Every year, nearly 700 million women access modern contraceptive methods, over 90 million give birth in a health facility, and tens of millions access safe abortion services in low- and middle-income countries (LMICs) all around the world. However, in the midst of this pandemic, bad policies and structural barriers may contribute to many people losing access to these essential services.
A Grim Picture
In order to get a clearer sense of the potential effects of the COVID-19 pandemic, a Guttmacher research team used data on sexual and reproductive health service provision from 132 LMICs, covering 1.6 billion women of reproductive age (aged 15–49), to estimate the impact of pandemic-related challenges on the provision of core services and subsequent health outcomes. These challenges include supplies, equipment and staff being diverted to other types of care; supply chain disruptions; women avoiding preventive care or choosing to deliver outside of facilities; and clinic closures.
The team estimated how sexual and reproductive health outcomes could change following only a modest decline of 10% in access to care. The implications are staggering in terms of needs left unserved, unintended pregnancies, unsafe abortions, and maternal and newborn deaths.
- A 10% proportional decline in short- and long-term reversible contraceptive use would result in an additional 49 million women with an unmet need for modern contraception in LMICs and an additional 15 million unintended pregnancies. In turn, this would lead to more unsafe abortions and other negative outcomes.
- A 10% decline in the provision of pregnancy-related and newborn health care would have disastrous implications for the lives of women and their newborns: An additional 1.7 million women who give birth and an additional 2.6 million newborns would experience major complications and not receive the care they need. This would result in an additional 28,000 maternal deaths and 168,000 newborn deaths.
- Additionally, if country-wide lockdowns force abortion clinics to close or countries treat abortion as non-essential, that would lead to a reduction in safe abortion procedures. Under the assumption that 10% of safe abortions become unsafe, we would see an additional three million unsafe abortions and an additional 1,000 maternal deaths due to unsafe abortions.
These estimates are shocking, but the reality could be much worse if more than 10% of services are compromised or disrupted. Moreover, the scale of the impact could be many times greater in specific countries or regions, as the virus and the lack of effective response has and will hit harder in certain areas.
Disproportionately Devastating Fallout
When assessing the potential fallout laid out in these scenarios, we must pay special consideration to people who already faced structural and systemic barriers to care before the pandemic, because these inequities are exacerbated under the weight of a global crisis. It is well documented that denial or lack of access to sexual and reproductive health services, including safe abortion, is especially devastating for marginalized populations who are already dealing with legal, economic, social, cultural and logistical barriers to care.
Policies and relief efforts must address the specific needs of marginalized people and populations, including migrants, people living with HIV/AIDS, people in humanitarian settings, people with disabilities, people experiencing intimate partner violence, LGBTQ+ individuals, incarcerated people, people with low incomes, adolescents, racial, religious and ethnic minorities, and others.
The Moment to Act
Policymakers in LMICs and their partners can avert or mitigate this catastrophe if they take swift, decisive action. Here are some steps they should take:
- First, they must define and promote sexual and reproductive health care—including safe abortion, contraception, and maternal and newborn care—as essential. This would allow people to travel for sexual and reproductive health services even in areas under stay-at-home orders or with travel restrictions without fear of legal consequences.
- Second, alongside private-sector actors, they must shore up and strengthen the national and regional supply chains to make sexual and reproductive health medicines and supplies more accessible to both providers and patients.
- Third, they must make contraception available without a prescription, decentralize distribution, and facilitate multi-month dispensing of sexual and reproductive health pharmaceuticals.
- Fourth, they must adopt innovative models of care, including telehealth, and prevent diversion of resources and staff away from sexual and reproductive health care.
- And finally, they must address the unique needs of vulnerable and marginalized populations, as they are contending with barriers exacerbated by the pandemic.
These actions would not only mitigate the impact of COVID-19 in the short-term but also provide benefits over the longer term, as innovations are adopted and institutionalized.
As the largest donor for sexual and reproductive health programs globally, the United States has a significant role to play in preventing this looming disaster.
- To enable health facilities to provide all necessary services, Congress should pass the Global Health, Empowerment and Rights Act to reverse the global gag rule, as it inhibits partners overseas from offering people comprehensive sexual and reproductive health services, including during this crisis.
- Congress should increase funding to global programs and support policies that alleviate pressure on health systems, expand access to sexual and reproductive health globally, and promote gender equality.
Outbreaks are inevitable, but catastrophic losses for sexual and reproductive health are not. By learning from prior epidemics, putting in place critical resources and systems, and promoting sexual and reproductive health and rights, we can prevent health system disruptions that would have devastating, lasting impacts on individuals, families and the global community.