NAIROBI, 19 May 2022– A new report reveals that women and girls from low-income backgrounds in five African countries faced multiple barriers in accessing sexual and reproductive health (SRH) services at the onset of the COVID-19 pandemic. The study also sought to examine how healthcare providers, women, girls, and sexual minorities in Burkina Faso, Ethiopia, Kenya, Malawi, and Uganda responded to offering and seeking services at the height of the pandemic. These vulnerable groups often experienced limited access to contraceptives, antenatal care, abortion care, HIV/AIDS prevention, and management. Based on interviews with 3473 women and girls, and 446 health providers, the study showed that care-seeking was often delayed, or postponed, while others reportedly stopped altogether.
The report, Impact of COVID-19 Pandemic on Sexual, and Reproductive Health Services in Burkina Faso, Ethiopia, Kenya, Malawi, and Uganda, further reveals the pandemic resulted in a spike in unintended pregnancies, increased sexual and gender-based violence, unsafe abortions and harrowing maternal and neonatal deaths. Additionally, sexual minorities- including the lesbian, gay, bisexual and transgender (LGBT) community- and persons with disabilities (PWDs) experienced challenges in accessing reproductive healthcare.
The study attributes the poor reproductive health outcomes to government policies that failed to strike a delicate balance between containing the spread of the COVID-19 pandemic and addressing the reproductive health needs, and priorities of women, girls, and sexual minorities. Most health facilities closed, and others were converted to isolation and treatment centres. Healthcare providers were often redeployed to COVID-19 units and reproductive health supplies were deprioritised. The study makes several recommendations.
Evelyne Opondo, Senior Regional Director for Africa, Center for Reproductive Rights (CRR) said: “At all times reproductive health services remain essential. The rights of entire populations to access sexual reproductive health services including during the pandemic remain a key responsibility of every government. Governments must accord the highest protection of reproductive rights for women, girls and sexual minorities.”
Boniface Ushie (PhD), Research Scientist at African Population and Health Research Center (APHRC), said: “Government policies in response to health emergencies must be continuously reviewed to ensure they effectively respond to evolving trends and developments.”
Victor Rasugu, Executive Director, Network for Adolescent and Youth of Africa (NAYA) said: “With fears that COVID-19 might become endemic, we can no longer afford to ignore essential interventions in other aspects of healthcare. Local and national governments must strengthen community health outreach to enhance adolescents and youth access to reproductive health information and services.”
L. Achieng Akumu, Esq. Africa Regional Director, Planned Parenthood Global (PPG) said: “Governments must supply private health facilities with reproductive health commodities to adequately serve the vulnerable women, girls and sexual minorities.”
Nelly Munyasia, Executive Director Reproductive Health Network Kenya (RHNK) said: “Governments must institutionalize inclusively, client-friendly training and sensitization of health providers to ensure effective service delivery in the wake of pandemics.”
Dr. Ernest Nyamato, Global Associate Director, Quality of Care at Ipas said: “Healthcare providers must be supplied with personal protective equipment (PPEs) to cushion them from the pandemic and psychological stress emanating from operating in such crisis contexts.”
Dr. Shiphrah Kuria, Reproductive Maternal, Child and Adolescent Health Expert at Amref Health Africa said: “Governments must adopt holistic responses and recovery strategies that access impacts of pandemics in different socioeconomic sectors.”
Other additional findings include:
• Access to SRH information: 48% of women and girls across the study countries received information from friends, 29% from the internet and <10% from teachers.
• Access to and uptake of SRH services: 26% of women and girls across the study countries could not access modern contraceptives, Burkina Faso (47%) recorded the least access. Most sought-after services included contraceptives (46%), followed by antenatal care (40 %). Post-abortion care/PAC (3%) was the least sought-after service during the pandemic.
• Access to contraceptives: 58% of women and girls across the study countries received short-acting contraceptive methods, 35% received long-acting reversible contraceptive methods.
• Barriers to SRH services: Women and girls across the study countries could not access services due to myriad factors: restricted movements (61%), closure of health facilities (13%), high costs (18%), and long distances (24%).
• Coping with barriers to SRH services: 46% of women and girls delayed seeking services. 21% visited another health facility or a health provider, while 19% never visited a health facility. Uganda (63%) recorded the highest delays number of women and girls who delayed seeking services
• Availability of SRH services: Health facilities across the study countries lacked medical abortion supplies. Burkina Faso (26%) was the most affected followed by Kenya (18%), Uganda (12 %) and Ethiopia (5%). Kenya (72%) was the most affected with stock out of Mifepristone/misoprostol, followed by Uganda (48%), Burkina Faso (23%) and Ethiopia (20%). Uganda was the most affected with stock out of implants, followed by Kenya (19%), Ethiopia (6%) and Burkina Faso (9%).
• Continuity of SRH services during a pandemic: Ethiopia (75%) and Burkina Faso (74) trained the highest number of providers, while Ethiopia (84%) and Kenya (77%) supplied the highest number of personal protective equipment/PPEs.
• Unavailability of some services: Providers in Burkina Faso (100%) did not offer post-abortion care/PAC due to a stock-out of commodities and the absence of trained healthcare staff. Providers in Uganda (83%) did not offer post-abortion care/PAC due to a stock-out of commodities. In Kenya and Ethiopia, services were not offered due to a lack of trained providers and the absence of patients
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