COVID-19 Curfew Restrictions Impact Reproductive, Maternal, and Newborn Health and Rights Worldwide
By Elena Ateva, Advocacy Manager, White Ribbon Alliance
The consequences of COVID-19 could be catastrophic for maternal and newborn health. Early modeling estimates a significant increase in maternal and neonatal deaths in low- and middle-income countries if maternal health services continue to decline. Within the next six months, we can see an increase of up to 1,157,000 additional child deaths and 56,700 additional maternal deaths. An important predictor of preventable maternal and newborn mortality is lack of access to facility delivery and skilled care at birth. However, facility access has been severely disrupted with the imposition of strict curfew and lockdown rules that have not taken the needs of pregnant women and their newborns into account.
Curfew in Kenya Blocks Access to Care
WRA Kenya conducted a survey in Bungoma, Kajiado, Kisumu, Nairobi and Narok counties to determine the impact of COVID-19 on reproductive, maternal, and newborn health services. From April 17 – May 4, WRA Kenya engaged 10 community mobilizers to collect perspectives from their communities to understand the extent at which COVID-19 has affected the delivery of reproductive, maternal and newborn health services in Kenya. The mobilizers applied mixed methods to engage community members, including phone conversations, WhatsApp messaging, an online survey, and face-to-face conversations where possible. Approximately 325 responses were submitted by adolescent girls, single mothers, women, men, people living with disability, community health workers, and local administration officials. The survey shows that women and girls have borne the brunt of the social and economic impact of COVID-19 with reported incidences of sexual and gender-based violence, difficulties accessing health facilities and disrupted economic activities.
Survey respondents reported inability to find transport to health facilities when going into labor as well as verbal and physical harassment from police for walking to health facilities. If a woman needs to move around outside after curfew, which goes into effect at 7 p.m., she needs a letter from the chief. These letters can be very difficult to get and if a woman does not have it, she is harassed by local authorities. Community members have asked for pregnant women to be exempt from the curfew but, so far, that has not passed.
Kenya Survey Shows Poor, Disabled Women Fare Worse
Marginalized women face greater challenges from the curfew. For example, women living with disabilities are having an even more difficult time moving and accessing services, and what limited specialty services were previously available for them are becoming even more scarce. Many citizens who live in slums do not even know about the curfew because they do not have phones or radios, nor do they have general access to information. Police have been reported as being extra brutal in slums, where social distancing is not possible, and misinformation is rampant.
The Kenya survey also revealed that family planning commodities have been severely affected, especially in Kisumu county, and frontline health workers are refusing to work in the area because they do not have personal protective equipment. The biggest crosscutting issue from the survey is immense mental stress and fear of loss of livelihoods. People are having a difficult time worrying about anything past their next meal.
The Civil Rights Defender’s Coalition reports similar concerns when examining the effect of COVID-19 restrictions on maternal health and rights in Kenya:
“Access to maternal healthcare for expectant women is a nightmare during the curfew period. Reports point at the possibility of unnecessary suffering of expectant women because of the fear of brutality they may be subjected to should they seek medical attention late in the night. Women in rural and in-city informal settlements and already marginalized, have suffered a great deal.”
Uganda, Pakistan Curfew also Limits Access to Care
The curfew imposed in Uganda has also limited women’s ability to travel and access health services when in labor. WRA Uganda has documented at least one instance of maternal and newborn death as a result of the lockdown. The government of Uganda has banned transportation, including private transport to health facilities, which is the primary means for women to reach facilities for childbirth, as public ambulances are scarce.
A coalition of organizations, including WRA Uganda, urged the government to reconsider its earlier stance and ensure that women have a way to access facilities for emergency services. As a result, President Museveni issued a directive on April 20 that pregnant women will no longer be banned from using transport to seek health services during the lockdown. However, it’s still remains very difficult for women to travel and access services.
Impact of Curfew on Providers
The curfews have also impacted the ability of providers to go to healthcare facilities to provide care to women and newborns. In Uganda, the transport ban includes most private vehicles as well as the public minibuses, boda bodas and three-wheeled tuk-tuks most residents rely on for transportation. This has left many providers without means to reach healthcare facilities to report for work or exposed them to police brutality when they try to do so. WRA Pakistan has also documented instances where midwives have to arrange for their own transportation to and from the facility where they work, at their own expense.
Working Together to Find Solutions
There are a few positive examples on how government and other actors can support women and girls during the pandemic and ensure access to services. In Uganda, UNICEF and the Ministry of Health have worked together in Yumbe district to train bodaboda drivers to safely transport women in labor to healthcare facilities. Similarly, in Madagascar, UNFPA and the Ministry of Health have teamed up to organize free transport for women in labor. Much more, however, remains to be done to avoid the prediction models becoming a reality in the next six months.