- Diversion of funds is one issue, stockouts of contracetives are another
While there is reason to celebrate our success against the Coronavirus, perhaps we need to look at the bigger picture before we fully understand in what ways covid-19 is impacting us. As we are beginning to understand how covid-19 has destroyed the economies across the globe, there are other impacts that will take time to unfold. One such less known phenomenon is women’s access to reproductive health services.
According to a recent report by UNFPA, during public health emergencies, human and financial resources are often diverted from essential health programmes to respond to the disease outbreak, and Pakistan’s response hasn’t been an exception to this. Such action would mean that resources for essential maternal, newborn health, gender, reproductive health services will be diverted to deal with the outbreak, contributing to a rise in maternal and newborn mortality and morbidity, increased unmet need for contraception and sexually transmitted infections.
For a country with over 217 million mouths to feed already, there is no time for complacency. While we may win the battle against the coronavirus, let’s not lose the war
Emergency maternal and reproductive health services may take the brunt, with inadequate facilities for isolation areas to assess and care for women in labour and the newborn. Life-saving procedures including treatment of pregnancy- and delivery-related complications are delayed due to staff deployment, staff not being prepared and lack of infection prevention and control capacities, and shortages and lack of infrastructure, such as operation theatres and ward space. Women who have to spend time recovering in hospital in Pakistan are often reliant on relatives for food and care, making isolation and infection control measures difficult and intensifying the risks of covid-19 spread.
Availability and access to family planning services may be impacted as recent evidence shows that the need for family planning increased during the period of imposition of isolation and lockdown at home. The unmet need for contraception is aggravated as the contraceptive commodities’ delivery to facilities and households are negatively affected by limited imports and in-country availability and distribution of contraceptive commodities. For most women in reproductive ages, family planning is at least as critical as other health care services. As public health infrastructure shifts to support and treat people with covid-19, it is essential that we maintain access to essential maternal health services and commodities including family planning. In the absence of these measures, the consequences could be life-threatening.
According to the Pakistan Demographic Health Survey 2017-18, each year in Pakistan, there are about 3.7 million unintended pregnancies, 2.6 million unsafe abortions and 5.5 million women with unmet need of family planning. Further, 8,300 women die each year from preventable pregnancy-related complications.
Estimates indicate that only a 20 percent decline in service coverage of essential maternal care may result in 796,808 additional births without access to health facilities leading to 2,133 additional maternal deaths and 58,541 additional still births in next three months.
Stock-outs of many contraceptive methods are being faced across Pakistan due to supply chain disruptions and diversion of funds to covid-19 response. Again, a 20 percent decline in use of modern contraceptives will result in 2.15 million additional women with unmet needs of modern contraception, over 900,000 additional unintended pregnancies, and around 390,000 additional unsafe abortions will happen.
What needs to be done to ensure availability and access to family planning services? For the availability of the family planning commodities, continuity of supplies like condoms, oral pills and injectables is critical to ensure continuous use and avoid any unintended pregnancies. Health and Population Departments should work on war footing for future contraceptive security, given emerging issues with insufficient supply globally. Furthermore, departments should invest in inventory building to avoid potential stock-out situations in the months ahead. We have a thriving private sector that is serving 43 percent of women in their use of modern contraceptives, almost equal to the public sector (44 percent). Joining hands and building public-private partnerships is the need of the hour, as pointed out in the recommendations from the Call to Action on Alarming Population Growth, that were approved by the Council of Common Interests. Government departments and the private sector need to promote alternate long-term modern methods to help clients continue use contraception and protect against unintended pregnancies.
For uninterrupted access to services, necessary protocols need to be developed to guide and support staff with respect to provision of services under the covid environment. This is an ideal time to integrate family planning services across Health and Population Welfare Departments. The Family Welfare Workers (FWWs) under the supervision and assistance of the Population Welfare Department urgently need to link up with Lady Health Workers (LHWs) to identify women and clients to supply them necessary commodities at their doorsteps and identify pregnant women who will be delivering in the coming weeks for referral for safe delivery at a facility. All workers providing family planning services must suggest and provide alternate methods to women to meet their immediate contraceptive needs. Investment in training and human development through technology is integral to all family planning programmes.
For a country with over 217 million mouths to feed already, there is no time for complacency. While we may win the battle against Coronavirus, let’s not lose the war.