Experience from past epidemics show that discontinuing essential health-care services deemed unrelated to the epidemic response resulted in more deaths than did the epidemic itself. Sexual and reproductive health is one such health care services which is being ignored during the current pandemic.
Sadly, issues related to sexual and reproductive health are among the leading causes of mortality and morbidity among women of childbearing age, with countries affected by fragility and crisis accounting for 61% of maternal deaths worldwide.
A study, published in the Lancet, has found that poor health outcomes will surge from the absence or disruption of lifesaving services, including emergency obstetric and newborn care, contraception to prevent unwanted pregnancies, and the management of abortion complications. Gender-based violence and sexual exploitation and abuse might increase during outbreaks because of confinement, increased exposure to perpetrators at home, economic precarity, and reduced access to protection services. The care for children and others confined at home further reduces women’s ability to properly care for themselves.
In the context of the pandemic preparedness and response, members of the Inter-Agency Working Group for Reproductive Health in Crises have issued various field guidance documents on sexual and reproductive health and coronavirus disease 2019 (COVID-19). Building on the overarching need for humanitarian actors to coordinate and plan to ensure that sexual and reproductive health is integrated into the pandemic preparedness and response, there are four prongs on how to mitigate the impact of COVID-19 on mortality and morbidity due to sexual and reproductive health conditions in crisis and in fragile settings.
Expanding Access to Sexual and Reproductive Health in Crisis
First, with the understanding that the risks of adverse outcomes from medical complications outweigh the potential risks of COVID-19 transmission at health facilities, the availability of all crucial services and supplies as defined by the Minimum Initial Services Package for sexual and reproductive health should continue.
Second, comprehensive sexual and reproductive health services should continue as long as the system is not overstretched with COVID-19 case management.
Third, clear, consistent, and updated public health information crafted with representatives of the targeted audiences should reach the community and health-care workers.
Fourth, COVID-19 infection prevention and control precautions, including hand hygiene, physical distancing, and respiratory etiquette should apply to patients (and accompanying family members if their presence is necessary).
To minimise preventable deaths, crucial health-care services, including sexual and reproductive health services, should remain accessible during public health emergencies, even when resources from already fragile health systems are often redirected for outbreak response. The COVID-19 pandemic will magnify the risks inherent to resource reshuffling at the expense of other services; however, sexual and reproductive health cannot be viewed as a luxury.