Health System Advocacy Partnership (HSAP) Project
As the COVID-19 pandemic rages around the world, governments are taking unprecedented measures to limit the spread of the virus, ramping up health system responses and announcing movement restrictions affecting millions. Amid these efforts, policymakers must not lose sight of the vulnerabilities of women and girls, which have been exacerbated by the crisis.
Sexual and reproductive health services and commodities are often overlooked in times of crisis. Yet, women and girls continue to require family planning, menstrual health supplies and maternal health care. Countries have already seen health systems forced to allocate staff and resources towards COVID-19 preparedness to the detriment of other essential health services.
It is a particularly worrying time for pregnant women in need of routine health services. Today, the coronavirus pandemic is exacting a significant toll on women’s livelihoods, considering control measures such as dusk-to-dawn curfew, closure of schools (which increases the burden of domestic care that typically falls to women), and travel restrictions affecting service industries and informal labour dominated by female workers.
Despite the odds, women need to give birth as labour is not a respecter of situation or person. Most mothers will agree that labour tends to start at night. During this time, women are living in fear of leaving their homes at night because of Kenya’s curfew that begins at 7 pm and ends at 5 am. Between these hours, every person is expected to be indoors except for those providing essential services.
In normal circumstances, women and girls are generally a vulnerable population. The circumstances brought about by the COVID-19 pandemic such as the stay at home, directive, and the enforced curfew just heightens their vulnerability. They are exposed to gender-based violence, diseases such as high blood pressure, increased anxiety, fear of infection and panic attacks. These factors may predispose them to preterm deliveries.
Seeking health care requires the availability of some finances, a strain for the average Kenyan in normal circumstances, let alone during a pandemic. When interviewed on the challenges faced while living in the time of the COVID-19 pandemic, a resident of Siaya County said: “The scarcity of running water makes it harder to wash hands.” The existence of pre-existing health conditions, including respiratory problems caused by indoor crowding in slums and informal settlements where a majority of low-income earners dwell makes it even more difficult for expectant mothers to thrive.
Amref Health Africa’s Health Systems Advocacy and Partnership project has supported counties by working with youth platforms, Community Health Volunteers (CHVs) and Civil Society Organisations (CSOs) to raise awareness and sensitize communities on ways to protect themselves from COVID-19. Youth forums working with CHVs in Kajiado and Siaya Counties have come up with a system to identify and link mothers to health facilities to access services. They ensure that the mothers have written permission documents and notifications for any appointment at the health facility on appointed dates or in case of an emergency. The appointments are well coordinated to ensure that social distancing is
enforced to avoid crowding at the facilities. Infection control measures must be taken to protect women in antenatal, neonatal and maternal health units.
This in-reach model is working well in Siaya County with the support of the County Department of Health and Reproductive Health Coordinators. In Kajiado, the County government has given authority to CHVs to offer some family planning services such as pills and injectables to clients.
Pregnant women also need access to reliable information and quality care. The risk to women and girls increases significantly if health systems divert resources from sexual and reproductive health, and more so if supply lines begin to buckle under the strain of the pandemic. Pandemics such as COVID-19 make existing inequalities for women and girls and discrimination of other marginalized groups such as persons with disabilities and those in extreme poverty, worse. This needs to be considered, given the different impacts surrounding detection and access to treatment for local communities.
Public health emergencies and their related stresses can also increase the risk of domestic abuse and other forms of gender-based violence. The economic effects of COVID-19, for instance, have been reported to lead to exacerbated sexual exploitation risks for women and children. Today, as families face heightened tensions, financial uncertainties and other pressures, women and girls continue to face intensified vulnerabilities.
Health systems are also urged to be prepared to provide essential support to survivors of COVID-19. All these survivors need to access protection, psychosocial support amid quarantines, cessation of movement and even after.
Article by Beatrice Oluoch.