Prepared by:
Tan Yi Xin (s2020353@siswa.um.edu.my / yixintan1009@gmail.com)
Koay Chia Yee (cyeekoay@gmail.com)
Institution: Faculty of Economics and Administration, University of Malaya
The Covid-19 pandemic caused by the novel coronavirus (SARS-Cov-2) has triggered an unprecedented public health emergency crisis ever since late 2019. In order to minimise the risk of contracting Covid-19 and infection spread, physical distancing and movement restriction measures are implemented across nations worldwide. The unpredictable trend of Covid-19 cases happening all around the world has resulted in excess demand for hospital beds, treatment facilities as well as medical staff. As a result, resources and healthcare personnel are re-prioritised and diverted for more critical Covid-19 services, which has severely compromised the provision of reproductive health care services, including but not limited to contraception and abortion care, sexually transmitted diseases testing and reproductive cancer screenings. The limited accessibility and suspension to these services due to lockdown-related closure and reduction of activities by service providers have become particularly concerning as it could put the health and wellbeing of the vulnerable groups at risk.
The negative impact of the Covid-19 pandemic on sexual and reproductive health often goes unappreciated, as the effects in general are not the direct consequence of infection, but an indirect effect of strained healthcare systems and service disruption. These impacts are likely to be non-uniform among different countries worldwide, which are predominantly due to the differences in the prevailing policy environment and nations’ preparedness to the pandemic. According to the International Planned Parenthood Federation (IPPF) (2020) in the Asia-Pacific region, 64% of its member associations reported a decline in the number of service delivery points, whereas 76% reported a scale down of service availability due to a decrease in operation hours and capacities. In the Philippines, the country experienced challenges of restricted access to contraception and family planning consultations. Similar Covid-19 lockdown-related impacts were also observed in Europe. A survey by the IPPF European network revealed that 94% of the service organizations experienced a decrease in the number and frequency of reproductive health services since the Covid-19 outbreak (IPPF, 2020). At the individual level, women from the lower-income group were more likely to encounter disproportionately greater barriers and delays in accessing contraception and birth controls services than those from the higher-income group during the pandemic (Lindberg LD, 2020).
The interruptions in the provision of essential reproductive and sexual health care have a significant potential to increase the domestic health burden of women due to a reduction of screening for sexually transmitted infections and reproductive cancers. Declines in laboratory testing could lead to missed asymptomatic cases and continued transmission of sexually transmitted infections. In the U.S., as much as 43% of missed chlamydia-positive cases were found in New York and New Jersey during the peaks of Covid-19 cases. Meanwhile, the regions around New York and New Jersey, although not the epicenter of the outbreak, reported a 32% of missed gonorrhoea-positive cases, which could be explained by the fear of the public to seek healthcare services which involve human interaction and contact (Pinto et al., 2021). In Australia, consultations significantly declined during the lockdown with an observed 68% reduction in symptomatic screening (Chow, Hocking, Ong, Phillips, & Fairley, 2021). To some extent, this situation is worsened by the unpredictable supply chain interruptions such as upstream manufacturing disruptions and delayed transportation, leading to commodities shortage and stock-out of contraception supplies such as the morning pill, implants and male condoms. Concerns of local supply shortages might also compel local governments to reduce exports of critical contraceptive supplies (UNFPA, 2021). As reported by Marie Stopes International (MSI), an international contraception and safe abortion services provider, approximately 9.5 million people in 37 countries are at risk of losing access to contraceptive and safe abortion services due to the pandemic (IPPF, 2020).
The relationship of Covid-19 pandemic and the fertility dynamics is less straightforward and rather complex. Several hypotheses have been proposed, suggesting two scenarios of stark contrast. The first hypothesis suggests an increase in fertility due to an increase in sexual activity and low contraceptive use during lockdown, which was depicted by the rise in birth rates in Bangladesh in 2021 compared to the earlier years (UNFPA, 2021). On the contrary, the second hypothesis suggests a decrease in fertility due to the economic burden of an additional child and fertility postponement. This hypothesis is consistent with an observed trajectory decline in fertility rate in Europe and the other developed countries. Data drawn from Thailand also suggests a similar downturn in fertility rate with nearly 23% decline in fertility in January 2021 compared to the same period in the previous year. Fertility preferences are also shaped in part by worries about financial instability, economic recession and unease about the future. A study by the Guttmacher Institute in the USA discovered that 40% women reported changing their plan to not have a child during the Covid-19 pandemic, and 34% wanted to get pregnant later or wanted fewer children (Lindberg LD, 2020). Shifting the geographics to the Malaysian setting, a national survey found that 1 in 3 of the married respondents claimed Covid-19 has affected their family planning decisions by delaying having children. More than half of the respondents selected the reduction in financial savings as the main reason, followed by worries about contracting Covid-19 and difficulty of accessing prenatal care and childcare (LPPKN, 2020).
It is an undeniable fact that women and girls have been made more vulnerable towards being exposed to a variety of harmful practises due to the Covid-19 pandemic lockdowns, including domestic abuse, unexpected pregnancies and teenage pregnancies, and higher maternal mortality resulted by unassisted home births. This statement is further supported by Dr Nurul AshikinMabahwi, the Women Youth Chief of Homeland Fighters’ Party, who claimed that there were 12,330 criminal cases involving women, children and sexual offences issued by the Malaysian police during the Movement Control Order (MCO) period as of September 2020 (Hani et al., 2021). The usage of the modern contraceptive methods by Malaysian women have remained at a relatively low level of 34% throughout the past two decades. The pandemic situation is expected to cause a more significant reduction in usage while increasing the risks of unintended pregnancies and its associated ill effects, putting many women’s lives in jeopardy and disrupting their families’ ability to survive the pandemic (CodeBlue, 2020). Teenage pregnancies, which have been one of the major concerns of the country, continue to worsen during the pandemic as a consequence of prolonged lockdowns, school closures, school dropouts as well as increased poverty due to unemployment and declined access to healthcare services.
The society, especially policymakers, play crucial roles in achieving gender equality and women empowerment, alongside the 5th Sustainable Development Goal (SDG). To elaborate, protection of pregnant girls and young mothers against discrimination should be provided by not prohibiting them from returning to school to attain education as they tend to suffer from stigma and discriminatory school re-entry regulations. Establishments of new ways of delivering information and support to teenage girls and young adults are required by not only making good use of social media platforms and remote learning, but also ensuring those who do not have access to digital resources to be provided with distance learning packages and relevant alternatives amidst the closures of schools and health services during the lockdown period. Furthermore, the government should prioritize sexual and reproductive services as lifesaving interventions by ensuring the continuity of access to services. Clinics should be allowed to continue operating with modified service-delivery models by utilizing tele-health as a substitute for physical appointments to avoid infection spread of the pandemic virus. The Women’s Centre for Change (WCC) in Penang have started using online platforms to approach their clients, especially those who are involved in domestic violence cases, by providing online counselling sessions via Zoom and WhatsApp, not limited to the pre-existing telephone counselling method. Online webinars are also conducted in various languages relating to topics on domestic violence, sexual harassment, child sexual abuse as well as cyberbullying with the main objective to gain public awareness and offer help to those who are in need (Teoh, 2020).
It is well recognised that reduced work-life balance, economic insecurity and restricted access to reproductive health service can act as barriers to couples in achieving their reproductive rights, nevertheless, reproductive rights and choices must not be taken lightly and continue to predominate. In response to the Covid-19 pandemic, the World Health Organization (WHO) has provided operational planning guidelines to help countries navigate through the challenges of maintaining the continuity of the delivery of essential reproductive health services. At the local level, the Ministry of Health should include a set of targeted and coordinated strategies to prioritise essential care during pregnancy and childbirth and care of young infants and older adults. Immediate needs for sexual health commodities and protective personal equipment should be addressed. Hence, collaboration among public and private sectors should also be encouraged so that the supply chain of contraceptives and essential medicines remains stable to fulfil the demand of those suffering from reproductive health diseases. As patients’ anxiety on contracting Covid-19 can lead to refusal and low uptake of treatments, it is imperative to ensure robust hygiene practices with respect to the safe provision of reproductive health care. For instance, the Ministry of Health of Malaysia has provided guidelines on the management of COVID-19 in Obstetrics and Gynaecology with details of the modifications of service provision to safeguard the safety of frontline healthcare professionals and patients in response to the pandemic.
The United Nations Population Fund (UNFPA) and the Federation of Reproductive Health Associations of Malaysia (FRHAM) have been working closely together to reach out to communities in geographically difficult areas by providing them with knowledge and services such as advice on sexual and reproductive healthcare, health screenings, pap smears, breast checks and access to long-acting reversible contraceptives. The former organization emphasizes on marginalized and underserved populations, while the latter organisation is dedicated to promoting sexual and reproductive health and reproductive rights of women, men and children (UNFPA, 2021). The Ministry of Women, Family and Community Development (KPWKM) as well as the National Population and Family Development Board (LPPKN) are government bodies that have shown interests in striving towards attaining equality across gender and protecting the rights deserved by women, children and adolescents through population surveys and counselling services. The use of helplines such as theTalian Kasih helpline is also widely advocated by the NGO Women’s Aid Organisation and KPWKM in response to a significant increase in distress calls and messages due to gender-based violence during the lockdown.
In short, despite the fact that outbreaks are inevitable, devastating consequences on sexual and reproductive health can be prevented beforehand by appropriate measures such as putting emphasis on critical resources and systems as well as prioritisation of essential sexual and reproductive health services. The existing barriers to reproductive rights which are identified during Covid-19 have been perpetuated by the pandemic to a larger scale on individuals, families and the global community. Longer-term tracking of individuals’ reproductive health care experiences will be crucial in prioritizing new approaches to improve multiple areas of women’s health. The Covid-19 pandemic should be taken as a great opportunity for radical and positive measures to address the long-standing disparities in women’s lives and to contribute to the creation of a world that is more equal and robust.
Winner of The Essay Writing Competition In Conjunction With World Population Day 2021: Tan Yi Xin & Koay Chia Yee, University of Malaya
REFERENCES:
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