COVID-19 has rerouted focus and resources internationally, yet there are needs which cannot be compromised even during emergencies – sexual and reproductive health services. The article addresses the current challenges to women’s health and what immediate action needs to be taken to attend to the health of millions of women.

Access to 'essential' sexual and reproductive health services during the pandemic.

Deepshikha Chhetri is a Youth Advocate for Women’s Health and Gender Rights. Currently a Public Policy Fellow at Citizens for Public Leadership, she has previously worked with the Government of Haryana as Chief Minister’s Associate to drive policy changes in the state. Deepshikha also has experience in grassroots leadership and change as an India Fellow where she worked on development projects. She holds a postgraduate degree in nutrition and continues to work as a public health consultant for multiple civil society organisations and government projects.

It’s been more than a month that the entire country has been put under lockdown and it is difficult to anticipate at present for how long the situation will sustain. Amid all the crises, India is putting their best of efforts but yet again, the tribulations of COVID-19 have affected women the most. 

With the increase in the rate of domestic violence, the news has been all over the media and served to shock the masses, but to be honest, we shouldn’t be. The Thompson Reuters Foundation Survey (2018), named India as the ‘world’s most dangerous country for women due to high risks of sexual violence. Even globally before the pandemic, the circumstances have not favored women. Statistics show that one-third of the women around the world experience one or the other form of violence in their lifetime.

The ramification of this violence is boundless, be it in terms of physical and mental health, however, sexual and reproductive health is affected the most at an alarming rate. Studies show that women who experience physical or sexual abuse are twice as likely to have an abortion.

As the COVID-19 pandemic has taken over the focus of the entire health system, access and delivery of basic sexual and reproductive healthcare services like routine checkups, testing for STIs to antenatal care, contraception, abortion have been significantly compromised due to low priority. This is a burden especially to developing countries as there are around 1.6 billion women who are in the prime childbearing group (15-49 years). Within this age group, 81.4% of the women are married in India, mostly because of early child marriage across different parts of the country which ultimately contributes to a high fertility rate. However, what is worrisome is that the Indian youth population (15-34 years old) constitutes 35% of the total population, and being at the early years of reproductive age, have a higher demand for the SRH needs as compared to the rest.

Prior to the global lockdown response as well, 217 million women have already unmet needs for contraception, despite the desire to avoid pregnancy. In India, 12.9% of married women (15-49 years) were not able to meet the need for family planning and 5.7% of the women could not meet the need for spacing (NFHS-4). 

Recently, the funding for reproductive and women’s health was reduced from 20% to 7% of the total budget by the Indian government, and considering the urgency, it is inclined to revise its health policy priorities. The situation is not just limited to India but across most of the low and middle-income countries, and if it persists, women’s health is going to hit harder in the long-run. The need for sexual and reproductive health services doesn’t slow during health emergencies, rather it becomes more vital when the access is disturbed. 

 

Gender inequity has been so historically entrenched in our roots that women find it difficult to negotiate for consistent safe sex or safe spaces, especially in marginalized communities where poverty and limited access to resources are prevalent. The lockdown makes it worse because if the provision of contraceptives is not prioritized as an essential healthcare service, it will ultimately result in a lapse in continuous coverage and undesirable sexual and reproductive health outcomes like unwanted pregnancies which thereby increase the maternal mortality and infant mortality rate. Similarly, the loss of quality of maternal health services, safe abortion, protection from gender-based violence, access to menstrual hygiene products needs high priority consideration during these times. 


Yet, I am confident that just like India has been able to curtail the widespread outbreak of coronavirus across the country, our efforts to improve the status of women’s health wouldn’t go in vain. Recently, multiple advocates and organizations working on SRHR came together to request the Government of India to consider and provide family planning and safe abortion services under the category of “Essential Health Services during the COVID-19 Outbreak”. With consistent perusal and pressure of the collective voices, the Ministry of Health and Family Welfare has announced contraception and abortion services under essential services and directed the State Governments to follow the same. Under this, contraceptives (condoms/ oral contraceptives pills MALA/Chaya, injectable contraceptives Antara/ emergency contraceptives) have to be provided to eligible couples/ others needing them through all Public Health facilities, including ASHA/SHC and PHC for easy access. Health facilities should display information about the delayed availability of IUCDs and sterilization services until routine services resume. Beneficiaries must be counseled for the adoption of and provided with temporary methods of other contraception methods like condoms/ OCP/ injectable etc. in the interim period. Also, medical and surgical abortion services to be ensured at an appropriate facility level with appropriate infection prevention measures including counseling for post-abortion care and provision of contraception.

This move needs to be well acknowledged by all of us, but this is also the right time to take a step back and look at our health policies with a gender lens and work together on our strategies to find solutions to combat these real-times issues and challenges. 

Way forward, to prepare for the long-lasting effects of the current crisis on public health, government and policymakers need to invest in maintaining access to primary healthcare and specialized sexual and reproductive health services for women, including adequate stock of menstrual hygiene products at health care facilities, medical supplies and medications like infectious disease vaccination, prevention, and treatment programming for women and children. Most importantly, medical staff and frontline health workers should be trained to recognize signs of domestic violence and provide appropriate support and services.

Along with a political will, the government needs to change policies to make it easier for people to access medical care virtually such as telemedicine and medications which can be taken in homes. Evidence has shown good results for medical abortion medication, which should be standardized as it will help in providing immediate care to women and girls and pare the burden on the health system.

Failure to take appropriate measures will only result in a rise in poor sexual and reproductive health outcomes, impacting the lives of women and girls beyond this crisis which will be severe and will set us back in terms of the progress we have all made together.

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