SADC: Access to services hampered by COVID-19

SADC: Access to services hampered by COVID-19

Date: December 30, 2020
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Sifisosami Dube

25 November : Lungelo woke up at four am in order to start the long walk to the nearest district hospital.  She  wanted to collect her monthly family planning pills as she was left with only two days’ supply. Upon arriving at the hospital, the process to collect the pills was slow as it was deemed a non-essential service during the COVID-19 lockdown period. When it was finally her turn to be attended to, she was told that the family planning tablets ran out two days ago and the next supply is expected the following week. Many women faced such situations during COVID-19 lockdown. The situation is worse for women in remote or rural areas.

The COVID-19 pandemic has had a crippling effect on the health care systems across the globe. The immense pressure forced the world to largely focus on increasing healthcare capacity, understanding the pandemic and in search of the cure while paying less attention to the usual health issues.

As the number of COVID-19 cases escalated, some countries were forced to make tough decisions about the most important health services. With no other option, decision-makers had to cut-off or divert most resources for women’s health care (such as funds and healthcare workers) to support Covid-19 initiatives.

No area of healthcare is immune to the impact of the pandemic including contraception. Although highly politicized, contraception is a very sensitive issue as it is crucial to prevent pregnancy-related health risks for women as well as improving their socioeconomic wellbeing.

Looking at 2019 data from World Health Organisation, among the 1.9 billion women of reproductive age (15-49 years) worldwide, 1.1 billion need family planning. Of these, 842 million use contraceptive methods, while 270 million have an unmet need for contraception. It is without a doubt that these numbers have escalated due to the lack of access to contraception caused by the pandemic and its stringent lockdown measures.

A 10% decline in the use of contraception over a year will result in an additional of 48 558 000 women with unmet need for contraception worldwide. And this would result in 15 401 000 additional unintended pregnancies, 1 745 000 additional women experiencing major obstetric complications without care, and 3 325 000 additional women resorting to unsafe abortions – according to the Guttmacher Institute estimates.

These are worrying statistics for just over a year. With the impact of the pandemic, the world is set to face challenges in dealing with women’s   health issues.

The UNFPA estimates that about 46 countries that usually receive supplies from the organisations will continue to experienced stock‐outs of one or more contraceptive modern methods, for at least six months. With the SADC largely depending on the supplies from overseas, the region is hit hard by the global supply chain disruption. Such disruptions have a tipple-effect in the provision of basic contraceptive methods, availability of emergency contraception and access to contraception services. This will impact the family planning progress that has already been achieved in various countries – making it difficult to meet the Sustainable Development Goals.

The region’s implementation of lockdowns has affected many organisations providing family planning services and more closures are predicted due to the lack of funds as donors have to deal with the COVID-19 crisis.

The travel bans and curfews put a strain on women who rely on public transport to collect their contraceptives.

About 60% of the population in the SADC region lives in the rural areas facing geographical distribution challenges, even before the pandemic. The restrictive movements amplified the current distribution crisis contributing to inaccessibility of proper sexual reproductive health services in various facilities that are remotely based.

With many women dependent on the public health facilities for contraception, some facilities did not have clear directives as to which services to provide during stringent lockdowns, since the focus was on increasing healthcare capacity for Covid-19. As many health care workers succumbed to the pandemic, there was a growing fear to access health facilities as well as to provide health care services. According to SECTION27, many women reported that some facilities refused to provide contraception services on the basis that it is not an emergence service.

The economic challenges caused by the pandemic have a consequential impact on the access to modern contraception methods. Many women will struggle to pay for these services especially migrant workers who often shy away from accessing family planning in public health facilities due to the fear of discrimination

In eight SADC countries (Comoros, DRC, Eswatini, Malawi Mauritius, Mozambique, Tanzania, and Zambia) more than half of women between ages 15 and 49 do not have a say in decision-making about contraceptive use. With the Covid-19 lockdowns that kept many women closed at their homes depriving them access to family planning outreach, the region will see a sharp rise in births rates with women facing repeated cycles of poverty.

COVID-19 responses on contraception

In light of the pandemic, some organisations saw an agent need to tackle sexual reproductive health issues by adopting measures to create family planning awareness and also help women in need of contraception.

With family planning challenges, and most women having conservative attitudes towards contraception, DRC and Malawi found it crucial to drive door-to-door family planning outreach. Action for Integral Health of Women and Girls (ASIFF) – a DRC based non-profit organisations with its work in the Nsona Kulu district raised family planning awareness in the places where women live and work. Through such initiatives, the organisation has changed the lives of several mothers – helping them to manage birth spacing which is a huge challenge in the country – affecting women’s economic development, poverty reduction as well as their health status.

The Art and Global Health Centre Africa (ArtGlo), an organisation that uses community dialogue to improve family planning for girls at Ntiya Village in Zomba, Malawi was highly affected by lockdown and social distancing measures as it could not run its face to face dialogues. However, in collaboration with radio stations and the use of various communication platforms, ArtGlo drove various initiatives to help women and girls to continue expressing their views and thoughts about family planning. At the same time creating generational dialogues with traditional and religious leaders who are usually not in favour of family planning and sexual education topics. This unique strategy has been effective in breaking barriers while allowing young girls and community leaders to get involved in normalizing family planning while ensuring access to contraceptives.

In an attempt to ensure access to contraceptives, some countries initiated mobile facilities for the distribution of contraceptives while fast-developing countries in the region like South Africa and Kenya leveraged the use of technologies for ordering and distributing contraceptives.

Exceeding family planning targets despite the impact of the COVID-19 pandemic

Despite the impact of the pandemic, Zambia continues to invest in contraception. The country saw a 17% increase in modern contraceptives in 2020, resulting in the addition of 82 000 women gaining access and helping the country meet its eight-year (2013-2020) target set to scale up family planning. Zambia’s Family Planning Scale-Up Plan 2013-2020 was launched in 2012 to increase the contraceptive prevalence rate (among married women) for modern methods from 33% to 58% by 2020 in line with the government’s regional and international commitments.

The country has a high usage rate of contraceptives with one in every two women aged 15 to 49 currently using a modern method which demonstrates the impact of deliberate government intervention. The Family Planning Scale-Up plan has shown positive impact in access to contraception. In 2017 alone, this plan enabled the country to prevent about 600 maternal deaths; 10 000 unintended pregnancies and 6000 unsafe abortions.

Over the past decades, Zambia is one of the SADC countries that has been making strides in improving family planning services. These include the introduction of innovations and capacity development for healthcare providers as well as encouraging family planning among poor and marginalised groups in the country. The country continues to improve its sexual reproductive health laws, policies and guidelines to ensure inclusive access to contraceptives and family planning.

Although with such initiatives in place, Zambia is facing challenges in ensuring contraceptive access to rural women. The common challenge is long distance travelling to facilities, which may also contribute to the country’s high maternal mortality rate (213 per 100 000 live births) in rural areas.

Although the COVID-19 pandemic has heavily impacted the health industry and people’s health, it allowed us to rethink and reshape current policies and practices regarding women’s health.

With wide disparities in contraceptive prevalence rate across the SADC region, the pandemic has forced us to reimagine the provision of contraception and ensure  effective results that advances several human rights including the right to life and liberty, freedom of opinion and expression, and the right to work and education. At the same time ensuring a healthier future for all.

The pandemic has also given us an opportunity as organisations to continue advocating for effective distribution and access to contraceptives while innovating and developing more community-centred and self-managed care that reaches women where they are.

Sifisosami Dube is a gender expert. She wrote the SRH services chapter of the #VoiceandChoice Barometer

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