Cash-Based Support for Sexual and Reproductive Health When Crises Disrupt Health Systems

The UNFPA guidance explains how cash and voucher assistance can reduce financial barriers that prevent women and girls from accessing life-saving sexual and reproductive health services during humanitarian emergencies. When carefully designed and coordinated, cash supports dignity, choice, and continuity of care while complementing, not replacing health systems and rights-based SRH programming.

Developed by the United Nations Population Fund (UNFPA) with support from the European Union’s Humanitarian Aid and informed by research and field evidence from partners such as the International Rescue Committee, Johns Hopkins University, the World Health Organization, the Global Health Cluster, and UNHCR, the report explains how cash and voucher assistance can strengthen sexual and reproductive health services in emergencies. The document is rooted in the principle that sexual and reproductive health is a human right, affirmed globally since the 1994 International Conference on Population and Development, and one that does not disappear during conflict, disaster, or displacement. In humanitarian crises, women and girls often face life-threatening barriers to care, not because services do not exist, but because they cannot afford to reach or use them.

Removing Financial Barriers to Life-Saving Care

The guidance shows how cash and voucher assistance can reduce the costs that prevent people from accessing essential services. These costs include transport to health facilities, user fees, medicines, diagnostic tests, food and accommodation during treatment, childcare, and lost income. By addressing these expenses, cash assistance can help pregnant women attend antenatal and postnatal care, deliver safely in health facilities, continue HIV treatment, access care after sexual violence, and obtain contraception or menstrual hygiene supplies. The document makes clear, however, that cash is not a replacement for health systems. Where services are unavailable, unsafe, or of poor quality, investments in health infrastructure, staffing, and financing are still required.

Supporting Emergency and Comprehensive SRH Services

Within the Minimum Initial Service Package for sexual and reproductive health in crises, cash can support key emergency objectives. It can help survivors of sexual violence safely reach health services when provided as unrestricted and unconditional assistance within survivor-centred case management. For HIV and sexually transmitted infections, cash can support continued access to treatment by covering transport and related costs during displacement. In maternal and newborn health, cash has been shown to reduce delays in reaching care, increase facility-based deliveries, and help families cope with emergency obstetric costs. The guidance is explicit that while cash can help people access voluntary family planning, it must never be used to pressure or incentivize contraceptive use.

Beyond the emergency phase, cash and vouchers can also support comprehensive sexual and reproductive health services in protracted crises and recovery. Examples include improving access to antenatal and postnatal care, enabling women and girls to purchase quality menstrual hygiene products with dignity, supporting continuity of cancer prevention and treatment, facilitating obstetric fistula repair, and complementing mental health services for pregnant and postpartum women. Evidence from multiple countries shows that these approaches can improve service use while reducing harmful coping strategies.

Designing Safe and Effective Cash Assistance

The document places strong emphasis on careful design. Before using cash or vouchers, programmes must assess whether services are available, affordable, and of acceptable quality, and whether financial barriers are the main obstacle. Gender, protection, and gender-based violence risks must be identified and mitigated throughout the programme cycle. UNFPA prioritizes individuals rather than households, focusing on women of reproductive age, adolescents, pregnant and postpartum women, persons with disabilities, sex workers, and people living with HIV, with selection based on financial need.

Unrestricted and unconditional cash is preferred whenever possible because it offers flexibility, dignity, and choice. Vouchers may be used when there are concerns about service quality or when recipients prefer restricted support. Conditional cash can encourage attendance at health visits or education sessions, but it must be used cautiously and never in ways that undermine dignity or access, especially in acute emergencies.

Coordination, Preparedness, and Long-Term Impact

Coordination is central to success. The guidance stresses that cash for sexual and reproductive health should complement multipurpose cash assistance provided by other agencies, as household-level support rarely covers women’s individual health needs. Working with cash working groups, health clusters, and UN partners can help ensure that SRH needs are visible and addressed. The document also highlights the growing role of cash in preparedness and anticipatory action, where pre-arranged transfers help pregnant women and others maintain access to care before and immediately after disasters.

Overall, the guidance presents cash and voucher assistance as a practical, rights-based tool that can save lives and protect dignity when carefully designed, well-coordinated, and firmly anchored within strong sexual and reproductive health programming in emergencies.