The dreadful effects of lockdown on access to sexual and reproductive health services
Since the sudden spread of COVID-19 around the world over the past six months, a number of countries imposed national lockdowns as a measure to flatten the curve of new infections and protect vulnerable people. COVID-19 lockdowns have brought a lot of uncertainties, fear and challenges.
From the beginning of the lockdowns, many public services have been interrupted, including critical services such as those related to sexual and reproductive health (SRH).
In South Africa, the national lockdown started on 27 March 2020. What was initially meant to be a 21 day lockdown became an indefinite, multi-staged lockdown due to the rapid spread of the virus across the country. The government released regulations that outlined broadly what goods and services were essential and would be provided or made available during lockdown. All healthcare services including those related to SRH formed part of the essential package.
At the beginning of the lockdown, however, there was a lot of confusion in communities and among some healthcare providers, about which services were essential. Some people who went to clinics to seek SRH services were turned away and informed that the clinics were solely attending to COVID-19 related matters. This meant some people could not access contraceptives; HIV prevention and treatment interventions; screening, testing and treatment of STIs; screening, testing and treatment of cancers of the reproductive system; and abortion services.
Since the beginning of lockdown, there has also been a growing fear for many to go to healthcare facilities due to the risk of infection. This fear has been shared by pregnant women who deliberately missed important antenatal care visits in efforts to protect themselves and their unborn babies from being infected with COVID-19.
In addition, interruptions in the production of contraceptives due to lockdowns around the world may perpetuate the already existing stock-outs of popular contraceptives such as the injectable, pills and abortion medication in South Africa.
The World Health Organization (WHO) recommends that countries ideally provide 3 to 6 months’ supply of anti-retroviral treatment (ART) for clinically stable people living with HIV during the COVID-19 pandemic. Following this recommendation helps to reduce the risk of COVID-19 infection as a result of regular visits to healthcare facilities to collect chronic medication. The Treatment Action Campaign (TAC) recently conducted a rapid survey of people living with HIV to assess whether public health facilities were adhering to the WHO recommendation, but about 28% of the respondents reported having been provided only 1 month or less supply of their ART.
The interruption of SRH services at the beginning of lockdown prompted civil society organisations SECTION27, the Sexual and Reproductive Justice Coalition (SRJC), the Women’s Legal Centre and others, to call on the Department of Health to confirm and publicly declare SRH services as essential. In response, the Gauteng Department of Health (GDoH) admitted to having released a circular that may have been misinterpreted by healthcare providers to exclude SRH services such as abortion and contraception. The response further committed to providing information and healthcare services to the youth and general public during such critical times. The GDoH also identified a contact person who civil society can approach with related concerns and sent an amended circular to all public health facilities in Gauteng affirming that SRH services should be prioritised during lockdown.
The obligation for most people to be confined at home during lockdown and the tension and pressure of widespread job losses has created a breeding ground for sexual and gender based violence (SGBV) against women and children. Since the beginning of lockdown, SGBV has been on the rise, with some women and children forced to be “locked down” with their abusive partners or family members. Between 27 and 31 March 2020, there were over 2 300 reported cases of SGBV to the South African Police Service. A rise in reported cases of SGBV was anticipated by the Minister of Police from the first declaration of the COVID-19 State of Disaster on the 15 March 2020. As a result he ordered the reinforcement of Family Violence, Child Protection and Sexual Offenses units in police stations.
Regrettably, putting such measures in place has not prevented women from dying at the hands of their partners. On 17 June 2020, in his address to the nation, President Cyril Ramaphosa announced that he was aware of 21 women and children who were murdered during the lockdown period.
The influx in reported cases of SGBV has also put a strain on already over-burdened women’s shelters – shelters that simultaneously have reduced capacity due to the need for social distancing. Moreover, some women’s shelters have been repurposed to serve as health centres as part of the response to COVID-19. Shelters across the country have reported a notable increase in the number of women in need of a place of safety.
There has been a welcome focus on the provision of food parcels by both government and independent donors, but unfortunately only a limited focus on the provision of sanitary wear, especially for girls who had been reliant on free sanitary wear from schools or NGOs before the lockdown. Maintaining menstrual hygiene for girls from poor families has been a nightmare, with some parents no longer able to afford to buy sanitary pads for their daughters due to loss of income. This has led to many women and girls needing to use pieces of cloth to manage their menstruation.
The job losses as a result of the COVID-19 pandemic and the lockdown have disproportionately impacted women (as shown in data from the recent NIDS-CRAM survey). These job-losses have increased the pool of women who now cannot provide for themselves, sacrificing basic reproductive health needs, including buying the sanitary wear of their choice.
Recognising the challenges posed by the lockdown, different government departments including the Department of Women, Youth and Persons with Disabilities (DWYPD) and DSD recently collaborated with the United Nations Population Fund (UNFPA), Water Aid Southern Africa, Footprints Foundation and Langelihle Youth Foundation to form a partnership that aims to ensure access to menstrual health and hygiene products to the most vulnerable and disadvantaged women and girls during and beyond lockdown.
The focus on COVID-19 has placed people living with other diseases and living in hotspot areas at a disadvantage because some medical treatments that ordinarily require hospitalisation are now not a priority. Recently, a group of doctors working at Groote Schuur Hospital in Cape Town, another epicentre of the pandemic, warned against the redeployment of health personnel to address the demand created by the pandemic. According to the doctors, medical personnel were moved from specialised wards including oncology and anaesthesiology to be on the frontline fighting COVID-19. This means that treatment of cancers, including cancers of the reproductive system, is on hold and will create a backlog at the end of the epidemic.
The COVID-19 pandemic has exposed many pre-existing flaws in the public healthcare system. It has been expensive, requiring the reprioritisation of substantial government funds. It is not surprising that some SRH related funds were also reprioritised. According to the supplementary budget review, R40 million that was allocated to the HIV/AIDS schools programme through the Life Skills subject has now been channelled towards providing information on measures to respond to the pandemic.
The negative impact of COVID-19 on access to SRH services has been felt worldwide, particularly elsewhere in Africa. The COVID-19 response in parts of East and Southern Africa has undermined many gains and achievements, made over many years, in the advancement of SRH rights. In Uganda, a ban on privately owned and public transport at the beginning of lockdown claimed several lives. Pregnant women were giving birth or dying on the side of the road trying to get to the nearest hospital on foot.
In Kenya, hospitals in most parts of the country reported a decline in the number of births taking place in hospitals and that young children have been missing their vaccinations due to fear of infection. In Zimbabwe, accessing SRH services was difficult because obtaining a permit to leave the house has not been easy since people living with HIV had to disclose their HIV status to obtain a permit to travel to nearby clinics.
In short, the effects of lockdown on access to SRH services have been dreadful.
While it is critical for governments to protect people from this deadly pandemic, it is equally important that governments also honour the commitments made towards the advancement of SRH – albeit in the Maputo Protocol, the Sustainable Development Goals, or in the recent SADC Sexual and Reproductive Health and Rights Strategy and scorecard. We can simply not allow COVID-19 to become an excuse for governments’ continued failures on SRH. Too many people would be harmed by it, too many people’s dignity infringed.
*Mbatha is a researcher at SECTION27. You can read the full article, which include other African countries, here.
Note: Mbatha is an employee of SECTION27. Spotlight is published by SECTION27 and the Treatment Action Campaign, but is editorially independent, an independence that the editors guard jealously. Spotlight is a member of the South African Press Council.
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