What counts as need? A qualitative study exploring perceptions of sexual and reproductive health in humanitarian settings

Sexual and reproductive health (SRH) is a core component of good health for people living in contexts affected by conflict, displacement or other crises. This paper explores how SRH needs are understood by the international humanitarian community, and the implications for the relative prioritisation of different components of SRH, spanning health-, rights- and justice-based approaches. I draw on feminist theory from situated knowledge and standpoint epistemology which highlights that there are different ways of representing problems. The methodology uses original semi-structured interviews with participants (n = 31) from international organisations, donor and research institutions working on humanitarian SRH. Data analysis was iterative and flexible, using memos, formal coding, and thematic networks. The study's findings suggest that partial evidence, humanitarian norms, and positionalities shape perceptions of SRH needs among the international humanitarian community. This has implications for who and what is visible, resulting in a de facto hierarchy within SRH service delivery in humanitarian settings. The research demonstrates the insights offered by a more critical approach to needs- and evidence-based humanitarian action. This lens is more relevant than ever in the current climate of aid funding cuts. I call for a paradigm shift towards incorporating more comprehensive, longer-term, and minority perspectives in interpreting and prioritising SRH needs that may better acknowledge and respond to the realities of affected people.