As the Covid-19 crisis continues to destabilize whole countries, NGOs are particularly concerned about its impact on the reproductive health of women, especially their right to abortion and access to contraception.
The date was 28 April 2020. One third of the world’s population was in lockdown, the total number of deaths attributed to Covid-19 had just topped 200,000. Given the circumstances, it was just one more bit of bad news to add to the pile: referencing a study conducted in partnership with development NGO Avenir Health and two universities from the English-speaking world, the United Nations Population Fund (UNPF) raised concerns of a surge in unwanted pregnancies all over the world, and particularly in emerging and developing nations.
The UNPF warned that this risk was a result of the difficulties encountered by women and girls in accessing family planning services during the pandemic. Looking at 114 low and middle-income countries, with a projected lockdown of 3 months, the study predicted between 325,000 and one million unwanted pregnancies depending on the level of disruption to healthcare services.
“That means more illegal abortions, more healthcare expenditure for the countries concerned and, above all, more women will die,” explains Charlotte Soulary, Director of Advocacy at the Reproductive Health Supplies Coalition. The RHSC has over 500 members – national governments, international organizations, civil society groups and businesses – united by the aim of improving access to reproductive health products, a key factor in the emancipation of women and children of child-bearing age.
Although the organization’s work is largely focused in developing and emerging countries, the global nature of the Covid-19 pandemic has added a new dimension to their missions: “All of the world’s societies have been simultaneously confronted with challenges we usually associate with humanitarian aid cases. The stakes have suddenly become so much higher,” Charlotte Soulary adds. An opinion shared by Katrine Thomasen, Senior Legal Adviser for Europe at the Center for Reproductive Rights and a specialist in legal action in defense of gender equality: “The threats to women’s sexual and reproductive health which were already present have now been accentuated.”
Covid-19: production of contraceptives at a standstill
One major cause of this crisis is the way our globalized economy (mal)functions. The vast majority of the world’s contraception, abortion and maternity products are manufactured in two countries: India and China. Supply and production chains ground to a halt as China gradually went into lockdown from 22 January onwards, and the whole of India was ordered indoors on 24 March. Reproductive health products are not immune to the risks posed by the globalized division of labor which characterizes the production of many medicines. The fact that their fabrication is concentrated in the hands of a small number of actors also increases global dependency.
In some developing countries, while the lack of qualified personnel – particularly healthcare logistics specialists capable of determining the quantities required and ordering adequate stocks – is a familiar problem, measures taken to curb the spread of the epidemic have also disrupted supply chains: how can we make sure that supplies reach isolated medical centers when freedom of movement has been suspended? “In the Central African Republic we have seen some dramatic stock shortages. In Burkina Faso, where a free contraceptive program was voted into law last year, logistics have been complicated further still by the fact that the north of the country is currently experiencing a serious humanitarian crisis,” explains Charlotte Soulary from RHSC.
Underlying these specific failures is the broader question of the position which women’s reproductive health occupies in public policy. In this regard, the change of stance operated by the Indian government is an interesting example: initially, access to abortion was not placed on the list of essential services which were to be maintained in spite of the pandemic. On 14 April, some three weeks after the lockdown started, the government finally relented – even if, in actual fact, access to abortion remains difficult for many of the women concerned.
Abortion rights, the eternal battle
Make no mistake, the right to abortion is still hotly-contested. Twenty-six years after the International Conference on Population and Development in Cairo, which cemented access to reproductive health services as a central objective of development programs, different stakeholders are still attempting to advance competing agendas on this sensitive issue. The current health crisis is shaking up the status quo.
In France, the debate over extending the legal limit for abortion is back on the table. The cause has been taken up by feminist campaigners, medical practitioners and some politicians, but French health minister Olivier Véran has thus far been intransigent on the matter. He has, however, allowed for a degree of flexibility by authorizing doctors to invoke “psycho-social distress” as justification for performing interventions after the legal 12-week limit. Authorized until the ninth week of pregnancy (the limit was previously set at seven weeks), access to abortion by medication has also been facilitated.
The situation is quite different in Poland, where the far right has taken advantage of the present circumstances to table a draft bill which would strip women of the right to abortion even in cases where the fetus shows severe abnormalities – one of the rare scenarios in which abortion is permitted in this staunchly Catholic country. For the time being the bill has been postponed, but associations working to defend women’s rights remain extremely concerned. In the USA, meanwhile, conservatives in several states, including Texas and Oklahoma, have attempted to use the argument that medical facilities are saturated as grounds for outlawing abortion by medication, despite the fact that these procedures take place in patients’ homes.
Covid-19 and the reproductive health of women, from one crisis to another?
The Covid-19 pandemic has also conferred a new degree of urgency upon issues of reproductive health policy which were just beginning to emerge before the crisis. A good example is the growing number of procedures which can be performed as self-care interventions, i.e. by women themselves without the involvement of a medical professional. Last year, and for the first time, such practices were the subject of new recommendations from the World Health Organization. Now “in light of the crisis, we’re realizing that we need to move faster on allowing the self-administration of certain products, contraceptives for example,” explains Charlotte Soulary. She cites France as an example, where women have been allowed to access birth control pills even if their prescription has expired.
Another subject which has come to the fore is menstrual health. Long considered a taboo topic, in recent years menstruation has inspired a growing wave of mobilization, particularly in India: the fact that the government included sanitary products on the list of essential products represents an important victory for associations working in this field.
And of course, we must now face up to the uncertainties of the post-lockdown world, overshadowed by the specter of a severe economic crisis and intensified geopolitical tensions. The WHO has been a collateral victim of the new world disorder: complaining of excessive deference to Chinese interests, the USA has announced its intention to cease funding the agency. The WHO has thus lost its biggest single financial backer, the source of almost 20% of its annual budget.
This hammer blow will have serious repercussions in the many countries, particularly in Africa, where the WHO funds programs to expand access to various forms of healthcare, including reproductive health and maternity care. And lest we forget, the pandemic is far from under control: the WHO recently warned that the propagation of the virus in Africa is accelerating. Meanwhile, the number of deaths in Latin America and the Caribbean recently topped 80,000. And the public health situation on the Indian sub-continent is looking highly precarious…
There can be no doubt about it: a month and a half after the alarm was first raised, the UNPF’s concerns regarding the reproductive health of women remain as pressing as ever.
The opinions expressed on this blog are those of the authors and do not necessarily reflect the official position of their institutions or of AFD.