Dangerous Price of COVID Rules for Women, Children in Africa

Sean Callaghan recalls the moment in late February 2020, sitting around a table with fellow researchers on a work trip in Kenya, turning to one and saying, “Oh, this virus thing in Wuhan …”

To which his colleague responded, “… yeah, I think this is the big one.”

Over the last decade, Callaghan, a senior consultant at the Ayaan Hirsi Ali Foundation, has done research and advocacy work surrounding gender-based violence and gender justice globally, with a special emphasis on East Africa.

Callaghan, who is from South Africa, predicted some of the effects that the COVID-19 pandemic has had on the African continent.

“Very early on, we saw this coming down the pike,” he says.

Callaghan was not alone.

Public health officials across the globe braced themselves.

Not only out of fear that COVID-19 had the potential to knock out large populations of the African continent, but also what it could mean for women and children.

“It was always clear that the moment there was identification of lockdowns, we knew that that would have significant consequences for women and girls across the continent,” says Sunita Caminha, a policy specialist for Ending Violence Against Women at the UN Women East and Southern Africa Regional Office.

New studies by Amref Health Africa show that COVID-19 safety responses, especially stay-at-home orders, have had dangerous and fatal effects for women and children across the African continent.

But many experts say these effects are rooted in deeper issues. COVID-19 only brought them center-stage.

Women‘s Health Services

One Amref Health Africa study, led by Shiphrah Kuria, MD, regional manager of the reproductive health and family planning program at Amref Health Africa, found a drop in the number of women who used or had access to critical health services, such as prenatal care, in Zambia, Uganda, and Kenya.

This was largely out of fear of getting infected inside health care facilities, findings show.

“They had a fear of contracting COVID-19 because they had minimal information about COVID-19,” says Brenda Mubita, project lead at Amref Health Africa and co-leader on the study.

Confusion about safety measures also played a major role, Kuria says.

“Messages to control the pandemic were misunderstood, leading to difficulties in seeking and accessing service,” she says. “For example, the stay-at-home message seems to have been understood to mean that even seeking services in facilities was to be avoided.”

The study also shows that many women who had planned to give birth in facilities chose instead to give birth at home, often without help from a trained professional. Those surveyed cited fear of getting COVID, confusion about stay-at-home orders, and nightly curfews during lockdown as some of the reasons.

Africa has higher rates of deaths due to complications in pregnancy and childbirth than any other continent, with around 200,000 deaths a year, according to UNICEF.

One of the main reasons behind the unacceptable number is that many women don’t have access to someone trained, such as a doctor or midwife, to help them while giving birth.

“The issue is that already, women and girls were facing challenges in accessing those basic services for safe childbirth,” Caminha says. “The restrictions created a situation where they were less inclined, also they had fewer supports, to access those services.”

The pandemic has also resulted in fewer women using or having access to birth control.

“In places like Kenya, we are seeing thousands and thousands of girls in teenage pregnancies and marriages, which would have never happened if the normal structure would have been there,” Callaghan says. “I don’t think it’s just kids that are bored.”

Money troubles play a big role, says Vivian Onano, a humanitarian and social entrepreneur.

Onano, who is from Kenya, says that schools being closed put many young girls in risky situations, especially with men taking advantage of their struggles.

“There have been really sad cases of girls who relied on school for sanitary towels [pads],” Onano says. “So, they sell their bodies for little money. There are a lot of taxi guys who will give you 50 shillings, and they will have sex with you unprotected. At the end of the day, you’re going to fall pregnant.”

Child Health and Nutrition Services

Restrictions on movement, limiting the number of people in health care facilities, and closing public places, like markets, have had huge impacts on children’s health and nutrition and has created an even bigger problem with malnutrition, says Simeon Nanama, regional adviser of nutrition at the UNICEF West and Central Africa Regional Office.

“In the West and Central Africa region, we were expecting, in 2020, 4.1 million children with severe wasting. With COVID, food insecurity, and crisis, it’s estimated that this number increased by 19%,” he says.

Severe wasting refers to children that have become too thin due to malnutrition, which can lead to death.

“If we take the example of vitamin supplements for children, through the pandemic, access of children to this service was reduced 50% to 75%,” Nanama says.

UNICEF Executive Director Henrietta Fore recently launched No Time to Waste, a program working to fight, and end, child malnutrition and wasting.

Fore talked about how 45 million African children were dealing with wasting before the pandemic, but another 9 million have been affected due to COVID, Nanama says.

Ready-to-use therapeutic food is a great treatment for severe wasting, but there is a lack in supply and in larger-scale programs to reach more children, according to Nanama.

Being vocal about these issues, especially to government officials, is one way to help, he says.

“The primary responsibility lies with the government,” Nanama says. “We need to continue to advocate for them to put more resources in social sectors, like child nutrition and education.”

Gender-Based Violence and Unequal Status of Women and Girls

Domestic violence rates have risen greatly in Uganda, Senegal, and Kenya, according to an Amref Health Africa study led by Rehema Chengo, project coordinator at Amref Health Africa.

But Africa is not alone.

This is only adds to the global issue of violence against women during the pandemic, which UN Women calls “The Shadow Pandemic.”

Findings show that 1 in 10 Senegalese, 1 in 5 Kenyans, and 1 in 3 Ugandans reported a rise in violence by their partners since the start of the pandemic, especially in households making less than $100 a month.

Within their three countries, 23% of respondents reported violence by their partners, 84% said the violence increased during the pandemic, and nearly 88% of the women reported being abused one to three times a week.

Most women said the abuse came out of frustrations over job loss and other money struggles due to the pandemic, according to the study.

Sexual assault has also been a big problem, Callaghan says.

Many teenagers in Africa get their high school education in boarding schools, which are often safe spaces, especially if you come from an abusive home.

“Suddenly, those schools were all closed,” Callaghan says. “If you did come from an abusive household, you were now in a stay-at-home with your abuser.”

The average age of sexual assault has also changed during the pandemic. It was once 16 years old, but is now between 12 and 14, Callaghan says.

All these actions show the lack of respect for women in society, along with men not being held accountable for their actions, Onano says.

She offers an example.

“Me as a young girl, I go to the police that my uncle is defiling me,” Onano says. “My uncle goes to the police and gives the police 500 Kenyan shillings. The police are going to release my uncle, and he’s going to come back home. I am the one that has to deal with the anger and animosity from my uncle. As a young girl, I don’t want to deal with that. So, I’ll just keep suffering in silence.”

FGM and Child Marriage

A study led by Tammary Esho, PhD, director of the Amref Health Africa End FGM/C Centre of Excellence, found a rise in the number of child, early, and forced marriages in Uganda and Kenya, along with rising numbers of female genital mutilation in Kenya, amid the pandemic.

Female genital mutilation, most known as FGM, is the cultural tradition of partial or total removal of the external female genitalia for nonmedical reasons.

It is illegal in a number of African countries, though it has been hard to stop altogether, given that it is a practice that has been done for centuries.

FGM is viewed as a “passage into womanhood” for young girls and is often tied to purity and femininity.

FGM comes with short-term effects, like severe pain, shock, and infections, as well as long-term effects, like complications in pregnancy and painful sexual intercourse. Not to mention the psychological effects on young women and girls who go through the practice.

While FGM has been practiced widely in Kenya, numbers have dropped greatly in recent years, especially through government efforts.

Onano says that educating, rather than demonizing, communities about the dangers of FGM has been successful.

“Those who’ve been educated and informed say, ‘Oh, I’ve been through it, but I don’t want my daughter to go through it, and I’m making sure my daughter is educated and educates others,'” Onano says. “They’ve become champions of FGM.”

Learning Opportunities

It’s also important to keep in mind the great efforts that have been made to help protect women and girls, Caminha says.

“UN Women and United Nations Development Program have a COVID-19 Global Gender Response Tracker that looks at the impact of COVID-19 policies. What we’ve seen is that there have been more policy responses looking at issues of gender-based violence, compared to other types of gender-responsive measures, such as economic recovery,” Caminha says.

The COVID-19 Global Gender Response Tracker shows that out of around 3,112 policy responses, about 40% are gender-sensitive, with most of the policies having to do with violence against women and girls.

One great example of protection efforts is legal help for women during the pandemic, with courts prioritizing domestic violence cases, Caminha says.

“Continuing to speak about these issues and raise visibility of them is really critical as important elements to make sure these issues are seen and addressed in a wholistic way,” she says.

Article first published on https://www.medscape.com/viewarticle/956198