Essential services needed to prevent unwanted pregnancies

“The current pandemic is straining human resources, disrupting supply chains and service delivery, and negatively impacting service-seeking among women and girls in countries around the world,” said Sarah Barnes, Project Director of the Wilson Center’s Maternal Health Initiative. She spoke at a recent an eventco-hosted by the United Nations Population Fund (UNFPA), on unwanted pregnancies during the COVID-19 pandemic. Rising rates of unintended pregnancies during the pandemic have exacerbated the vulnerabilities of many women, said Anneka Knutsson, chief of sexual and reproductive health at UNFPA.

According to a recent Lancet Global health study, more than 50% of women of childbearing age in low- and middle-income countries want to avoid pregnancy, said Beth Sully, senior researcher at the Guttmacher Institute. And one in four of these women has an unmet need for modern contraceptive methods.

Additionally, the pandemic has increased the risk of unintended pregnancies for women due to school closures, limited access to comprehensive sex education and contraception, and an increased risk of violence against women. and girls in low- and middle-income countries, Barnes said.

The pandemic has given us the opportunity to see how our sexual and reproductive health services are treated differently, where we make them exceptional and where we don’t see them as essential, routine and normal, Sully said.

The effect of COVID-19 in low- and middle-income countries

In Nepal, information about sexual and reproductive health is considered taboo, said Lirisha Tuladhar, secretary of the Youth Coalition for Sexual and Reproductive Rights, Nepal. During the pandemic, school dropout rates have increased, further limiting young people’s access to even minimal sexual and reproductive health information. Even so, school sex education curricula do not cover unwanted pregnancies and abortion, which exacerbates the intergenerational information gap, she said.

The situation worsened when Nepali men working abroad lost their jobs due to the pandemic and returned home. During the lockdown, sexual contact increased leading to an increase in unwanted pregnancies, Tuladhar said.

The lockdown has prevented products that could help prevent unwanted pregnancies from reaching the Democratic Republic of Congo (DRC), causing supply shortages, said Dr Jean Claude Mulunda, DRC representative at Ipas.

Pandemic programming and initiatives

Although rural communities in Nepal generally do not have access to digital platforms, COVID-19 has made it mandatory for these communities to be online, Tuladhar said. Remote nursing enabled nurses to provide sexual health counseling and information to people who needed it, in collaboration with YoSHANshe says.

In the DRC, Ipas has partnered with Experian to create a smartphone app to improve accessibility to abortion services without using the internet, Dr. Mulunda said. During COVID-19, Ipas trained young champions to help navigate the app and raise community awareness, he said.

Argentina’s health ministry has authorized access to modern contraceptive methods and voluntary termination or legal termination of pregnancy, said Valeria Isla, director of sexual and reproductive health at Argentina’s health ministry. Declaring these essential services during COVID-19 established the importance of sexual and reproductive health in all provinces, she said.

“Before the pandemic, we used to send sexual health kits to 5,500 health care centers across the country in addition to provincial sexual health areas to meet some unmet demands,” Isla said. . However, despite the sufficient number of kits, a major challenge was to open primary health care centers to provide services, she said.

In Argentina, a national toll-free helpline helped people access contraceptive methods during the pandemic. Direct interventions by the national government and local provinces enabled individual referral to health facilities for legal termination of pregnancy, Isla said. The hotline answered more than 10,000 phone calls in 2020. In addition, the government has promoted virtual meetings, digital prescriptions and the provision of emergency hormone therapy, she said.

The pandemic has given us a lens right now to reflect on our regulatory regimes, our supply chains, our standards and our delivery of care to determine how and why we treat sexual and reproductive health differently, Sully said.

Cross-sectoral solutions and coalition building

Collaboration from every sector is needed, Tuladhar said. It cannot be solved by one person or one organization alone. The most important thing for Nepal is to reduce the stigma associated with sexual and reproductive health and rights. We can work with older and younger generations to make sexual and reproductive health holistic, she said.

In the DRC, civil society organizations worked with the Ministry of Health to identify and train young champions. During COVID-19, these efforts have helped us maintain momentum in our efforts to prevent violence against women and improve access to abortion services, Dr. Mulunda said.

An important factor for Argentina has been the development of feminist organizations, networks and movements such as Ni Una Menos (not one less), who catalyzed and united activists of all ages across the country for sexual and reproductive health justice, Isla said.

By consolidating a budget for sexual health, we ensured that supplies could be purchased by the federal government and distributed to provincial health centers, Isla said. Since adolescents do not usually go to health centers in Argentina, we must create mechanisms to reach them in all sectors and disciplines, she said.

“We need to continue to work with civil society organizations and we need to understand that working with civil society organizations, feminist and transfeminist movements, means embracing complexity but also diversity,” Isla said. “If we can respect this diversity, we will be able to create a sexual health program with the greatest impact and a more comprehensive program,” she said.

The pandemic has taught us the importance of treating sexual and reproductive health care as an essential service, Sully said.

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Sources: Guttmacher Institute, NPR, The Lancet, United Nations Population Fund, YoSHAN.

Photo credit: Women dressed in traditional African fabrics and socially distanced. Ivanfolio/Shutterstock.com.

Michelle J. Kelley