Rethinking “Elective” Procedures for Women's Reproduction during Covid‐19

Abstract

Common hospital and surgical center responses to the Covid‐19 pandemic included curtailing “elective” procedures, which are typically determined based on implications for physical health and survival. However, in the focus solely on physical health and survival, procedures whose main benefits advance components of well‐being beyond health, including self‐determination, personal security, economic stability, equal respect, and creation of meaningful social relationships, have been disproportionately deprioritized. We describe how female reproduction‐related procedures, including abortion, surgical sterilization, reversible contraception devices and in vitro fertilization, have been broadly categorized as “elective,” a designation that fails to capture the value of these procedures or their impact on women's overall well‐being. We argue that corresponding restrictions and delays of these procedures are problematically reflective of underlying structural views that marginalize women's rights and interests and therefore threaten to propagate gender injustice during the pandemic and beyond. Finally, we propose a framework for triaging reproduction‐related procedures during Covid‐19 that is more individualized, accounts for their significance for comprehensive well‐being, and can be used to inform resumption of operations as well as subsequent restriction phases .

Accounting for Context: Using Qualitative Methods to Model the Effects of Adaptations to Family Planning Services During COVID-19

“…Models that account for the likely interaction between context and service delivery adaptations are needed to help inform decision-making about FP services during the COVID-19 pandemic. Gross et al's triage framework for the prioritisation of procedures relating to women's reproductive health in light of COVID-19 begins to move beyond an exclusive focus on economic or operational considerations and enables a more patient-centred approach to decision-making by taking into account the non-physical well-being of women (38). For instance, it suggests considering how a woman's future access to FP services, and therefore her reproductive options, may be jeopardized by the pandemic when looking at whether adaptations such as delayed LARC removals should be prioritised.…”

“…Adaptation 11: Adopt a rights-based and patient-centred response strategy (3,4,6,13,31,33,38). Seven sources highlighted the need for rights-based and patient-centred strategies to safeguard women's decision-making autonomy and to ensure FP services are high quality and remain responsive to people's needs.…”

“…Additional counselling to promote correct and consistent condom use in the event of supply chain disruptions was also suggested, as was making counselling available for women using emergency contraception at home. Adaptation 11: Adopt a rights-based and patient-centred response strategy (3,4,6,13,31,33,38). Seven sources highlighted the need for rights-based and patient-centred strategies to safeguard women's decision-making autonomy and to ensure FP services are high quality and remain responsive to people's needs.…”

“…Examples of ways to address supply-chain disruptions were mentioned in six sources and included: expanding mail-based or doorstep distribution of MCMs and medical abortion products where possible; facilitating appropriate supply availability in dispensing sites; and ensuring the availability of alternative MCMs in the absence of routinely used methods. Adaptation 3: Modify legislation to retain or improve accessibility of MCMs(2,3,(36)(37)(38)(39). Amendments to existing legislation and the introduction of new legislation were suggested in six sources to: enable homebased medical abortion; extend emergency supply of oral contraceptives to cover multi-month periods; and make oral contraception and self-administered injectables prescription-free and widely available in pharmacies.…”

Abortion and the COVID-19 pandemic: insights for Latin America

“…The understanding that, when not practiced therapeutically, abortion is an elective procedure, contradicts guidelines and the positions expoused by experts, and public health organizations 32,33 . The term "elective", in general, is used for health procedures that can be scheduled, planned and, if necessary, postponed, but never canceled.…”