How the coronavirus disease 2019 pandemic is impacting sexual and reproductive health and rights and response: Results from a global survey of providers, researchers, and policy‐makers

Abstract

Introduction: We aimed to give a global overview of trends in access to sexual and reproductive health and rights (SRHR) during the Covid-19 pandemic and what is being done to mitigate its impact. Material and methods: We performed a descriptive analysis and content analysis based on an online survey among clinicians, researchers and organizations. Our data was extracted from multiple-choice questions on access to SRHR services and risk of SRHR violations, and written responses to open-ended questions on threats to access and required response. Results: The survey was answered by 51 people representing 29 countries. 86% reported that access to contraceptive services was less or much less due to Covid-19, corresponding figures for surgical and medical abortion were 62% and 46%. The increased risk of gender-based and sexual violence was assessed as moderate or severe by 79%. Among countries with mildly restrictive abortion policies, 69% had implemented changes to facilitate access to abortion during the pandemic, compared to 0 among countries with severe restrictions (p<0.001), 87.5% compared to 46% had implemented changes to facilitate access to contraception (p= 0.023). The content analysis showed that i) prioritizations in health service delivery at the expense of SRHR, ii) lack of political will, iii) the detrimental effect of lock-down, and iv) the suspension of sexual education, were threats to SRHR access (theme 1). Requirements to mitigate these threats (theme 2) were i) political will and support of universal access to SRH services, ii) the sensitization of providers, vii) free public transport, and viii) physical protective equipment. A contrasting third theme was the state of exception of the Covid-19 pandemic as a window of opportunity to push forward women´s health and rights. Conclusions: Many countries have seen decreased access to and increased violations of SRHR during the Covid-19 pandemic. Countries with severe restrictions on abortion seem less likely to have implemented changes to SRHR delivery to mitigate this impact. Political will to support the advancement of SRHR is often lacking, which is fundamental to ensuring both continued access and, in a minority of cases, the solidification of gains made to SRHR during the pandemic.

Moving ahead together, on a foundation of rights-based evidence

“…In the COVID-19 era, women have faced even greater barriers to access time-sensitive services such as abortion and contraceptive services, maternal health has suffered in many cases, gender-based violence has intensified and whilst all children have suffered, school closures are likely to have had particularly negative consequences for girls in terms of exploitation, pregnancy and early marriage. [14][15][16] Capturing the consequences through robust and rights-informed research will be crucial and we have kept open our call for papers on sexual and reproductive health and rights in the era of COVID-19.…”

“…SRHM has often pointed to the impact of political change and power on sexual and reproductive health and rights. 16 A recent review of public policy and health in the Trump era highlights well the negative impact that change in political leadership can have on sexual and reproductive health and rights domestically and globally. 19 We watch while the US enters a new era with the welcomed axing of the "Global Gag Rule".…”

Uncertainty, Sex and Sexuality during the Pandemic: Impact on Psychosocial Resilience

“…Both inaccessibility and violation of sexual and reproductive health rights have been noticed across many countries during this pandemic, in terms of access to contraception and abortion, cessation of sexual education, sexual violence, etc. [92]. This may lead to increased vulnerability of the individual [93], shackling resilience and health.…”

Celebrating 100 years of AOGS with a focus on global health

“…Drawbacks to sexual and reproductive health and rights during the pandemic and how countries rise to the challenge is described in the paper by the FIGO committee on Human Rights, Refugees, and Violence against Women. 3 Although ultrasonography may, in some cases, have a role in facilitating safe completion of surgical abortion by guiding the surgeon and monitoring the procedure intraoperatively, 4,5 or by diagnosing ongoing pregnancy and incomplete abortion during the follow-up when indicated, 6 the demand for ultrasound dating has become a potential barrier to abortion access. The safety of non-ultrasound confirmed second trimester abortion is the focus of a retrospective study from Nepal.…”

“…The active participation of Nordic countries in international professional and scientific organizations, and their input into infrastructure development and educational programs around world, must continue to serve as inspirational examples of our joint efforts to improve women's global sexual and reproductive health and rights. Ganesh Acharya 1,2 Kristina Gemzell-Danielsson 3 Oskari Heikinheimo 4 Vibeke Rasch 5,6 Martin Rudnicki…”