Maternal and newborn care in a crisis (MISP)
Women keep giving birth whatever is happening around them, and most obstetric emergencies cannot be predicted. The Minimum Initial Service Package (MISP) sets out what must be in place from the very start of every crisis so that mothers and newborns do not die from causes we know how to prevent.
- For midwives, nurses, clinical officers, doctors and community health workers in humanitarian settings
- Reviewed October 2026
The MISP in one table
The MISP is a set of life-saving sexual and reproductive health services to start at the onset of every emergency, all at the same time. It is the minimum, not the goal: build on it towards comprehensive services as soon as possible, ideally within 3 to 6 months.
| MISP objective | What it means for the clinic |
|---|---|
| 1. A lead agency for sexual and reproductive health | Know who the coordinator is; share what services you offer and what supplies you have. |
| 2. Prevent sexual violence and respond to survivors | A private, safe space for clinical care after sexual violence, with referral to other support. See Clinical care after sexual violence. |
| 3. Prevent HIV and other STIs | Safe blood transfusion; standard precautions; free condoms; continue ART (including for pregnant women); PEP after sexual violence and occupational exposure; co-trimoxazole prophylaxis for people with HIV; syndromic STI treatment. |
| 4. Prevent maternal and newborn deaths | Clean and safe birth, essential newborn care and emergency obstetric and newborn care; a referral system that works 24 hours a day, 7 days a week; post-abortion care; clean delivery kits where facility birth is not possible. |
| 5. Prevent unintended pregnancy | A range of long-acting reversible and short-acting methods, including emergency contraception, with counselling that respects informed choice and privacy. |
| 6. Plan comprehensive services | Integrate sexual and reproductive health into primary care as soon as possible. |
| Other priority | Safe abortion care, to the full extent of the law, in health centres and hospitals. |
Source: IAWG MISP reference sheet, Inter-Agency Field Manual 2018
Safe birth at each level
- Community
- Tell people where safe delivery and emergency care are available and why it matters to give birth with a skilled attendant. Give clean delivery kits to visibly pregnant women and birth attendants where a facility birth is not possible.
- Health centre
- Skilled birth attendants and supplies for normal births and basic emergency obstetric and newborn care (BEmONC).
- Referral hospital
- Skilled staff and supplies for comprehensive emergency obstetric and newborn care (CEmONC), including caesarean section and blood transfusion.
| Sphere indicator | Target |
|---|---|
| BEmONC facilities | At least 5 per 500,000 people |
| CEmONC facilities | At least 1 per 500,000 people |
| Births with a skilled attendant | At least 80% |
| Obstetric and newborn referral | Available 24 hours a day, 7 days a week |
| Caesarean births in facilities | 5 to 15% |
Source: IAWG MISP 2018; Sphere Handbook 2018, standard 2.3.1
Refer now: danger signs
Give first-line emergency care following your national protocol and refer at once, with someone to go with her, to a facility that provides emergency obstetric care:
- Bleeding in pregnancy, or heavy bleeding after birth or after a miscarriage or abortion
- Convulsions, or severe headache with blurred vision
- Fever, or foul-smelling discharge
- Severe abdominal pain
- Labour that is not progressing, or the baby lying in the wrong position
- Difficulty breathing or reduced consciousness
Essential newborn care for every baby
Whether or not a skilled attendant is present, every newborn needs:
- Warmth
- Dry the baby, keep them warm with skin-to-skin contact, and delay bathing.
- Clean care
- Clean birth practices, handwashing, clean cord, skin and eye care.
- Feeding
- Breastfeeding straight away and only breast milk; do not throw away the first milk (colostrum).
- Watching
- Look for danger signs of infection or other problems that need referral.
- Postnatal visits
- Care at or close to home in the first week, with the first 24 hours the most important. Aim for three home visits in the first week.
Source: Sphere Handbook 2018, child health standard 2.2.1
Newborn danger signs: refer
- Not feeding well
- Convulsions
- Fast breathing, severe chest indrawing or grunting
- Fever, or the baby feels cold
- Moves only when stimulated, or not at all
- Yellow skin in the first day, or yellow palms and soles
- Very small baby
Keep the baby warm and breastfeeding on the way, and follow your IMCI sick young infant chart for pre-referral treatment.
Source: WHO IMCI chart booklet (sick young infant); WHO postnatal care recommendations, 2022
Contraception
- Ask the community, including women, men and adolescents in separate private discussions, about local views on contraception.
- Offer a range of long-acting reversible (implant, IUD) and short-acting methods (pills, injectables, condoms) and emergency contraception, in private.
- Counsel on informed choice, how well each method works, privacy and consent.
- Sphere target: every primary health centre offers at least four methods of contraception 3 to 6 months after the start of the crisis.
Source: IAWG MISP 2018; Sphere Handbook 2018, standard 2.3.1
Reproductive health kits
| Level | Examples | Designed for |
|---|---|---|
| Community and health post | Condoms, clean delivery, post-rape treatment, oral and injectable contraception, STI treatment | 10,000 people for 3 months |
| Health centre (BEmONC) | Midwifery supplies, management of miscarriage and abortion complications, repair of tears, vacuum extraction | 30,000 people for 3 months |
| Referral hospital (CEmONC) | Obstetric surgery, blood transfusion | About 150,000 people for 3 months |
Kits are a start, not a supply system. Ask the reproductive health coordinator or UNFPA country office what is already being ordered, and move to routine procurement as soon as possible.
Source: IAWG MISP reference sheet, 2018 (IARH kits)
What to tell pregnant women and families
- Where to go to give birth, and how to get there day or night.
- Come straight away for bleeding, fits, severe headache, fever or severe pain.
- Breastfeed your baby straight away and keep the baby warm against your skin.
- Contraception and HIV treatment are available here, in private.
Please come to give birth here if you can. If you cannot, use this clean delivery kit, and come straight away if you bleed heavily, have a fit, or the baby will not feed.
Sources
- Inter-Agency Working Group on Reproductive Health in Crises (IAWG). Inter-Agency Field Manual on Reproductive Health in Humanitarian Settings, and Minimum Initial Service Package (MISP) reference sheet. 2018.
- Sphere Association. The Sphere Handbook, fourth edition (sexual and reproductive health standard 2.3.1; child health standard 2.2.1). 2018.
- World Health Organization. WHO recommendations on maternal and newborn care for a positive postnatal experience. 2022.
- World Health Organization. Integrated Management of Childhood Illness (IMCI) chart booklet. 2014.