When humanitarian crises strike, disruptions to health services can mean life or death. Women, girls and other historically marginalized people often face heightened risks and additional barriers to care — including unintended pregnancy, obstetric complications, gender-based violence and HIV infection. Yet less than three decades ago, sexual and reproductive health and rights (SRHR) services were almost entirely absent from emergency response.
Sarah Knaster, Coordinator of the Inter-Agency Working Group (IAWG) on Reproductive Health in Crises, first encountered this gap early in her career. She started in public health as an events assistant at Doctors Without Borders before moving to the Guttmacher Institute, a sexual and reproductive health think tank. The gaps around SRH and the politicization of women’s health were apparent early in her career. “You can’t talk about human rights without acknowledging the intersections with health and how we’re failing women and girls,” she said.
Her path led to a Master’s in Public Health, during which she conducted a family planning baseline study among Burmese refugees in Kuala Lumpur — an experience that cemented her commitment to SRHR. “Seeing, in person, the impact these services, or lack of services, had on people’s lives was grounding and experiencing the ways in which SRHR was deprioritized and dismissed ignited my passion for this work. I knew that I wanted to be a part of the community that was working to change things.”
IAWG was founded in 1995, following the International Conference on Population and Development (ICPD) in Cairo, where global leaders, for the first time, made a formal commitment to strengthening reproductive health services for refugee populations. At a time when SRH in humanitarian settings was virtually non-existent, IAWG brought together dedicated partners who were committed to integrating SRH into humanitarian response from the earliest days of an emergency throughout response and recovery.
From those beginnings came a simple but revolutionary concept: the Minimum Initial Service Package (MISP), a set of core, lifesaving SRH interventions that must be implemented in the first 48 hours after an emergency. “Reproductive health is often dismissed as extraneous, or an unrealistic luxury in acute settings,” Knaster said. “The MISP is helping to change that narrative. It defines SRH as essential and feasible, even in the most restrictive settings, with the evidence to back it up.”
Today, IAWG is a diverse coalition of more than 100 organizations and individuals that shape global standards and drive collective progress in SRH in humanitarian settings. Its work spans four interconnected pillars:
“Ultimately, we serve crisis-affected women and girls, in all their diversity,” Knaster said. “But our immediate audience is the people supporting SRHR and implementing services on the front lines — clinicians, program managers and humanitarian coordinators at global and local levels. We provide them with resources, guidance and a supportive community, while serving as a constant champion and advocate for their work.”
As humanitarian needs grow and funding from donor countries becomes more constrained, IAWG’s model of coordination and collaboration has only become more essential. “With reduced staff and resources across the sector, IAWG offers a model for more efficiently advancing our shared goals,” Knaster said.
IAWG’s diversity — across technical sectors, regions and organizational types — gives its outputs unique credibility. When the coalition issues a joint statement or recommendation, for example, governments and agencies take notice. “People know that so many diverse actors are on the same page and that carries weight.”
One powerful example came in the late 2010s, when family planning was added to the MISP. “It wasn’t always recognized as lifesaving,” Knaster pointed out. “Together with other coalitions, we made the case that preventing unintended pregnancies is wanted, needed and absolutely feasible, even in fragile settings.”
Despite its global impact, IAWG has always been driven more by passion than by payroll. “People often assume everyone involved is paid to do this work or that we have a large secretariat staff behind the scenes,” she said. “In reality, for most of IAWG’s existence, it has been all volunteer. It’s such a testament to the shared belief in the mission.”
Even today, Knaster is the only full-time staff member dedicated exclusively to IAWG. The rest of the network contributes time, expertise and institutional support because they believe in the cause. “That dedication and goodwill are what has kept IAWG alive, and thriving, for three decades. I am so honored to serve this community.”
Over the past year, IAWG has been revising its structure to better reflect its growth, the current needs of its members, and its commitment to inclusivity and accessibility. A streamlined governance model now separates technical leadership from executive oversight and better integrates diverse technical expertise across three working groups (Advocacy and Accountability, Technical Assistance, and Evidence and Learning).
That approach aligns closely with IAWG’s new host organization, the Canadian Partnership for Women and Children’s Health (CanWaCH).
“It’s such a good fit,” Knaster said. “CanWaCH knows what it takes to make coalitions work — the behind-the-scenes effort to build trust, spark dialogue and align diverse actors. We share values around partnership, global health and the intersection of humanitarian and development work. Together we’re modeling an impactful way of working across the sectors.”
One of IAWG’s most ambitious current efforts is the next iteration of its Global Evaluation, a multi-year meta-analysis that brings together data from partners across the world. The goal is to capture where progress has been made, document what works in insecure and resource-limited settings, and identify creative, locally-led solutions.
“The Global Evaluation is one of the most powerful advocacy tools we have,” Knaster explained. “It helps us highlight what’s working — not just the gaps — and make the case for smarter, more sustainable approaches.”
As IAWG marks its 30th year, Knaster hopes to see even more leadership and participation from local and regional organizations. “We want our work to benefit them directly, not just global partners. We need their inputs and their leadership to guide IAWG’s strategy.”
For Knaster, who has been with IAWG for 12 years, the motivation remains deeply personal. “Sexual and reproductive health is a life-saving part of primary health care. It’s non-negotiable and it’s fundamental to human rights and dignity,” she said. “It’s essential for healthy, thriving and resilient communities.”
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