Ensuring Sexual and Reproductive Health during COVID
By Nabiya Vaffoor
Between 2015 and 2019, on average, 73.3 million induced safe and unsafe abortions occurred worldwide each year. Among these, 1/3 were carried out in the least safe or dangerous conditions. Over half of all estimated unsafe abortions globally were in Asia, most of them in South and Central Asia. Further, 3/4 abortions that occurred in Africa and Latin America were unsafe, while the risk of dying from an unsafe abortion was the highest in Africa. Estimates from 2010-2014 showed that around 45 per cent of all abortions were unsafe.
This situation has deteriorated with the COVID-19 pandemic. Ceylon Today would like to offer an insight regarding safe abortions during the pandemic and how other countries help women to get safe abortions during the pandemic. The webinar titled ‘Sexual and Reproductive Health and Rights (SRHR) and COVID-19: The Global South Approach to Safe Abortion’ by the AsianPacific Resource & Research Centre for Women (ARROW) in partnership with the International Planned Parenthood Federation/Western Hemisphere Region (IPPF/WHR) and Society for Sexual, Affectional, Intersex, and Gender Expansive Identities (SAIGE) recently shed light on this topic. Dr. Tlaleng Mofokeng (MBChB), a South African physician, and United Nations Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, says information regarding SRHR is key to safe abortions.
"I am an abortion provider firstly. I think what is important is to acknowledge the fact that I was also a young woman who may have needed an abortion at some point, whether I have had one or not is not the issue, but the point is I had information to know my rights about access and I also knew where to go if I ever needed an abortion and I think this is a privilege that many young people around the world do not have, particularly in the Global South.
Many global health programmes targeting sexual and reproductive health are often devoid of a human rights perspective on abortion, where abortion never actually makes it on the table during discussions on SRHR and when they do it is often riddled with stigma... Bodies of women, girls and genderdiverse people have long been subjected to discrimination, violence and oppression. These human rights violations occur unabated.
The right to sexual and reproductive health is an integral element of the right to health," added Dr. Mofokeng. Dr. Mofokeng further stated that many interrelated obstacles stand between individuals and the enjoyment of sexual and reproductive health rights. "We have the biggest opportunity to change matters in a clinical environment because regardless of the context of the patient, whether they are under severe crushing weight of religious and cultural expectations about their womanhood and their need for an abortion or what the story is or how they end up getting pregnant with a pregnancy that they deem insupportable, whether it is the legislation or the policy.
When a patient is one-on-one with a healthcare provider in a consultation room, there's a particular moment where we can affirm and promote and advance people’s rights regardless of everything else that they had to deal with externally. I wish one day abortion providers and healthcare workers can see their clinical practice as a human rights defence," she added.
Obstacles of health systems
Obstacles of the health system include healthcare facility managers, administrators, the issues of course of policy and legislation and currently in the world we are experiencing regressions in terms of abortion legislation. We have seen different elements playing out in different Courts around the world, where there have been direct and very clear, sustained attacks on the right to autonomy related to abortion care. This remains a problem because it often leads to fracturing of primary health facilities and healthcare.
Even within SRHR, it positions abortion as something that is not a healthcare service because it continues to be underfunded, and there is very little advancement in terms of biomedical developments and technology because of the lack of resourcing and how people don’t see abortion as healthcare. Abortion is healthcare! A global obstacle faced by women seeking abortions during this COVID-19 pandemic was that of transportation, owing to the travel restrictions imposed within districts and provinces.
Mirembe Mariam from COHERINET Africa said abortion services have been swept under the carpet and they are not considered as essential in Uganda. A study found that within 2019-2020, nearly 8 per cent of maternal deaths in Uganda were due to unsafe abortions. "Many African countries such as Uganda had been given limited access to contraceptives during the pandemic, to access needed health facilities the women who seek abortion have to travel a long distance to access health facilities which is impossible with the COVID-19 regulations most of the time.
A majority remained pregnant and others subjected themselves to unsafe abortions. Unsafe abortions are on the rise in our country as well as teenage pregnancies. Women are unable to access contraceptive methods due to disruption in the supply chain because of the pandemic," she added. Mariam also added that they are currently experiencing a significant increase in maternal deaths in Uganda, due to the lack of provisions that was allocated to COVID-19.
"When the COVID-19 outbreak began no country had allocated provisions for such a pandemic. There was a lack of contraceptives, as they are not considered as essentials by the Government. Recent reports by the United Nations Population Fund (UNFPA), highlighted that 47 million women have no access to contraceptives and 17 million women have thereby been subjected to unsafe abortions.
We should be adapting many innovative methods, such as hotlines, allowing women access to information regarding sexual and reproductive health for selfmanaged abortions," she added. Representing India, Pragya Roy, Programme Coordinator for Safe Abortion For Everyone (SAFE) stated that when addressing abortion, the pregnant women in the marginalised communities weren't focused on enough.
"Most times when abortion is discussed, pregnant women in marginalised communities such as sex workers, migrant workers, refugees, queer and trans people, people with disabilities, people who live with HIV are always lost. Though abortion is legal in our country, it wasn't easy to access these resources during the pandemic. And it is important to acknowledge that though the legal framework does support abortion, the cultural and the social environment in India look down upon the choice.
Inadequate information, limited transport, low mobility, service becoming unaffordable, limited access to medical professionals are the main threats that we always have to face. The YP Foundation found that the abortion seekers of the states of West Bengal, Assam, and Punjab had to incur huge expenses to seek very basic abortion services and abortions being a time-sensitive procedure the challenges are further increased in a pandemic situation," added Roy.
Lack of contraceptives are one of the key issues in safe abortion practices, as the supply chains were affected by COVID-19, stated IPPFWHR CEO, Giselle Carino from Latin America. "Mexico's Supreme Court just issued a landmark ruling decriminalising abortion, which is a celebration for Latin American women, as they would no longer be subjected to imprisonment.
All the states that still criminalise abortion are now obligated to modify their frameworks. The historic ruling last week is the latest in a series of victories for abortion rights advocates in Latin America, a largely Roman Catholic region that has long had some of the world’s most restrictive laws against the procedure.
The vast majority of women in the region still lack access to legal abortions, but restrictions have now been lifted or relaxed over the last 15 years in at least half a dozen countries. Yet, we are one of the first regions to be affected by COVID-19. By March 2020, we had to shut down all our services, even the UNFPA reports say that about 20 million women in Latin America were affected by the lack of access to contraceptives due to the interruption in the supply chain because of COVID-19."
Carino noted that Latin America was a country where abortions were an illegal and criminalised practice, during which many organisations helped women who seek abortion in several ways, including providing information related to sexual and reproductive health, and funding women to travel to the needed facility to get the abortion done.
Carino added that as an organisation, the IPPFWHR has serviced partnerships with clinics and pharmacies, enabling women to have access to prescriptions required to get contraceptives. Shanta Shrestha, representing the Beyond Beijing Committee Nepal (BBCN), said Nepal has adapted a progressive method on safe abortions during the pandemic.
"The pandemic has increased pregnancies and reduced family planning services, yet the Nepal Government has found a way to provide, making changes to the national reproductive health guidelines, allowing for medical abortions to be delivered outside of registered facilities.
This has allowed providers to be more flexible in their delivery, and to ensure continuity of access to medical abortions despite COVID-19 measures," stated Shrestha, explaining a progressive method that Nepal has adapted in an attempt to reduce both the risk of unsafe abortions and the spread of COVID-19.