As the Covid-19 pandemic continues to spread throughout the world, concerns are rising about the effect of the virus on women and girls’ sexual and reproductive health, and their access to contraceptive care. Past humanitarian crises have shown that when there is a disruption in the supply and access to routine health care services, it is women and girls’ who are disproportionately affected, simply by virtue of their sex.  

In an attempt to halt the spread of the virus, governments across the world have ordered sexual and reproductive health services to close, on the grounds that these services do not meet the ‘essential’ criteria. The reallocation and reprioritisation of these services have only exacerbated rates of neonatal and maternal mortality and morbidity, increased rates of adolescent and unwanted pregnancies, HIV and other sexually transmitted infections. Forced closures have also ensured that women and girls have been discouraged from accessing safe abortion services, putting the lives of themselves and their unborn babies in serious danger. 

This article will explore the ways in which Covid-19 has disrupted the provision and supply of sexual and reproductive health services, with a particular focus on contraceptive access for women and girls across the world. Policy recommendations, which can help governments and humanitarian organisations to understand the ways the pandemic exacerbates direct and indirect health impacts on women and girls, will also be explored. 

The Effect of Covid-19 on Women and Girls’ Access to Contraception and Abortion 

While the bid to reduce the transmission of Covid-19, and the search for an effective vaccine remains a central priority of most governments, there are other health-care issues which we should not lose sight of. Not only will these health issues not disappear during the pandemic, the risk is that they will likely be compounded by a lack of attention given to them. During the first peak of Covid-19 in 2020, the World Health Organisation (WHO) issued advice which called for sexual and reproductive services to be prioritised. However, research by the Lancet and Human Rights Watch have found that governments in Nepal and India deemed these services as ‘non-essential’ and even ‘illegitimate’, denying women and girls access to “time-sensitive and potentially life-saving services”. The shutdown of these routine health services, as well as individuals’ fear of contracting the virus in these places, have led to a decline in the use of safe delivery, neonatal and family planning services. 

The Health Impact of Sexual and Reproductive Service Closures

Marie Stopes International (MSI), operating in 37 countries, has found that forced closures of sexual and reproductive services, due to the pandemic, may result in up to 9.5 million women and girls losing access to contraception and safe abortion services. The consequences of this would be devastating with an anticipated 3 million unintended pregnancies, 2.7 million unsafe abortions and 11,000 pregnancy-related deaths. 

Research by the United Nations has also found that the diversion of attention away from contraceptive resources can expose women and girls to greater risks of contracting HIV and other sexually transmitted infections. The research also makes the grave projection that an additional 18 million women in Latin America and the Caribbean will lose regular access to modern contraceptives. Simon Cooke, MSI’s Chief Executive has pointed to the gender disparity in experienced healthcare inequalities, stating that; “women and girls will pay the price if governments do not act now to safeguard access to essential healthcare, including safe abortion and contraception”. We must also recognise how the provision of sexual and reproductive services will be affected by virus prevention measures, particularly health workers’ access to personal protective equipment (PPE). This access is likely to be more restricted in developing countries, where it is more of a challenge to gain adequate funding.  

Covid-19 has made it harder for women to plan families and have rightful control and ownership over their bodies. Sarita Ojha, a Counsellor at Marie Stopes Nepal’s Centre recalls a conversation that she had with a woman on the phone who was in deep emotional stress. She notes that the woman was crying and asking: “when will your services restart? I cannot afford to have another child. Please help me!”. Indeed, the mental health impact of forced health service closures should also be considered alongside the pandemic. 

The Lessons of Past Humanitarian Crises

As we look at the devastating impact of Covid-19 on women and girls’ health, it is important to learn from past humanitarian crises to see whether it can inform our approach to dealing with the current crisis. 

Marie Stopes International (MSI) have pointed to the 2013-2016 Ebola outbreak in West Africa and how women’s access to essential reproductive healthcare was disrupted. In the Western Area rural district, some women reported concerns with the standard of care that was given to them at healthcare facilities:  

“Nothing [No family planning] as of now because they are not treating us, so there is no way for us to escape any pregnancy.” (Female, 15-24, W/A Rural)

“The last time I went to the health centre to take the injection but the nurse there refused to give it to me saying she is afraid. My sister-in-law also went there for the same injection; they refused to give it to her.” (Female, 24-49, W/A Rural)

Indeed, research has shown that the decrease in the use of essential reproductive, maternal and neonatal health services in Sierra Leone translated to “3600 additional maternal, neonatal and stillbirth deaths in the year 2014-15”. It is clear, therefore, that there are other healthcare issues that do not disappear during a crisis. Though not a direct consequence of Covid-19, the all-important side-effects which occur as a result of Covid lockdowns and quarantines, need to be given more attention. If not, there is the real danger that more lives will be lost due to the inaccessibility of essential healthcare services, than the actual pandemic. 

Policy Recommendations

I want to propose a series of policy recommendations that can help governments and humanitarian organisations to better understand the biggest challenges facing women and girls around the world right now. Based on an extensive set of interviews conducted in Colombia, Honduras, Greece, Uganda, Mozambique, South Africa, Iraq and Afghanistan, Medicins Sans Frontieres (MSF), have found the most pressing challenges are:

• The closures and cuts to sexual reproductive services
• Unclear public health information and guidance 

What should be done?  

• Sexual and reproductive health care services should be classified as ‘essential’. The labelling of services as ‘illegitimate’ should also be removed. Such classifications would prioritise these services and also help to remove the stigma and negative connotations. 
• Learning from past humanitarian crises, particularly the Ebola Crisis, governments must remove the barriers to women and girls, preventing them from being able to access such services.  
• Stronger acknowledgement of the time-sensitive and life-saving nature of contraceptive and abortion services. Alongside this, there must be more attention given to the adverse health impact of forced closures and postponing of health checks and screenings.  
• Increased access to contraception and safe abortion care during the Covid-19 pandemic. 
• An increase in funding to sexual and reproductive health care services, with enough supply of PPE equipment. More funding should be given to those services in developing countries. 
• An increase in funding to develop more Covid-prevention safety measures.  
• An increase in funding to allow for more counselling, pastoral and wellbeing experts, who can work with patients to address mental health issues. 
• Governments and funding agencies should follow the advice from the UN,  that women and girls will always need sexual and reproductive health care services, regardless of the pandemic. 
• More extensive insurance coverage for routine healthcare services, particularly in rural and marginalised communities where funding is very low. 

Though the elimination of Covid-19 and the search for an effective vaccine remains the central priority of most governments, there is still the need for safe contraceptive supply and access. Safe delivery, neonatal and family planning services does not just disappear during a pandemic and should not be ignored. Doing so only threatens sharp increases in maternal and neonatal mortality and morbidity, and a range of other health-related illnesses for women and girls around the world. 

Rohini Anand 

Rohini Anand is a MSc student in International Social and Public Policy from the London School of Economics. Her research interests lie in crime and criminal justice policy.

The featured image (top) is entitled ‘Three women, Masked 02’ and is by byronv2 on Flickr. It is licensed under Attribution-NonCommercial 2.0 Generic (CC BY-NC 2.0).

Bibliography:

Kumar, Manisha, Maura Daly, Eva De Plecker, Christine Jamet, Melissa McRae, Aine Markham, and Carolina Batista. “Now is the time: a call for increased access to contraception and safe abortion care during the COVID-19 pandemic.” BMJ global health 5, no. 7 (2020)

Makins, Anita, Sabaratnam Arulkumaran, FIGO Contraception and Family Planning Committee, Jill Sheffield, John Townsend, Petra Ten Hoope‐Bender, Megan Elliott et al. “The negative impact of COVID‐19 on contraception and sexual and reproductive health: Could immediate postpartum LARCs be the solution?.” International Journal of Gynecology & Obstetrics (2020)

Sochas, Laura, Andrew Amos Channon, and Sara Nam. “Counting indirect crisis-related deaths in the context of a low-resilience health system: the case of maternal and neonatal health during the Ebola epidemic in Sierra Leone.” Health policy and planning 32, no. suppl_3 (2017): pp.32-39.

MSI Reproductive Choices: April 2020: https://www.msichoices.org/news/2020/4/95-million-women-could-lose-access-to-our-services/

Women and girls face greater dangers during Covid-19 pandemic: July 2020: https://www.msf.org/women-and-girls-face-greater-dangers-during-covid-19-pandemic

The Indirect Impact of Covid-19 on Women: August 2020: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30568-5/fulltext

Policy Brief: The Impact of Covid-19 on Women: https://www.un.org/sexualviolenceinconflict/wp-content/uploads/2020/06/report/policy-brief-the-impact-of-covid-19-on-women/policy-brief-the-impact-of-covid-19-on-women-en-1.pdf

Women’s health: Medicins Sans Frontieres: https://www.msf.org/womens-health

New UNFPA projections predict calamitous impact on women’s health as COVID-19 pandemic continues: April 2020: https://www.unfpa.org/pcm/node/24174

Are we ready to mitigate the impacts of COVID-19 on family planning and contraceptives? June 2020: https://www.globalfinancingfacility.org/are-we-ready-mitigate-impacts-covid-19-family-planning-and-contraceptives

Sexual and Reproductive Health and Covid-19: https://www.who.int/teams/sexual-and-reproductive-health-and-research/key-areas-of-work/sexual-reproductive-health-and-rights-in-health-emergencies/covid-19