Is reproductive health falling into the cracks amid the COVID-19 pandemic?
The COVID-19 pandemic has triggered fear worldwide and influenced all of us in some way or another. It is spreading rapidly, and it is expected to cause major health, economic and societal implications globally. The pandemic has not just resulted in a global economic collapse and the disruption of normal life; it has also caused havoc across healthcare systems around the world. COVID-19 has shown us the shortcomings and inequities that have been hidden within our health systems worldwide, including deficiencies in the contraceptive manufacturing and supply chains, over-medicalization, health insurance limits, healthcare workers’ insecurity, and much more.
Lessons from the Past
Previous public health crises have shown that the influence of an outbreak on Reproductive Health (RH) frequently goes unrecognized because the results are often not the direct outcome of the infection, but instead are the indirect consequence of stressed healthcare systems, delays in treatment, unavailability or lack of Reproductive Health services and diverted resources. For instance, evidence from the outbreak of Ebola virus in West Africa between 2013–2016 indicated the negative, indirect effect of this outbreak on Reproductive Health.
According to a study by Sierra Leone’s Health Management Information System, reduction in maternal and newborn care, decrease in antenatal care coverage, postnatal care services, and family planning services due to interrupted facilities and fear of seeking treatment during the Ebola epidemic led to an estimated 3,600 maternal deaths, neonatal deaths, and stillbirths. The maternal deaths almost exceeded deaths from Ebola in Sierra Leone. This shows that the indirect effects of a crisis on mortality rates because of healthcare systems lacking resilience may be as significant as the direct effects of the crisis itself on the mortality rate.
Is History Repeating Itself?
Reproductive Health is one area that is already falling into the cracks globally because of the pandemic. For instance, the supply chain for contraceptive commodities is already affected as the manufacturers are now focusing more on the pandemic – factories are either shuttered due to the recent outbreak, or their employees are forced to stay home or work limited hours. The closing of borders and restrictions in the supply chain flows of manufacturers also adversely affects the production and distribution of contraceptives, and essential maternal health medicines, including antiretroviral (ARV) medicines.
Moreover, during this pandemic, resources and service providers are being reallocated to the COVID-19 response. The lack of Personal Protective Equipment (PPE) results in restrictions on having a companion at birth or delays in care. Restriction of women’s mobility, unavailability of emergency transfers to facilities, compulsory separations of mother and infant, not allowing or encouraging post-birth breastfeeding, increased dependency on unnecessary medical C-sections, inductions and instrumental deliveries and the augmentation of labor has further worsened the situation.
The burden put on health systems by the outbreak has undoubtedly impacted the Reproductive Health of people especially living in low- and middle-income countries like Pakistan. There have always been obstacles to Reproductive Health in Pakistan, nonetheless, the pandemic has brought the harsh reality of these challenges to the fore. The general population is now witnessing what many disadvantaged individuals, such as people with disabilities, marginalized communities, and people residing in rural areas have faced for a long time – limited to no access to Reproductive Health services.
Reproductive Health is also affected by societal responses to the pandemic. The shift of medical equipment, staff and healthcare programming towards the medical needs arising from the pandemic causes a decline in women’s access to Sexual and Reproductive Health (SRH) facilities. Consequently, the lack of access to SRH care like contraceptives can lead to unwanted pregnancies and unsafe abortions which ultimately endangers the physical health of women.
Furthermore, the national lockdown has also caused Reproductive Health facilities to shut down if not considered necessary. The effects of closed clinics, lack of availability of service providers, social distancing, self-isolation, and economic slowdowns have made individuals, especially women, hesitant to go to Reproductive Health facilities for availing services.
What Needs to Be Done?
Activism in all forms and on all levels is essential. We should use the pandemic to highlight the inequities in our institutions and collaborate with a broad variety of stakeholders, including the government, policymakers, healthcare staff, and NGOs to ensure that the Reproductive Health services do not drop to the bottom of the priority list.
Furthermore, there is a need to maintain the functioning of the health system: to keep updated the right information and resources on Reproductive Health, to protect health workers, and restrict the spread of COVID-19 as much as possible. Therefore, the provision of PPE supplies like masks, boots, goggles, gowns, hand sanitizer, soap, water and other cleaning supplies for the healthcare staff should be ensured. Moreover, the facilities must have proper guidelines for the supply and management of infections to ensure adequate protection of pregnant women, mothers and newborns who are COVID positive or show some symptoms.
Additionally, all women must have access to respectful and safe delivery, continuity of antenatal, intrapartum, postnatal, newborn, and mental health care, including screening testing in compliance with national guidelines and standards, and the government should provide these guidelines. These services should be available especially during the pandemic when access to services for pregnant women, women in labor, and lactating women is adversely affected.
Finally, and most importantly, the voices of women should be amplified so that these can be heard by concerned decision makers. One of the great recent examples of elevating the voices of women can be seen from White Ribbon Alliance’s Pakistan chapter through the What Women Want (WWW) campaign. Through this campaign, an opportunity was provided to women to speak about their experiences and the Reproductive Health demands of nearly 250,000 women around Pakistan were mobilized. In the current pandemic situation the allies of women voices such as media, civil society, non-conventional partners such as bar associations, local community-based organizations, press clubs, and more must come forward to escalate the voices of women so that they can reach the policy annals.