The World Population Day is observed on 11 July each year as a means to place the spotlight on global population issues. To mark World Population Day 2021, the United Nations Population Fund (“UNFPA”) called for the prioritisation of reproductive health and rights at a time when the COVID-19 pandemic has severely disrupted health care systems, including sexual and reproductive health services.[1]Although lockdowns are necessary to curb the pandemic, its negative impacts on reproductive health and rights should not go unnoticed. To illustrate, lockdowns have caused disruptions in the supply of contraceptives which, in turn, would result in a surge of unplanned pregnancies. Conversely, individuals with access to sexual and reproductive health services may opt to delay childbearing due to economic uncertainty.[2] UNFPA also revealed that gender-based violence (“GBV”) has increased exponentially during lockdown.[3]To demonstrate the magnitude of these issues, UNFPA estimated in 2020 that after six months of lockdown, approximately 47 million women would be unable to use modern contraceptives which would then lead to an additional 7 million unplanned pregnancies.[4] On top of that, there would be approximately 31 million cases of GBV.[1]These factors contribute towards changing fertility rates which, at present, is a cause for concern for many countries.[2] In this context, this essay focuses on the main issues related to sexual and reproductive health and rights (“SRHR”) that arose or were exacerbated due to the pandemic as well as recommendations on government responses that prioritise SRHR.
What are reproductive health and rights?
Before delving into the prioritisation of SRHR during the pandemic, it is necessary to address the concepts of reproductive health and rights as well as the relevant terminologies. The earliest official recognition of reproductive rights could be traced back to the 1994 International Conference on Population and Development (“ICPD”) Programme of Action (“PoA”) which took place in Cairo, Egypt.[1]The PoA was adopted by 179 countries and represented the first and most comprehensive international document on reproductive health and rights. Subsequently, the ICPD agenda was reaffirmed at the 1995 Fourth World Conference on Women and provided a foundation for the Millennium Development Goals (2000 – 2015). In brief, the PoA defines reproductive health as “a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes”.[2]This implies that individuals are able to have a satisfying and safe sex life as well as the capability to reproduce and freedom to decide if, when, and how often to do so.[3] On the other hand, the PoA defines reproductive rights as “the basic right of all couples and individuals to: decide freely and responsibly the number, spacing and timing of their children; have the information and means to do so; attain the highest standard of sexual and reproductive health; make decisions on reproduction free of discrimination, coercion and violence”.[1]
Based on the abovementioned definitions, it is pertinent to note that, while sexual health, sexual rights, reproductive health, and reproductive rights can be viewed as separate concepts, these concepts are inherently intertwined and may be synonymous with each other. Most discussions and literature on reproductive health and rights are typically subsumed under the general concept of SRHR. As such, this essay adopts the umbrella term of SRHR for its discussion on reproductive health and rights.
It is also important to emphasise that SRHR are regarded as human rights and an essential element of the universal right to the highest attainable standard of physical and mental health.[1] Although there is no single human rights instrument solely devoted to SRHR, the ICPD has firmly established that SRHR are not a new set of rights, but rather a constellation of freedoms and entitlements that are recognised in various national laws, international human rights instruments, and consensus documents.[2] For example, Article 25 of the Universal Declaration of Human Rights (“UDHR”) protects the right to an adequate standard of living, while Article 12 of the International Covenant on Economic, Social and Cultural Rights (“ICESCR”) protects the right to the highest attainable standard of health. SRHR are notably reflected in Articles 12 and 16 of the Convention on the Elimination of All Forms of Discrimination Against Women (“CEDAW”) which prescribe that states parties shall ensure “access to health care services, including those related to family planning” (Article 12.1), “appropriate services in connection with pregnancy, confinement and the post-natal period” (Article 12.2), and “the right to decide freely and responsibly on the number and spacing of children” (Article 16.1(e)). In addition, preventable maternal mortality infringes the right to life which is enshrined in Article 6 of the International Covenant on Civil and Political Rights (“ICCPR”).[1]In the Malaysian context, SRHR are implicitly recognised as Malaysia has affirmed acceptance of the UDHR and ratified the CEDAW. While the Federal Constitution does not formally guarantee the right to health, Article 5 does guarantee the right to life. In relation to national laws, Malaysia does not have a specific legislation that addresses SRHR. However, most of the government’s policy objectives for women’s health and reproductive health can be found in the Eighth Malaysia Plan.[2]
SRHR issues that arose or were exacerbated due to the COVID-19 pandemic
Despite the seemingly universal legal recognition of SRHR as fundamental human rights, SRHR remains an area that suffers from inadequate resources and political opposition in numerous countries.[1] The pandemic has further compromised SRHR by compounding existing inequities, stigmas, and vulnerabilities.[2]At the heart of this problem is the non-prioritisation of SRHR. To illustrate, countries at all income levels that have implemented lockdowns exempt essential services, yet many countries have categorised SRHR services as non-essential. Relegating SRHR to such a position reveals and perpetuates deep-rooted political and ideological rifts regarding sex and reproduction.[1] This extreme pushback against SRHR prompted 59 governments to issue a statement urging governments to prioritise SRHR in light of the pandemic in order to ensure that this crisis does not reverse decades of progress.[2]
Essentially, the pandemic has created or exacerbated several issues that justifies the current need to prioritise SRHR. One of which is the limited access to SRHR services which includes sexual and reproductive health care, menstrual hygiene products, contraceptives, antiretroviral therapy, self-testing kits for sexually transmitted infections (“STIs”), and safe abortions to the extent permitted by law.[1]Such access has been curtailed due to mandated clinic closures, restricted movement, disrupted supply chains, and health system perturbations.[2]Besides that, staff and equipment involved in the provision of SRHR services may be diverted to respond to the pandemic.[3]The International Planned Parenthood Federation was forced to close thousands of their family planning facilities around the globe due to government orders. Malaysia, amongst other countries, had to close at least 100 of such facilities.[1]Consequently, individuals may be denied certain time-sensitive and potentially life-saving services such as abortion care.[2]Marie Stopes International estimated that, across the 37 countries where it works, the closure of their contraception and safe abortion services could lead to an additional 3 million unintended pregnancies, 2.7 million unsafe abortions, and 11,000 pregnancy-related deaths.[3]By July 2020, “traumatic” incidents have been reported across 45 countries which defied World Health Organisation guidelines. Such incidents include the deaths of pregnant women due to care delays. Dr. Karla Berdichevsky, General Director of the National Centre for Gender Equality and Reproductive Health in Mexico, stated that the lack of access to SRHR services during the pandemic has triggered a peak in maternal mortality.[4]Furthermore, even in countries where SRHR services are deemed as essential, family planning facilities have seen a huge reduction in visits, possibly due to fears of infection or reduced income.[5]
As previously mentioned, there has been significant disruptions in the global supply chains for contraceptives as major manufacturers in several countries, including Malaysia, have been forced to close.[1] In fact, one Malaysian factory under semi-lockdown produces 1/5 of the world’s condoms.[2] It follows that if the availability of contraceptives is not given immediate attention, the ensuing worldwide shortage of contraceptives would lead to increased unintended pregnancies and STIs.[1] A study on the impact of the pandemic on SRHR has estimated that a 10% proportional decline in the usage of short- and long-acting reversible contraceptive methods in low- and middle-income countries would result in an additional 15 million unintended pregnancies over a year.[2]
Another serious SRHR issue catalysed by the pandemic would be the rise of GBV, particularly domestic violence. Lockdowns have forced women to be isolated at home with their abusers and have adversely impacted women’s escape routes and support networks, such as hotlines and shelters.[1]Interruptions to social and protective support networks, in combination with disruptions to livelihood and increased burden of care responsibilities, contribute to the elevated risk of domestic violence against women and girls.[2] According to Plan International (2020), reports of GBV during lockdown in Colombia increased by175% as compared to the same period the previous year.[3] Most European countries encountered a surge in reports of GBV as well. For example, France saw an increase of 32% in 2020.[4] Similarly, in Malaysia, the Women’s Aid Organisation recorded a staggering four-fold increase in the number of calls received as compared to the period prior to the imposition of the Movement Control Order.[5]
Besides that, the issue of disruption to comprehensive sexuality education (“CSE”) should not be overlooked. Approximately 90% of the world’s school-aged children faced interference to their education due to the pandemic. Accordingly, this would hinder their access to information regarding SRHR and reduce their autonomy.[1] In addition, research has shown that CSE, being an important topic for teenagers’ development and health, can be difficult to deliver remotely.[2]
In view of the abovementioned SRHR issues, it is worth noting that governments should be cognisant of the fact that these negative effects on SRHR are more severely felt by the vulnerable and marginalised population, such as people living in poverty, people with disabilities, indigenous peoples, refugees, and migrants.[1] These groups must not be left behind in policy responses to the crisis.
Recommendations on government responses
As the pandemic continues, governments must take steps to mitigate the harmful impacts of the pandemic on SRHR. A useful starting point for planning responses would be to look at lessons from the West Africa Ebola virus outbreak.[1] As noted by Clare Wenham, Assistant Professor of Global Health Policy at London School of Economics and Political Science, the Ebola virus outbreak demonstrated that there is a need for “simple steps” to facilitate access to health care, such as transferring SRHR services out of hospitals or into the community, and free distribution of contraceptives at pharmacies or other places where women are not afraid to go.[2]
However, it is submitted that the effective prioritisation of SRHR requires governments to go further than these “simple steps”. Experts have proposed a holistic framework for policy responses that adopts a multi-level and intersectional approach.[1]To illustrate, at the macro level where policies are formulated and political commitments are made, it is crucial for SRHR to be a political priority and at the top of public health debates.[2] The pandemic should not be used as an excuse to deny or delay SRHR services. Therefore, there is an urgent need for governments to reaffirm their political commitments to SRHR by categorising SRHR services as essential and ensuring access without discrimination to all SRHR services, information, and commodities.[3] Governments also need to ensure that GBV-related services and resources, such as hotlines, shelters, and One Stop Crisis Centres, are recognised as essential services and remain accessible to victims of GBV. In addition, government responses need to be gender-sensitive, as such, women’s perspectives should be included in decision-making.[4]
At the meso level where national policies and commitments are implemented, governments should coordinate with private sector actors in order to provide SRHR services through innovative service-delivery models, such as SRHR consultations and counselling via telemedicine and mHealth.[1]Policies should also be adapted so as to remove procedural or administrative barriers to SRHR services. Examples include making contraceptives available without a prescription and deliver services to homes if possible.[2] For pregnant women with suspected or confirmed COVID-19, governments should ensure that they have access to respectful maternity care, such as maternal screening tests, neonatal care, and psychosocial support.[1] Besides that, governments and their partners should address the urgent need for contraceptives and personal protective equipment by securing alternative suppliers and support for shipping. The unique needs of the vulnerable and marginalised population should be given due attention as well.[2] In addition, cooperation between the health sector and education sector would be pivotal to coordinate CSE.[3]
Lastly, at the micro-level where end-users access services, engagement with community health workers or gatekeepers is important to ensure that the SRHR services are culturally appropriate.[1]
Conclusion
It is clear that the demands of tackling the pandemic threaten to undermine SRHR milestones. However, on a positive note, the pandemic provides a global opportunity to push for progressive changes in SRHR by making it an area that is politically prioritised and properly resourced. Apart from government efforts, financial and logistical support from international organisations to countries in need would assist countries towards the goal of prioritising SRHR during the pandemic.
Winner of The Essay Writing Competition In Conjunction With World Population Day 2021: Lee Jien Lynn, University of Malaya
REFERENCES:
International instruments
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Websites
[1]World Population Day: Prioritizing reproductive health and rights during COVID-19(11 July 2021). Retrieved 21 July 2021 from <https://news.cgtn.com/news/2021-07-11/World-Population-Day-Prioritizing-reproductive-health-and-rights-11NNNSjzOBG/index.html>
[2]Rights and choices are the answer: Whether baby boom or bust, the solution to shifting fertility rates lies in prioritizing the reproductive health and rights of all people (11 July 2021). Retrieved 21 July 2021 from <https://www.unfpa.org/events/world-population-day>
[3]Ibid.
[4]Plaza, L. (25 September 2020). Sexual politics amidst the COVID-19 pandemic. Retrieved 21 July 2021 from <http://petrel.unb.br/destaques/102-sexual-politics-amidst-the-covid-19-pandemic>
[5]Ibid.
[6]Supra note 2.
[7]What are sexual and reproductive health and rights?Briefing note, European Humanist Federation (January 2015). Retrieved 21 July 2021 from <https://humanistfederation.eu/wp-content/uploads/What-are-sexual-and-reproductive-health-and-rights-EHF-briefing-F.pdf>
[8]PoA, Para 7.2.
[9]Ibid.
[10]Ibid.
[11]Sexual and Reproductive Health Rights. Retrieved 21 July 2021 from <https://www.amnestyusa.org/pdfs/SexualReproductiveRightsFactSheet.pdf>
[12]Reproductive Rights are Human Rights: A Handbook for National Human Rights Institutions(2014). Retrieved 21 July 2021 from<https://www.ohchr.org/documents/publications/nhrihandbook.pdf>
[13]Ibid.
[14]Women of the World: Laws and Policies Affecting Their Reproductive Lives – East and Southeast Asia(2015). Retrieved 21 July 2021 from<http://arrow.org.my/wp-content/uploads/2015/04/Women-of-the-World-Laws-and-Policies-Affecting-Their-Reproductive-Lives_Monitoring-Report_2005.pdf>
[15]Samuels, F. and Daigle, M.,Sexual and reproductive health and rights after Covid-19: A forward-looking agenda (16 June 2021). Retrieved 21 July 2021 from<https://odi.org/en/publications/sexual-and-reproductive-health-and-rights-after-covid-19-a-forward-looking-agenda/>
[16]MacKinnon, J. and Bremshey, A.(2020). Perspectives from a webinar: COVID-19 and sexual and reproductive health and rights. Sexual and Reproductive Health Matters, 28(1), 533.
[17]Schaaf, M., Boydell, V., Van Belle, S., Brinkerhoff, D. W., Asha George, A. (2020). Accountability for SRHR in the context of the COVID-19 pandemic. Sexual and Reproductive Health Matters, 28(1), 49.
[18] Plaza, supra note 4.
[19]Plaza, supra note 4.
[20]Schaaf, supra note 17, 50.
[21]Riley, T., Sully, E., Ahmed, Z., and Biddlecom, A. (2020). Estimates of the Potential Impact of the COVID-19 Pandemic on Sexual and Reproductive Health in Low- and Middle-Income Countries. Guttmacher Institute, 46, 73.
[22]The Right of Everyone to Sexual and Reproductive Health: Challenges and Opportunities During Covid-19 (10 June 2021). Retrieved 21 July 2021 from<https://www.hrw.org/news/2021/06/10/right-everyone-sexual-and-reproductive-health-challenges-and-opportunities-during>
[23]Riley, supra note 21, 73.
[24]9.5 million women could lose access to our services(3 April 2020). Retrieved 21 July 2021 from<https://www.msichoices.org/news/2020/4/95-million-women-could-lose-access-to-our-services/>
[25]Studies show severe toll of COVID-19 on sexual and reproductive health, rights around the world (21 April 2021) Retrieved 21 July 2021 from<https://www.unfpa.org/news/studies-show-severe-toll-covid-19-sexual-and-reproductive-health-rights-around-world>
[26]Sexual and Reproductive Health and Rights during the COVID-19 pandemic, A joint report by EPF & IPPF EN(22 April 2020). Retrieved 21 July 2021 from<https://www.ippfen.org/sites/ippfen/files/2020-04/Sexual%20and%20Reproductive%20Health%20during%20the%20COVID-19%20pandemic.pdf>
[27]Schaaf, supra note 17, 50.
[28]Supranote 26.
[29]MacKinnon, supra note 16, 532.
[30]Riley, supra note 21, 74.
[31]Supra note 26.
[32]MacKinnon, supra note 16, 532.
[33]Cousins, S.,COVID-19 has “devastating” effect on women and girls(1 August 2020). Retrieved 21 July 2021 from<https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31679-2/fulltext>
[34]Supra note 26.
[35]Tengku Nur Qistina, Community responses to gendered issues during Malaysia’s fight against COVID-19(14 December 2020). Retrieved 21 July 2021 from<https://blogs.lse.ac.uk/seac/2020/12/14/community-responses-to-gendered-issues-during-malaysias-fight-against-covid-19/>
[36]Supra note 22.
[37]Ibid.
[38]Coronavirus Disease (COVID-19) Preparedness and Response, UNFPA Interim Technical Brief (23 March 2020). Retrieved 21 July 2021 from<https://www.unfpa.org/sites/default/files/resource-pdf/COVID-19_Preparedness_and_Response_-_UNFPA_Interim_Technical_Briefs_Maternal_and_Newborn_Health_-23_March_2020_.pdf>
[39]Cousins, supra note 33.
[40]Ibid.
[41]Samuels, supra note 15.
[42]Ibid.
[43]Supra note 26.
[44]Ibid.
[45]Ibid.
[46]Riley, supra note 21, 75.
[47]Supra note 38.
[48]Supra note 26.
[49]Samuels, supra note 15.
[50]Ibid.
