The COVID-19 pandemic has wreaked havoc on health systems, led to a global economic shutdown, and upended life as we know it. As the virus spreads at alarming rates, the fallout has spanned the globe and revealed the ill-preparedness of governments, health systems, and social safety networks to respond to the longstanding and emerging needs of people worldwide, especially relating to the health and rights of women and girls.
While the global response has rightly focused on containing the virus and treating the infected, it has also illustrated gaps in our existing approach to sexual and reproductive health care and articulated the need to embrace a comprehensive approach to health care long after the crisis ends.
This is not unique to the COVID-19 outbreak; existing inequalities and policies of discrimination are often exacerbated during crisis with widespread and severe consequences of women, girls, and LGBTQI people. This was the case in the 2014 Ebola outbreak, where sexual and reproductive health and rights were sidelined, the 2015-2016 Zika crisis, where draconian restrictions on reproductive rights hampered Brazil’s response, and, according to IWHC Director of Advocacy and Policy Shannon Kowalski, continues in today’s approach to COVID-19, where increasing restrictions on movement and requirements to “stay at home” have further aggravated barriers to sexual and reproductive health care:
There are a few things we know about what happens in times of crisis to women and girls.
First, domestic and intimate partner violence increases. Working from home, closing of schools, the inevitable job losses and all of the stress and lack of control that comes with it…
— Shannon Kowalski 💚 (@skowalski) March 16, 2020
Here are four critical sexual and reproductive health and rights issues impacted by the ongoing COVID-19 pandemic:
Requirements for social distancing and increasing “shelter in place” orders are needed to combat the spread of the virus, but have the unintended consequence of trapping people in violent and abusive relationships. For those in abusive relationships, violence often increases in times of crisis and leaving in uncertain circumstances can feel impossible.
Sexual & Reproductive Health Access
As health systems are increasingly strained, sexual and reproductive health care services are often mischaracterized as non-essential or “elective,” and thus de-emphasized with critical consequences.
Access to contraceptives has been reduced due to COVID-19. In the United States, where many young women receive contraception on college campuses, the closure of schools has created access challenges. Young girls and women who fulfill their gynecological needs through their general practitioner could run into difficulty scheduling an IUD installation or hormonal implant as many are limiting in-person visits. The limitations on in-person visits can additionally create a barrier to oral contraceptives, which require an appointment to acquire a prescription for initial access and subsequent refills.
Abortion—often restricted even in normal circumstances—is commonly pushed aside to accommodate personnel shortages or funding reallocation. In Ohio and Texas, state legislatures have moved quickly to declare abortion services as “non-essential.” The strain on health systems caused by the pandemic is further exacerbated by laws and policies that restrict access to abortion care, like gestational limits, the Global Gag Rule, and refusals of care. For example, in Italy, one of the countries most impacted by COVID-19, 70 percent of gynecologists refuse to provide legal abortion care, undermining women’s rights and further reducing access to critical care.
Even in countries where access is widely enjoyed, abortion procedures become more difficult to schedule due to decreased capacity and supplies as well as social distancing measures. In contexts where abortion is restricted or people mitigate the consequences of refusals of care policies by traveling elsewhere to access abortion, “shelter in place” orders or travel bans effectively remove that as a possibility. In addition to highlighting the dangers of restrictions on care, the ongoing COVID-19 crisis further highlights the necessity of destigmatizing and increasing accessibility to self-managed abortion.
The pressure placed on health systems reduces access to common infection diagnosis and treatment, sexually-transmitted disease screening, pre-natal and post-natal care, and pelvic exams. Similarly, urgent care centers—usually an option for a screening, prescription, or exam—have longer wait times and larger crowds, providing patients with a greater risk of exposure to the virus.
Giving birth during a global health crisis is particularly challenging and stressful. The strain on health systems and facilities have reduced resources for labor and delivery and led many people to consider at-home births. However, for those with higher risk pregnancies or other concerns, at-home births are less viable and they must continue to navigate the changing landscape of health systems with reduced resources. In New York, a major hospital system has barred partners and other visitors during childbirth, going against guidance from the World Health Organization and undermining the rights of pregnant people and the support systems they count on.
Impact on Marginalized Groups
As with all crises, the consequences of the COVID-19 outbreak are felt most acutely by those already marginalized in society, including women and girls—particularly low-income and those in rural settings—LGBTQI individuals, people with disabilities, and indigenous people among others. For example, gender-affirming surgeries have been postponed or cancelled both in the US and around the world. Many of these individuals already face barriers in access to health care and other essential services, which tend to increase in times of economic and social strain.
As we continue to adapt to our new normal it is more important than ever to ensure sexual and reproductive rights–and identify creative approaches to filling health care gaps. For example, we are once again seeing the potential of telemedicine, which could greatly increase access to sexual and reproductive health services—both during a pandemic and in normal circumstances—if restrictions were removed.
The bottom line is sexual and reproductive health needs do not cease to exist simply because COVID-19 demands greater attention and resources. Policymakers have a responsibility to use this crisis to inform investments in health care and to ensure that sexual and reproductive health and rights will not, once again, be left behind.