Women wait to be seen by staff at MSF’s Ayilo hospital. Adjumani, Uganda, November 2014. © Isabel Corthier
The coronavirus COVID-19 pandemic is having potentially catastrophic secondary impacts on the health of women and girls around the world. Decisions made at every level of the response to the pandemic are resulting in women being further cut off from sexual and reproductive health services, threatening sharp rises in maternal and neonatal mortality.
Women and girls are often denied care outright or face dangerous delays getting the services they need. The impacts of misguided policies and barriers to care are especially severe in places with weak or overburdened health systems – including many of the places where Médecins Sans Frontières (MSF) works.
A significant lesson from the West Africa Ebola outbreak of 2014-2016 is that the biggest threat to women’s and girls’ lives was not the Ebola virus, but the shutdown of routine health services and people’s fear of going to health facilities where they could get infected. Thousands more lives were lost when safe delivery, neonatal, and family planning services became inaccessible due to the outbreak. Right now, we are witnessing the same dynamic on a much larger scale.
In addition, there has been significant reporting about the economic impacts of the pandemic, with poor and marginalised communities hardest hit. Refugees, migrant workers, and people working in informal jobs already face extreme difficulties getting access to basic healthcare, and these challenges are compounded by COVID-19.
Sexual and reproductive healthcare is essential healthcare
Sexual and reproductive health needs are often neglected in the midst of an emergency – and COVID-19 has been no different. In March, the World Health Organization (WHO) issued interim guidance for maintaining essential services during an outbreak, which included advice to prioritise services related to reproductive health and make efforts to avert maternal and child morbidity and mortality.
Nevertheless, as governments, ministries of health, and frontline providers were forced to make tough choices about which services are most important, women were often left out. Resources for women’s healthcare were sometimes diverted to support COVID-19 activities.
Although access to safe delivery care has long been acknowledged as an essential health service, many pregnant women suddenly found themselves with fewer options for care. In Likoni, Kenya, health centres where women normally deliver were shut down, and health workers were reassigned to the COVID-19 crisis.
In Mosul, Iraq, after a main government hospital was temporarily repurposed as a COVID-19 treatment centre, MSF’s hospital started seeing much higher numbers of pregnant women coming in for delivery care. Our project in Choloma, Honduras, also saw a sharp rise in patients; as government hospitals in the city also became COVID-19 centres, our average births per month rose from 55 to 75, despite a paralysing total lockdown on movement.
Some sexual and reproductive health services, such as contraception and safe abortion care, are often seen as non-essential or even illegitimate. These services have been highly politicised, making them all the more likely to be deprioritised during a crisis as we are seeing now.