Last month, a United Nations Population Fund (UNFPA) report shared a shocking estimate: there will be 7 million more unwanted pregnancies in middle and low-income countries during the COVID-19 pandemic. This spike is caused by 47 million women in such countries losing access to modern methods of contraception due to closure of many family planning (FP) services. This disruption of FP services could lead to the death of many women and children around the globe. In Pakistan, many health care professionals are ringing alarm bells about an increased risk to women’s reproductive health due to inaccessibility to FP services here.
Primarily, the policy of lockdown is said to be the only solution for avoiding death and destruction during this pandemic. However, this lockdown led to the closure of many essential services like Outpatient Departments (OPDs) in the government hospitals and routine immunization activities. This closure has not only reduced the access of many women to reproductive health services but has also made women and children vulnerable to injury or even death. Many women are being forced to go to the private hospitals, which are either too expensive or the doctors are unfamiliar with their patient history. This has been a subject of tremendous inconvenience and concern to women.
Even though the government has partially opened the OPDs under the lockdown, women still face inconvenience. Women are avoiding hospitals due to the risk of infection. In Pakistan, government hospitals, population welfare department facilities, social marketing entities and health workers are the main source of FP advice and tools to many women. The existing situation has made FP inaccessible to these women and they could face unwanted pregnancies. This will also increase Pakistan’s unmet needs ratio- inaccessibility of a woman of reproductive age to contraceptive supply. This is one of the biggest reasons for abortions in Pakistan and it is expected that during the COVID-19 pandemic this rate will rise. Couples may opt for unsafe methods, which can lead to the death of the mother.
It is beyond doubt that COVID-19 must be the government’s priority right now, but family planning and reproductive health cannot be ignored in any way whatsoever
FP services are further hindered by the global shortage of modern contraceptive supplies. Most of these contraceptives are produced in China, which has recently lifted its lockdown. Many factories were temporarily shut during the initial lockdown in the Hubei province. While they are now reopening, their production lines have been shifted to meet the increased global demand of masks and Personal Protective Equipment (PPE). This shift in manufacturing priorities has further reduced couples’ access to family planning commodities, thereby exposing them to serious repercussions.
Another ignored aspect of this deterioration of FP services under the pandemic is the work and safety of the Lady Health Workers (LHWs). A LHW’s basic job is to provide FP information and modern contraceptives to the women in her community. During the current crisis, either these LHWs are avoiding work due to the risk of infection or they are working unprotected. Some women may not allow LHWs to enter their homes due to the risk of catching the virus. This is another challenge faced by Pakistan’s FP program during these testing times.
Furthermore, the attention of the government is diverted from FP to the COVID response, which is definitely where government’s priority must be. However, it creates an even bigger challenge for the government once the pandemic is over. Unwanted pregnancies will lead either to population growth or unsafe abortions, which will increase the death toll and economic burden in Pakistan. The government is not at all ready to handle such challenges after the crisis.
Therefore, it is important that the government takes some steps to ameliorate the current situation. First of all, the government must include FP services in its recently initiated telehealth service. Couples must be encouraged to use this service in order to gain FP information. Secondly, an awareness campaign should be launched about the significance of maternal care and FP during this crisis. It is important to educate people that taking care of the health of women and children is essential, now more than ever.
Thirdly, LHWs must be provided PPE so that they can continue their crucial FP service under this crisis without any fear. The government must also ensure that the LHWs are supplied with all the tools they need for the routine check-ups of women. The supply of modern contraceptives to rural women must be restored at all cost. Rural women are most vulnerable to unwanted pregnancies and unsafe abortions at this time
It is beyond doubt that COVID-19 must be the government’s priority right now, but family planning and reproductive health cannot be ignored in any way whatsoever. Provision of modern, short and long-acting contraceptives, information, counselling and services is lifesaving and must be available and accessible during the COVID-19 pandemic response. It needs to be remembered that any failure to meet this ‘intimate yet essential need’ of the citizens now will in all likelihood reverse the recent gains made by Pakistan towards ensuring universal access to sexual and reproductive health.
The author is a policy consultant with the Forum for Safe Motherhood, a Research and Development Organization focusing on reproductive, maternal and newborn health and rights