Coronavirus fallout affects family planning, women’s health rights

Women are especially vulnerable to the effects of the current COVID-19 pandemic spreading across the world. In this report by Sade Oguntola, experts linked their vulnerability to the disruptions in sexual and reproductive health services and reduced access to gender-based violence services.

The global epidemic of COVID-19 is wreaking havoc on a wide array of health, economic, social and personal decisions. With many cities on lockdown and businesses and schools shutting their doors, the COVID-19 virus is dramatically changing everyday life for people across the country, including those seeking reproductive health services.

Recognising that the lockdown is necessary to slow the spread of COVID-19 as the country races against time, however, it will be harder more for women.

Certainly, men have a higher death rate from COVID-19, and slightly more men than women appear to be infected right now. But the disruption caused by the virus will likely hit women harder.

Dr Natalia Kanem, executive director of the United States Population Fund (UNFPA), cautioned that the coronavirus outbreak has “severely disrupted” access to sexual and reproductive health (SRH) and gender-based violence (GBV) services “at a time when women and girls need these services most”. Women are also faced with an increase in the workload at home.

She identified pregnant women who need antenatal care but are unsure whether to attend a clinic, and women in abusive relationships trapped at home during the lockdown to be among the risk groups deprived of sexual and reproductive health services.

Some women stayed away from medical facilities due to quarantine restrictions or misconceptions about virus transmission.

At the same time, she said that the systems for protecting women and girls may weaken or break down. With schools around the world closed during the pandemic, girls are more exposed to sexual violence and unwanted pregnancy.

Much more, Dr Olusoji Jagun, a consultant obstetrician and gynaecologist, Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, Ogun State, stated that poor access to reproductive health services, increased by the lockdown, is an issue with consequences on the health of women and the girl-child.

According to Dr Jagun, access to family planning commodities such as condoms and contraceptive pills, medical treatment or the opportunity to discuss their reproductive health issues with a physician are affected.

Access to treatment of other problems of the reproductive tract, such as cancer, menopausal symptoms and infertility is postponed.

He declared, “We are not in an environment where they can say I want to have a chat with my healthcare provider on the phone. How many hospitals have dedicated lines to be used to talk to a doctor or a nurse before they can actually come to the hospital?

“There is a restriction in access to healthcare, the pharmacy shop and so on. All these have a consequence and a multiplying effect. For instance, you have a lot of unwanted pregnancies; the truth about our healthcare system is abortion is illegal in Nigeria,” he added.

Dr Jagun said the lockdown had also created the opportunity for increased sexual activity, including rape, unplanned pregnancies and post-coital laceration, one of the problems that come with sex.

He added, “you may not find the classical rape occurring but you may have nonconsensual sex.”

Certainly, many government hospitals still run antenatal services and take deliveries of new babies, including the provision of caesarian deliveries. “I can tell you that in OOUTH, Sagamu our wards are full. They come to deliver,” Dr Jagun added.

Moreover, Dr Chris Aimakhu, a consultant obstetrician and gynaecologist, University College Hospital (UCH), Ibadan, Oyo State, said due to COVID-19, attention has moved from gynaecological issues to how to survive.

Although there would not be much of teenage pregnancies really because the lockdown will prevent people from having access to their boyfriends right now, Dr Aimakhu said many unplanned pregnancies would occur among couples.

While the transmission of sexually transmitted diseases may not be much, since they are likely to keep to their partners, Dr Aimakhu stated that problems will be more with poor access to family planning services and family planning commodities.

A shortage of condoms, or any contraceptive, could lead to an increase in unintended pregnancies, with potentially devastating health and social consequences for adolescent girls, women and their partners and families.

Previous research had found that natural disasters have led to significant increases in childbirth rates and reduced spacing between successive births, particularly for uneducated women.

Also, even when pregnancies occur, to ensure the pregnant woman commences antenatal care promptly may be hindered because of the lockdown.

Worse still, Dr Aimakhu stated that the lockdown can promote food insecurity and partner violence, including violence among neighbours in a particular community.

“Partner violence is on the increase because people cannot tolerate their spouses; some are finding out that their spouses have boyfriend or girlfriend because they are calling them. Also, violence among neighbours is on the increase because people are on the edge because there is no money,” he noted.

But even as the pandemic’s economic fallout and disruptions to the health system escalate, he said it is important that individuals continue to practise safe sex.

Mrs Josephine Effah-Chukwuma, founder and executive director, Project Alert on Violence Against Women, Lagos stated that the effect of COVID19 on gender-based violence (GBV) and sexual and reproductive health and rights can be best imagined.

Mrs Effah-Chukwuma declared, “If before the lockdown when people were moving freely and weren’t restricted to one place for 24 hours for weeks, domestic and sexual abuses were occurring, then imagine now, when people are stuck with each other.

“No space, no relief; no going out to let out steam; no time off with children in school; not enough money and food in the house; no recreation for couples other than sex; no running to a relative for respite etc. There will be and already we are experiencing a spike in reported cases of gender-based violence.”

She said the lockdown had left a lot of tension in homes. There is fear, concern and uncertainty over the virus; there is concern over the income of the family; there is fear about bills and where money will come from.

There is also the fear of being locked in with the enemy (man or wife) with the inability to run out if needed and there is the fear of sexual abuse in the home by young girls in the home, including relatives and maids.

Also, Mrs Effah-Chukwuma said further worrisome at this time is the plight of the vulnerable such as women with a disability and the elderly.

Sadly, when it comes to the challenges faced by women during this global pandemic, it doesn’t just stop at our health. Women are also more likely to hold jobs outside a permanent, full-time capacity, which means many of them on part-time, casual, temporary or other precarious statuses will be hit most severely when the economy grows volatile.

Additionally, the government should minimise disruptions in reproductive health care, build inventories of contraceptives, ensure access to sanitary products and offer counselling and support for reproductive health care needs through the continued presence of health workers on the ground.

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