Sexual and reproductive healthcare is often neglected during crises. COVID-19 is no exception. The biggest threat to women’s health during the pandemic is not the virus; it is the secondary effects of the pandemic on their access to sexual and reproductive health and rights (SRHR).
Médecins Sans Frontières (MSF) and Marie Stopes International (MSI), two nonprofit organizations that provide SRHR services to women worldwide, have reported on the significant changes in their ability to provide care during the pandemic and what it means for the people, mostly women, who need them. So far, 2 million fewer women received SRHR services through MSI, which could indicate 1.5 million excess unsafe abortions, 900,000 excess unintended pregnancies, and 3,100 excess deaths. Thousands of centers providing SRHR services have shut down, and more closures are predicted. Such closures could eliminate as much as 80% of these services and result in millions of additional unintended pregnancies, unsafe abortions, and maternal deaths.
This lack of care is caused by a wide spectrum of barriers. Travel restrictions such as curfews and lockdowns prevent women from leaving their homes to receive care. Supply chain breaks cause shortages of PPE and medications. Fear of infection prevents people from seeking care. Overwhelmed healthcare systems divert resources to the COVID-19 response, leaving patients seeking SRHR services with longer wait times, fewer care options, and cut services.
While many of these problems are not unique to SRHR, the conditions of the pandemic and the stigma and misconceptions about the importance of SRHR leaves it especially vulnerable during these times. SRHR services are often politicized and painted as illegitimate, resulting in them being deprioritized during a crisis and more likely to have barriers to access. Such politicization has wide impacts, as countries like the United States use their financial power to block the use of international humanitarian aid on SRHR services, restricting a wide spectrum of essential care for women, from cervical cancer screening to sexual violence treatment. While the need for all these services remains high, or even increased in the case of sexual and domestic violence, during lockdowns, such policies to restrict care become increasingly harmful. Furthermore, stigma relating to these services causes a large amount of misinformation surrounding them and their importance, preventing women from getting essential treatments in a timely manner.
MSF and MSI are working to mitigate the effects of these barriers by modifying the way they provide care, such as increasing telehealth visits, providing transportations for patients, and delivering long term supplies of medication. They are also working with local governments and community leaders to ensure that SRHR services are classified as essential, in some cases pairing up these services with other essential services such as food distribution programs to ensure that people have access. To ensure that people have access to information, they are working with community leaders and using forms of communication such as radio to provide information and guidance to patients.
Such modifications to meet women where they are and integrate care into communities could be beneficial in the long run to make these services more accessible. Initiatives started during COVID-19, such as programs creating peer networks of sex workers to provide care for one another and increased self-managed medication, have already started transferring the power of care to the women in these communities. Trusting and empowering women to care for themselves through programs like these can transform the way SRHR services are provided and widely expand access beyond the pandemic.