The Covid-19 pandemic is having potentially catastrophic secondary impacts on the health of women and girls around the world. Decisions made at every level of the response to the pandemic are resulting in women in some instances being cut off from sexual and reproductive health services. Women and girls are often denied care outright or face dangerous delays getting the services they need.
Sexual and reproductive health needs are often neglected in the midst of an emergency. In March, the World Health Organization (WHO) issued interim guidance for maintaining essential services during an outbreak, which included advice to prioritise services related to reproductive health and make efforts to avert maternal and child morbidity and mortality. Governments were, however, forced to make tough choices about which services are most important, and women were often left out. Resources for women’s health care were sometimes diverted to support Covid-19 activities.
Some sexual and reproductive health services, such as contraception and safe abortion care, are often seen as non-essential or even illegitimate. These services have been highly politicised, making them all the more likely to be deprioritised during a crisis as we are seeing now, reports Doctors Without Borders (MSF). Since the Covid-19 pandemic began, many centres that provide reproductive health services have shut down.
Abortion, for example, is a time-sensitive service, and women needing safe abortion care are facing appointment dates well into the future. In Rustenburg, abortion services were initially shut down by health facilities due to the misperception that abortion services are not essential health care. MSF’s advocacy with local health authorities and providers helped get those services reopened. Travel bans and movement restrictions imposed to limit the spread of the Coronavirus have had unintended consequences on all aspects of sexual and reproductive care. Lockdowns and social distancing measures have also contributed to a disturbing spike in reports of domestic violence, including sexual violence. Staying home is not safe for many women and girls who may be trapped with an abuser. WHO reports that one in three women experience physical or sexual violence, mostly from an intimate partner.
Even as the need for sexual violence care is apparently growing, access to health services is more difficult. In many places, MSF is seeing a disturbing rise in reports alongside reductions in people actually coming for care. In South Africa, a national hotline that receives reports of sexual violence saw a three-fold spike in calls after the country-wide lockdown took effect. “But while there was an increase in reports, there was a decrease in clinic visits,” says Kgaladi Mphahlele, MSF safe abortion care and family planning activities manager in Rustenberg. Across the city and surrounding areas, other clinics reported the same. Many callers were likely not able to leave their homes or get transportation to a health facility, Mphahlele says. MSF provides transportation for people who seek treatment for sexual violence, and we have continued to do so throughout the lockdown and also started telehealth counselling.
There have been a series of reports by news media and by major manufacturers about the domino effect of the supply chain breakdown resulting in shortages of family planning products. Manufacturing halts in countries like China, India, and Thailand earlier this year meant that regular orders of everything from condoms to mifepristone – an abortion medication – could not be filled. Now, factories face a long list of backorders. Shipments of products have gotten stuck at airports and seaports, so shipping and customs clearance services also face long backlogs. Supply deliveries are further delayed along transportation routes due to curfews, lockdowns, and checkpoints.
MSF’s teams have been able to mitigate the worst effects by having essential stocks pre-positioned, which is something they to prepare for emergencies. Nonetheless, many of the programmes worldwide, including sexual and reproductive health projects, have been affected by a lack of medicines and PPE.
Many MSF projects are adapting to the curbs on face to face care by using some form of telehealth, whether it’s establishing hotlines for people with health concerns or reaching out by phone for counselling sessions. The Covid-19 pandemic could be an opportunity to fundamentally change aspects of how sexual and reproductive health services are delivered, in order to make them more accessible. “We have to simplify the process and meet women where they are,” says Dr Manisha Kumar, head of MSF’s task force for safe abortion care, “not sit around and wait for them to come to health facilities. Women need to be trusted and empowered to care for themselves.”
At Doctors Without Borders, they know that more women and girls are likely to die due to the secondary impacts of the Covid-19 pandemic than due to the disease itself. Governments, health authorities, and health providers need to act to eliminate barriers to care and save as many lives as possible. Movement restrictions must be adapted to allow for women to access all essential health services when they need them. Health facilities must continue to offer essential health care, including contraception services, safe abortion care, and treatment for sexual violence, to anyone who needs them. Communities need to receive clear communication and guidance to prevent the misinformation and supply chain disruptions affecting medical materials, including contraceptives and key sexual and reproductive health medications, must be addressed.