This year the International Day of Action for Women’s Health falls in the shadow of the COVID-19 pandemic. People’s lives have somewhat been put on hold due to COVID-19 and the efforts to deal with it. However the personal health needs of women and the youth have not been put in abeyance, in fact, now more than ever, there is likely to be a rise in complications from unsafe abortions, maternal mortality and an increase in the need for adequate sexual and reproductive health information and services. Though it may be too early for decisive data on the full effects of COVID-19 on women’s access to sexual and reproductive health (SRH) services, available anecdotal and presumptive information suggests the impact on the region’s access to such services has been and is likely to be substantial, and is likely to disproportionately affect those who are most socio-economically disadvantaged. This can be attributed to factors related to the COVID-19 focus and response.
Extensive focus on COVID-19 has caused, in some instances, restrictions in access to healthcare, and even the closing of institutions. For instance, some family planning clinics in Zimbabwe and Zambia have reportedly been closed, reducing access to affordable and targeted family planning services for women. Even for those clinics that remain open, the restrictions on outreach services may have a dramatic impact on how many people these clinics can actually reach. In Zimbabwe, for example, the NGO Marie Stopes International has suspended all outreach services, which reach more than 60% of its clients. At clinics that do remain open, the number of clients has dropped by 70%. In addition, at the health facilities that do remain open, health providers are likely to be overwhelmed by responding to COVID-19, including the need for training, and reluctant to treat patients because of shortages in Personal Protective Equipment (PPE). The prioritisation of COVID-19 in terms of production and provision of medical supplies and equipment also means that there is less investment and availability of supplies required by women and girls to cater for their sexual and reproductive health. This is likely to result in disruptions of supplies, including stock-outs of family planning medication like pills and injectables.
To reduce or curb the spread of the virus, government interventions have almost invariably been in the form of lockdowns, curfews or other restrictions on movement and association. Although access to health care, having been declared an essential service, has been allowed during lockdown restrictions, there has not been the express mention of SRH services. As a result, problems have arisen in accessing SRH services, from a lack of medical providers providing the service, to problems with getting physical access to health institutions. Restrictions in movement have also made it difficult for women to go out to seek reproductive health services, which is exacerbated by fear of being arrested or assaulted by law enforcement officials. Presumably, the indignity of having to explain the need to seek services relating to sexual health would also act as a barrier. In addition, lack of availability of transportation in rural areas also impacts on women’s ability to access maternity care services.
The UNFPA estimates that, should lockdowns continue for the next 6 months, 47 million women in low and middle-income countries in the world are likely to stop using modern contraception. This is likely to exacerbate the already great unmet contraceptive needs in the region. Without adequate government responses, these disruptions will lead to a substantial increase in unintended pregnancies, leading to unsafe abortions, and poor SRH outcomes for women. It is therefore vital to remember that, despite the very serious existence of the COVID-19 pandemic, and the need to invest resources in order to deal with it, women’s SRH needs cannot be put on hold, and should not be left behind in a comprehensive health response. In line with the themes of the International day of Action for Women’s Health, African governments should remember that “Women’s Health Still Matters”.
Tambudzai Gonese-Manjonjo & Amanda Shivamba
