to assist with household duties. For many girls, schools serve as a safe haven, providing not only education but also a sense of security, routine and social support. To address these challenges, it's essential to prioritize the protection and education of girls during crisis. This may involve implementing interventions to keep girls in school, providing support services to mitigate the impact of disruptions on their well-being, and addressing underlying gender inequalities that contribute to their vulnerabilities. The escalation of child labor during crisis underscores the desperate measures families take to cope with economic hardships. In many cases, children are compelled to seek alternative livelihoods to contribute to their family survival, often at the expense of their education and well-being. Tragically, these coping mechanisms can expose children, especially girls, to various forms of exploitation and abuse. Addressing the root causes of child labor during crisis requires a comprehensive approach that combines immediate humanitarian assistance with longer term strategies for economic recovery and social protection. This includes strengthening child protection systems, expanding access to education and vocational training, and addressing the underlying factors that drive families to resort to child labor. By prioritizing the safety and well-being of children, we can mitigate the risks they face and help break the cycle of exploitation and poverty.
By empowering women and girls, promoting gender equality and strengthening community-based support systems, we can work towards creating environments where all individuals can thrive even in the face of crisis.
In what ways are the challenges of SRHR in humanitarian contexts a reproductive justice issue?
The challenges faced by women and girls during crisis underscores the urgent need to address gender disparities and ensure the protection of their reproductive health and rights.
In Somalia, various factors, including the lack of basic health care, limited access to resources, gender discrimination, and social exclusion, exacerbate the vulnerabilities faced by women and girls, particularly in the realm of sexual and reproductive health. Key reproductive health and rights that women often lack include the right to quality health care, the right to be free from harmful practices, the right to consent to marriage, the right to privacy, the right to decide the number and spacing of children. Addressing these challenges requires concerted efforts to empower women and girls to promote gender equality and ensure access to comprehensive sexual and reproductive health services and information. It also includes strengthening health care systems, implementing policies to prevent harmful practices, promoting gender sensitive programming, and providing educational resources to support women's reproductive health rights and rights and choices.
What can the global community do to support your humanitarian work and the sexual and reproductive health and rights of women and girls in humanitarian contexts?
Indeed, the global community plays a crucial role in addressing the reproductive health needs of women and girls during and after crisis. Two key areas where the global community can contribute significantly are advocacy and funding.
Advocacy is a critical need, which is aimed at the UN, governments, and other stakeholders to prioritize women’s health, including reproductive health, during emergencies. Advocacy initiatives can also raise awareness about the specific challenges faced by women and girls in crisis settings and advocate for policies and programs that address their unique needs. This includes advocating for the integration of reproductive health services into emergency response plans, ensuring access to essential health care services, and promoting gender-sensitive approaches to programming.
Adequate funding is essential to support reproductive health programs in crisis affected areas. Unfortunately, funding for reproductive health services during emergencies is often limited despite the increased risks and vulnerabilities faced by women. We feel the allocations that are made for sexual and reproductive health are very, very limited. The global community can therefore mobilize resources and allocate funding to support sexual and reproductive health services, including family planning, maternal health, and gender-based violence prevention and response. This includes funding for all implementing organizations working on the ground to deliver essential sexual and reproductive health services.
By prioritizing advocacy efforts and increasing funding for sexual and reproductive health programs during emergencies, the global community can help ensure that women and girls have access to the essential health care services they need to stay safe, healthy, and empowered during times of crisis.
Read more about CARE’s work in Somalia here.