Sexual and reproductive health rights (SRHR) have long been recognised as fundamental human rights. However, they have continued to be ignored and abused, particularly with regard to vulnerable populations and women. Whilst significant gains have been made in terms of achieving equality for the SRHR of women and girls, the COVID-19 pandemic poses a threat to this progress and may induce a reversal of these accomplishments.

As a global panic set in after the emergence of COVID-19, all medically trained hands were on deck to tackle, treat, and thwart the transmission of the virus. Despite this, COVID-19 quickly reached nearly every country around the world. Naturally, the virus became a global priority, impacting all sectors of society - but none more so than the health sector. As attention, staff and funding were allocated to responding to the COVID-19 crisis, little thought was paid to where these resources were being redirected from.

THE IMPACT OF COVID-19 ON SEXUAL AND REPRODUCTIVE HEALTH SERVICES

Health systems have struggled to continue providing primary care services whilst simultaneously responding to the unprecedented global emergency. Even prior to the pandemic, many health systems struggled to meet the healthcare needs of all of the people they hoped to. Services deemed non-essential were halted early on during the pandemic or have been scaled down in order to prioritise the needs of the fight against COVID-19, with SRH services being hit hard. SRH facilities have been closed and outreach services have been scaled back due to the lack of resources. Even if these had remained open, however, the provision of public transport has also been cut back, meaning that those seeking SRH care may be struggling to access the necessary transport to reach it. Furthermore, the pandemic has had repercussions on the SRH manufacturing industry as well. Factories producing contraceptives, such as condoms and hormonal methods, have had to close or reduce their output in the midst of COVID-19, resulting in global contraceptive shortages. The lack of their availability has resulted in limited choices being offered to individuals; people seeking SRH services may not therefore be able to meet their needs via their preferred method or may be coerced into using other methods which are not suitable.

ATTEMPTS AT OVERCOMING BARRIERS TO CARE

SRH services in all countries around the world have therefore been impacted by the pandemic to one degree or another, with the most severe disruptions occurring in low- and middle-income countries (LMIC), in part due to the pre-existing fragility of their health systems. In many countries, the implications of the pandemic on SRH services, and on other health services, has led to the acceleration and scaling up of different types of medical interventions, such as telehealth, service integration, and community health workers. These interventions have provided a way to overcome many of the barriers to SRH services, and the success they have had is leading many countries to consider integrating them into their health systems in the long-term.

However, as often is the case, vulnerable populations are at risk of being overlooked and disadvantaged by these interventions. For instance, whilst telehealth offers individuals the chance to receive health advice and referrals without the need to travel to any healthcare facility, it relies on the presence of suitable and adequate infrastructure, including individual ownership of or access to a phone or computer, a reliable internet connection, and knowledge of telehealth and its availability. Individuals who live in rural settings, where access to such technology is generally even more restricted, are immediately disadvantaged. Therefore, whilst the impact of these interventions can be significant, their reach is limited, meaning that the human rights of vulnerable and rural populations continue to be disproportionately neglected.

THE CONSEQUENCES OF OVERLOOKING SEXUAL AND REPRODUCTIVE HEALTH

One difficulty related to securing SRH services is that the impact of ignoring their necessity is not always immediately apparent. However, it has been predicted that over the span of a year, due to the effects of COVID-19 on SRH services, an additional 48.5 million women in LMIC will not have their SRH needs met, leading to 1.4 million unintended pregnancies. This means fewer girls will be able to attend school, limiting their future career opportunities. The influence education and female empowerment can have on a country’s economy is well known; indeed, improving the education of girls around the world has been a key aim of the UN’s Sustainable Development Goals (SDGs). More drastic, however, is the anticipated increase in the number of deaths of girls, women, and their infants. As the incidence of unintended pregnancies rises in countries and regions where abortion is illegal, so the incidence of unsafe abortions increases - and so too does the number of abortion-related deaths. Added to this is the reduction in the number of institutional births that occurred throughout the pandemic, which is calculated to have led to an additional 28,000 maternal and 168,000 infant deaths within the pandemic’s first year.

GOVERNMENTAL SHORTCOMINGS

The ignorance of governments in terms of the importance of upholding SRHR is proving fatal. Unfortunately, we have seen this all before. Although they did not occur on a global scale, the Ebola outbreaks which occurred between 2013 and 2016 should have been an opportunity for governments to learn that public health emergencies indirectly contribute to worsened SRH outcomes, and can result in a rise in fatalities that are potentially as significant as the number of deaths from the disease itself.

Whilst both COVID-19 and Ebola required urgent responses that are proportional to their impact, more support and political backing is needed to ensure that SRH services are kept resilient and sustainable during such emergencies. As an issue that has been stereotyped as the primary concern of women, the political world (which remains dominated by men) continues to lack the willpower to focus on them.

The impacts of overlooking the ongoing preservation of SRHR during the pandemic are catastrophic, and their long-term implications will be felt for years to come. Ignoring SRHR has infringed the rights of millions of individuals, primarily vulnerable women, around the world. Whilst the onset of the pandemic rattled the whole world, we have now adapted to the new normal; structures aimed at preventing or minimising the disturbances caused by the pandemic should hopefully have been set up by now. More should have been done - and still needs to be done - to ensure that SRHR are upheld and considered in emergency plans without further exacerbating existing inequalities.

Elizabeth is a recent Master in International Health graduate with a background in paediatric nursing in the UK and the Philippines, alongside which she completed a Diploma in Tropical Nursing.

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