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Department of Public Information . News and Media Division . New York

16 April 1999

The emergency reproductive health kits sent by the United Nations Population Fund (UNFPA) to United Nations agencies on the "front lines" of the Kosovo refugee crisis contained more than just emergency contraception to prevent unwanted pregnancies, the Executive Director of UNFPA, Dr. Nafis Sadik, told correspondents at a Headquarters press briefing Thursday afternoon.

Responding to recent criticism that the reproductive health kits sent by the UNFPA contained "abortion pills", Dr. Sadik said that was false. The kits contained so-called "morning after" pills to prevent unwanted pregnancies at the outset, but those could not interrupt an established pregnancy. That was just one component of the health kit -- but, the one used to oppose the provision of reproductive health care to women in emergencies.

Dr. Sadik was introduced by the Director of the Information and External Relations Division of UNFPA, Stirling Scruggs. He said that UNFPA, along with the Office of the United Nations High Commissioner for Refugees (UNHCR) and other United Nations partners and non-governmental organizations (NGOs), such as the International Committee of the Red Cross (ICRC), had been working with the Albanian Health Ministry to provide reproductive health kits to the estimated 350,000 refugees who recently crossed into Albania from Kosovo.

There were an estimated 20 births per day among the Kosovo refugees, Dr. Sadik continued, requiring health kits for safe deliveries. The kits also contained the means to diagnose and treat sexually transmitted diseases, transfusion equipment, and contraceptives for people who requested it. Suturing for tears resulting from violence was also in the kits, plus equipment for treating complications arising from miscarriages and unsafe abortions.

Emergency contraception, or the "morning after" pill, had been around nearly as long as the oral contraceptive itself, she said. It was an elevated dose of birth control pills that prevented pregnancy when taken within 72 hours of intercourse. It should not be confused with RU-486, which is an abortion pill that is not distributed by UNFPA.

Several years ago, the UNFPA, along with the UNHCR, the ICRC, the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), and some 50 NGOs developed a package of responses for women in emergency, conflict and disaster situations. The reproductive health kits were developed with WHO's technical oversight.

She said that, in the course of their work, those groups found that normal services and support for women -- most importantly for women coping with the consequences of rape and violence -- had simply not been addressed. Bosnia was an important example of what happened to women without that kind of support. Since then, much more information had been collected around the world.

The UNFPA sent some emergency reproductive health kits from the Netherlands to Tirana, Albania, she went on. Those arrived on 8 April, and were being distributed as part of the health care services being provided by the Albanian health service, the Albanian Family Planning Association, the UNHCR and the ICRC. While the UNFPA was not on the front line, it strongly advocated that attention to women in emergency situations, including refugees, must include medical emergency services.

In the case of Kosovo, she was disturbed by some newspaper articles originating in Italy, which indicated that the UNFPA was distributing abortion equipment. That assertion was totally false. Emergency contraception was a form of the oral contraceptives that were normally used to prevent pregnancies, and was just a special formulation that prevented a woman from becoming pregnant in the case of an unsafe sexual exposure. The decision to use the emergency contraception was a decision for the individual woman to make. The UNFPA believed in the provision of that information and access to the service, so that a woman who had been violated would have the option of not becoming pregnant.

The UNFPA had conducted a survey in Kosovo in December 1998, with a view to developing a programme in that area. It had found then that the use of contraception was very low -- only some 10 per cent of women were actually using contraceptives, and most Kosovo women were using abortion as family planning. Thus, the incidence of abortion was very high: 11 abortions per 100 deliveries. Part of UNFPA's programme was to replace that dependency on abortion with contraceptive use, to prevent unwanted pregnancies.

A correspondent asked how the UNFPA made the decision to organize those kinds of packages, in particular, whether that was based on a list containing the names of the rape victims.

Dr. Sadik said that the kits were not based on any such list. The packages contained reproductive health services, including pre-natal care for pregnant women in need of vitamins, blood pressure equipment, and so forth. If a woman required delivery assistance, the delivery kit could be used. If she had been raped and asked if she could do something to prevent her pregnancy, the health worker could use the emergency contraceptive pill to help her. If a woman was using contraceptives and requested more, the health worker could provide it.

In a follow-up question, the correspondent asked again whether the UNFPA had been provided with a specific list of alleged rape victims.

Dr. Sadik said she did not have any concrete information about the number of rape cases, but from other refugee and emergency situations, she knew that rapes did occur. The kit had been developed on the basis of experience with other emergency situations and was a response to the kinds of services that were required by women in those situations. If a woman was the victim of sexual violence, the kit had materials with which to repair any physical damage, antibiotics, and testing and treatment for sexually transmitted diseases.

Asked if she had any comment about some recent criticism by some commanders of the North Atlantic Treaty Organization (NATO) in the field that the refugee crisis was being mishandled, especially by the UNHCR, she said she did not have any particular response, because the UNFPA was not on the front lines. The United Nations agencies were really trying their best to respond to a very acute emergency.

They had really gone in, she said -- Sadako Ogata of the UNHCR, Carol Bellamy of UNICEF, and Catherine Bertini of the World Food Programme (WFP) -- they had visited many places and they were doing the best they could. Led by the UNHCR, they had organized themselves into one coordinated response.

Another correspondent asked whether Dr. Sadik had actually received any communication from the Vatican about the provision of emergency contraception in Kosovo and, if so, had their stance been any different than the views recently expressed in United Nations preparatory committees?

Dr. Sadik said the news releases seemed to convey some misinformation. She had seen a report in an Italian newspaper that defined emergency contraception as RU-486, which it was not. She reiterated that emergency contraception did not contain any chemicals that produced abortion. Rather, it contained steroids that were used in oral contraceptives, in an approved formulation.

But you received no direct complaints from the Vatican about the provision of the kits to Kosovo? the correspondent asked in a follow-up question.

Dr. Sadik said, no. In the Preparatory Committee for the General Assembly's special session to review the International Conference on Population and Development (Cairo, 1994), the Holy See had made a particular observation about emergency contraception, which the WHO clearly refuted. Somehow, the impression being generated was that it was an abortion pill.

She said she had been described in a press statement as a promoter of an abortion pill, which had really shocked and upset her. The kit had been developed by technicians. She personally did not decide what contraceptives would be given; she had merely taken the advice of the WHO. She had wondered to herself if she was being "attacked" because she was a Muslim woman.

With the "morning after" pill only effective for up to 72 hours, one had to assume that most of the rapes had occurred well before that time, another correspondent noted.

Dr. Sadik said perhaps that was so, but in camp situations violence occurred continually, and most women did not know that pregnancy could be prevented if something was done within 72 hours. Often, they did nothing or resorted to unsafe abortion.

She drew attention to data from a camp in United Republic of Tanzania comprised of refugees from the Great Lakes region of Africa, which pointed to an extremely high number of women requiring treatment as a result of unsafe abortions. In one camp, for example, there were some 200 cases of induced, unsafe abortions requiring treatment. The idea was to prevent that pregnancy, rather than resort to abortion.

The kits were being used, she went on. The UNHCR had informed her that there was a big demand for the services. Moreover, a refugee situation did not preclude normal kinds of needs. There were many women who were pregnant and in need of help. There would be some sexual activity and a need to prevent sexually transmitted diseases. Moreover, in a refugee situation, people sometimes travelled from an area where there was a very high incidence of HIV/AIDS to another country, or vice versa. Those populations needed to be protected.

How was the effectiveness and use of the services being monitored? another correspondent asked. That had been done by training people in the organizations at the scene, she said. For example, a memorandum of agreement had been formulated with the ICRC and the International Federation of Red Cross and Red Crescent Societies to train people in countries around the world on how to use the emergency reproductive health kits.

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