Lack of access to SRHR and health care during the pandemic. How the pandemic has impacted the SRHR and what are the immediate steps that should be taken to mitigate it?

How the pandemic has impacted SRHR

Conflicts and disasters endanger the lives and dignity of women disproportionately. Women are exposed to unique threats in such situations. In March, 2020, the world came to an unprecedented standstill to control the spread of the Covid-19 pandemic. While the lockdowns imposed might have contributed to controlling the spread of the virus, they resulted in a shadow pandemic that threatens to erode decades of developmental progress women have made. Regions across the world reported that Covid-19 had a disproportionate impact on womens’ emotional health, in their access to medical care and products, in loss of livelihoods and through the increased burden of unpaid work and care.

The conversations across various forums like collaboratives - such as the COVID Action Collab, social media interactions and insights by experts in the areas of gender, health, well-being, safety and criminology afforded us valuable and critical insight into understanding of the impact of Covid-19 on Sexual and Reproductive Health Rights.

Covid-19 and Gender Based Violence

The UNFPA predicts that the pandemic could reduce progress against gender-based violence by one-third. The National Commission for Women reported a spike in domestic violence cases reported during the lockdown. The uncertainties and anxieties that come with a pandemic have not only led to an increase in stressors but have also restricted the ways in which it is generally dealt with. There is a higher risk of abuse and gender-based violence. While these are prevalent across socioeconomic status, it is largely unmitigated in the lower economic strata, where the resources, services and the space are constrained.

Helpline services and community based organisations acted as a port of call for victims of abuse, however, victims of abuse were unable to access safe houses, leaving them trapped with their abusers. Safety, security and justice are essential social determinants for all health and wellbeing, but especially so for sexual and reproductive health. These determinants tend to get exacerbated when vulnerable groups face economic hardships through loss of livelihood. With Covid-19 and ensuing lockdown, the intersectionality of livelihoods and SRHR began to manifest. 131 countries across the world implemented cash transfer programs in the wake of Covid-19 with many of these being targeted at women. Financial inclusion must therefore be at the core of any intervention aiming to address SRHR needs of the community.

Covid-19 and access to menstrual management services

A survey by the Menstrual Health Alliance of India found that 62% of community organizations reported a disruption in the supply of menstrual health management products, specifically sanitary napkins. There were a number of factors that contributed to this fiasco that affected over 335 million women and girls across the country. The unplanned closure of schools and workplaces meant that most vulnerable women were cut off from their regular source of menstrual health management products. The strict conditions of the lockdown in some states restricted their access to pharmacies and stores and with the loss of employment, menstrual health management products simply were not a priority for households anymore. There’s been a gradual shift back to using cloth to manage one’s menstruation, however, without the correct maintenance and disposal mechanisms, these rags can be hazardous to women and the environment.

We learnt that this was an opportune moment to partner women in their adoption of safe and sustainable menstrual wellness solutions which proved to be economically viable to them as well. Micro Entrepreneurships began to see the light of day around cloth pads and menstrual cups which helped the most marginalized women not only address their period needs amidst reduced access to products but also find ways to earn and harbour goodwill through localized marketing.

Covid-19 and access to healthcare

The Ebola pandemic in Sierra Leone resulted in increased rates of maternal mortality and stillborns since fewer women accessed healthcare services. Studies estimate that disruptions in access to contraceptive services as a result of Covid-19 and the ensuing lockdowns, would lead to approximately 47 million women in low- and middle-income countries not being able to meet their contraceptive needs, and potentially 7 million unintended pregnancies in the coming months; or a 10% reduction in use of spacing methods, and 49 million women with unmet need, and 15 million unintended pregnancies.

Poor populations, faced with financial constraints, coupled with a burden of both acute illnesses and chronic diseases, social determinants and limited access to health care, end up seeking health care only when they are seriously unwell or faced with catastrophic illness. Womens’ health needs in fact are the least prioritized. Swasti’s communities too faced barriers in accessing sexual and reproductive health services. With tele-care, these concerns, along with mental well-being concerns or menstrual wellness concerns, or gender based violence - which are all critical social determinants for health and well-being - can be discreetly addressed.

Tele-care solutions that address numerous stressors through the provision of a dedicated helpline for access to medical support, social protection information, mental well-being services and a menstrual wellness support system have proven to be an answer.

Take-aways

Learning from challenges we saw over the course of this pandemic, it is essential that we create agile systems of response and resilience that talk to each other through an integration of tele-care and access to institutions.

Going hyper-local is definitely the answer - be it in building sustainable solutions for menstrual well-ness, entrepreneurship and financial inclusion of women that protect them from being at the mercy of their abusers and creating sustained access to SRHR services and action.

In July 2020, Reshmi (name changed) called Arogyadeepa Swasth Samiti, her neighbourhood community organization’s Tele-Care number with an SOS request. Reshmi’s husband had become increasingly violent and abusive and the lockdown meant she was unable to find an exit for safety. Tele-care enabled the Samiti’s nurse to immediately set in motion a cascading response, mobilising the Samiti’s field teams to step in and provide assistance. Once the team was able to secure her safety, the team connected her with a counsellor via the phone to be able to receive mental health support, while leveraging local partner networks to ensure legal support.

Tele-care as a standalone solution is a toothless tiger. It needs to be paired with the right network of implementing partners on ground, to really act as a catalyst to provide support to communities. It is also imperative to take a holistic approach to provision of care by ensuring integrations with other aspects of gender based violence such as mental health support and livelihoods.

The pandemic revealed gaping holes in our systems and it was the vulnerable who were most affected. It is essential that as we head down the path to recovery, we strengthen health systems by partnering with community systems.The relief-recovery and resilience building packages we built and delivered for our varied communities, from factories to women in sex work helped them strengthen community systems.

It is imperative to bring womens’ sexual and reproductive health rights at the front and center of conversations so that they don’t fall into the crevices of bureaucratic apathy. We at Swasti are doing so by using micro-enterprise as a tool to take SRHR to the community, first, tackling easier to deal with issues such as menstrual management products that are relevant and find buy-in as a pathway to build relationships and set the stage for more difficult conversations around family planning and gender based violence.

Radhika Chabria

Guest Author Sexual & Reproductive Health Lead, Swasti.