The issues arising from COVID-19 have been endless from its origin to its evolution. Even so, the focus has never fallen on the often-neglected issues concerning reproductive health and rights. Following its definition, the optimal state of sexual health and reproductive health is referred to as the state of complete mental, social and physical wellness relating to the reproductive system and sexuality (Manimaran, Vikneswaran, Ng, &Chiew, 2017). However, during the pandemic, the freedom to manage reproductive health is compromised as the sequential lockdowns and reduction in movements interrupt healthcare access and family planning services. This hinders the achievement of the ideal reproductive health state. While various agencies globally and within Malaysia strive to increase awareness of reproductive health and rights, the COVID-19 pandemic has set upon new challenges that further strains the difficulties to promote its importance.
As the pandemic worsens, the United Nations Population Fund (UNFPA) emphasized the significant projection of lower access to potentially life-saving sexual and reproductive health services. This was proven by a Rutgers-led survey that involved nearly 2,700 young people across Indonesia, Kenya, Ghana, Nepal, Uganda, and Zimbabwe illustrating that more than a third of these young individuals were unable to access the necessary family planning services and felt more vulnerable to sexual abuseas compared to before COVID-19 (Sansone, Mollaioli, Ciocca, Limoncin, Colonnello, Vena, &Jannini, 2021). Another research indicated that if contraception use declines by 10 percent due to COVID-19, another 49 million women of childbearing age would have an unmet need for modern contraceptives and 15 million more unintended pregnancies would occur. In simple words, 10 percent of safe abortions will become unsafe and another 1, 000 preventable maternal deaths would take place (Riley, Sully, Ahmed &Biddlecom A, 2020). This cements the fact that unfettered access to reproductive healthcare and contraception for women and men, be it the usage of condoms, oral birth control or long-acting contraceptives like an IUD or vasectomy is of paramount importance. With constant access to family planning supplies and information, each individual can have the best reproductive choice. In turn, it avoids placing individuals in financial dilemmas, interruption in education and career as well as safeguarding their physical and mental health.
In addition to psychological and financial burdens, the isolation within societies further amplifies the problem. With the expanding financial pressure in the pandemic, it hampers the ability to obtain menstrual hygiene information and supplies, especially when it is deemed as superfluous commodities in the face of potential food and water shortages. Furthermore, the numerous lockdowns and economic imbalance is predicted to lead to the escalation of gender-based violence and deleterious practices such as child marriages and genital mutilation. The abominable abuse of human rights including the one-child policies and the existence of sterilization camps is not a viable answer for forming a sustainable society. An equitable society should not condone forceful inhibition of population growth. Instead, our focus should shift to prevent accidental births through the provision of family planning supplies. In turn, this will lower birth rates that stem from unwanted pregnancies and allow for harmonious societal growth.
Sexual and reproductive health services also function as entry points to the healthcare system. For example, during these health services, individuals can be screened for other conditions such as malaria, HIV or cervical cancer. In effect, it serves as an additional barrier to the spread of these diseases while allowing for early treatment that can lower the morbidity and mortality rate. In spite of the numerous evidence of the benefits of sexual and reproductive health services, it is frequently excluded from the priorities of many countries even in non-pandemic circumstances, especially with regards to the discussion of financing healthcare and allocating resources (Otu, Danhoundo& Yaya, 2021). Thus, another perspective to consider is that during public health emergencies, the human and financial resources would generally be diverted to controlling the infectious disease outbreak. While this decision is understandable and may be the most prudent given the course of events, it must also be noted that the neglect of sexual and reproductive health services will exacerbate the pressure upon the healthcare systems particularly in low to middle-income countries (OCHA, 2021).
In fact, studies have shown that individuals residing in poorer countries are three times more likely to have an unwanted pregnancy in comparison to those living in more advanced countries due to the lack of reproductive health services. Moreover, the rate of undesired pregnancies seems to be more common in the countries that place restrictions upon abortion rights in comparison to those in the countries that legalize abortion. Similar to a domino effect, reproductive health supplies and education will result in the rise in the number of pregnant women. We must remember that pregnant women have a higher healthcare need thus presenting arduous requirements to meet given the scarcity of materials and personnel during the pandemic. Besides that, there is also a question of how COVID-19 affects maternal and neonatal health. While no evidence currently suggests adverse effects of COVID-19 on pregnant females, they belong to the vulnerable and high priority population given the potential increased risk of adverse outcomes, and negative effects on neonatal and maternal health. In turn, the additional care given such as the attendance of skilled healthcare professionals, obstetric maternal screening tests, fetal medicine, neonatal care, as well as mental health and psychosocial support, would also lead to an increased cost on the healthcare system thereby further aggravating the cycle of insufficient supply and overwhelming demand. As such, we must ensure that individuals’ rights and choices regarding sexual and reproductive health should be preserved regardless of the pandemic.
The obstruction in the dissemination of correct information and health education is further intensified with the closing of schools as reproductive health and rights education is impeded. With lower access to sexual and reproductive health education and supplies, the increase in unwanted pregnancies will fuel the issue of unsuitable population growth. While the implications of inapt population growth already cry for urgent action to be taken, the ramifications of unprepared pregnancies, as well as the rise in the number of patients contracting reproductive health-related issue stemming, is heightened during the pandemic whereby mobility is restrained alongside the difficulties in meeting basic living needs.
Unfortunately, bringing contraception back into the conversation is a strenuous feat in and of itself due to stigmatization and lack of support from the general community, particularly in South-East Asian countries such as Malaysia. Many women are unwilling to acquire contraceptive devices and birth control pills due to the assumption that it restricts their reproductive futures. As a matter of fact, even the topic of the constant reproductive health check-ups may be considered taboo or alarming. While lawmakers and lockdown measures are not leaving room for education on the significance of birth control methods, the upsurge of unsafe sex cases has led to an unsustainable population growth which puts pressure on human communities, exacerbating food and water shortages and making it difficult for vulnerable communities to rise out on intergenerational poverty (Center for Biological Diversity, n.d.). Additionally, it is important to train healthcare workers to reduce stigmatization and discrimination thereby allowing for better patient-healthcare provider relationships to effectively promote reproductive health. Everyone will react differently and perceive these pieces of information either with fear, anticipation and some, with shame.
Another downside to the impairment in the facilitation of reproductive health education is the inability to differentiate between false and true information. The fast-paced digital world has caused an alarm within the women population as news has been passed around that contracting COVID-19 can render one infertile. As such, for those who are conscious of their reproductive health, there is a question of how precisely to combat and care for themselves given the new potential threat. On the other hand, for those who have not yet realized the importance of reproductive health, the relationship between COVID-19 and fertility may incite panic due to the sudden influx of information. There are concerns regarding certain components within the ovaries, such as the ACE2 receptor, that may be potential targets for damage by COVID-19. The downregulation of these receptors by the novel virus may cause alterations in the normal ovarian physiology, such as follicular development and oocyte maturation, impacting oocyte quality and fertility (Lee, Mok, & Chung, 2021). While COVID-19 has not yet been reported to harm female fertility, its potential detrimental effects cannot be ignored and future research should be conducted to assess these parameters. Meanwhile, efforts to reinforce accurate and precise sexual and reproductive health information and services are crucial so that contraceptive devices or injectables can be restored.
On the other hand, the effects of the virus on male reproductive health have received less attention than the effects on the female reproductive system. Currently, there are no definitive studies that show the harm of the disease or demonstrate health concerns on male reproductive organs such as reduced fertility and increased pregnancy-related complications (New Straits Times, 2021). On top of that, the extent to which COVID-19 can affect the sperm count is still unknown. There is no evidence that after recovery from the virus, sperm cell development will alter, but it sparks a line of thought on whether or not COVID-19 can also damage male fertility (Gonzalez, Nassau, Khodamoradi, Ibrahim, Blachman-Braun, Ory& Ramasamy, 2021). Although the effects remain unclear, the disease transmission has been suggested to disrupt the reproductive hormones as the virus targets the same receptors, the ACE2 receptors, to access lung tissues which are found on the surface of some testicular cells. While it may not be a warning bell to take immediate action, a study has shown that there is a 50% reduction in sperm count, volume, and motility. If the person’s infection is high or even moderate, it might lead to temporary infertility. Once more, there is a question as to how we can circumvent the effects of COVID-19 to ensure good reproductive health in relation to fertility.
One of the ways that we can promote reproductive health and rights is to ensure that individuals of the community of all ages are appropriately educated and advised. Following the inculcation of knowledge, the efforts to ensure a steady supply of contraceptives is available should be enhanced (United Nations, 2021). Additionally, a solid fundamental understanding of reproductive health and rights would aid in de-stigmatization thereby encouraging individuals to come forward to enquire and check the state of their health. As a functional society, we must ensure that the information regarding contraceptive services and reproductive health is provided respectably to facilitate informed decision-making and provide full autonomy. Besides that, allocation of funds and resources must be given to further research regarding COVID-19 and how it alters the approach to reproductive health.
Prioritizing reproductive health is not only confined to family planning and using contraceptives. It is a means to improve familial harmony and community well-being. It is an investment to help us become more proactive, listen to our bodies and get early treatment when necessary. In most cases, those who choose to put their health first will consolidate gains including being able to combat HIV/AIDS and other diseases. Improving access to healthcare and providing guided counseling can not only aid one’s physical being but include promoting the rights to healthy and respectful relationships that are safe as well as appropriate.
In conclusion, the current pandemic has obscured the importance of reproductive health in the face of worldwide panic. However, it is irrefutable that negligence in addressing the concerns of reproductive rights and matters can affect and be affected by the chains of events that occur in the pandemic itself as well as the changes in the healthcare systems. Nonetheless, at the very essence of the solution to this larger problem, the route to prioritizing reproductive health relies on education which can then lead to better utilization of the supplies and tools available and reduce the incapacious stigmatization. Having laid a solid foundation of understanding, tolerance and respect, the implementation of the usage of family planning and birth controlling methods can take place and save millions of lives. We must ensure that there are services of high quality and availability of a full range of choices for both women and men. After all, following the famous quote of Gautama Buddha, every human being is an author of his own health and disease.
Winner of The Essay Writing Competition In Conjunction With World Population Day 2021: Nadia Izzati Binti Zamri & NayleeIzzati Binti Zamri, Personal
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