– Women and girls in the Asia-Pacific region were adversely impacted due to COVID-19 pandemic responses – with marginalized women and girls’ access to sexual and reproductive health rights (SRHR) and gender-based violence (GBV) services profoundly affected.
These were the findings of a study by the Asian Population and Development Association (APDA) and the United Nations Population Fund (UNFPA). The research conducted from 2020 to 2021 reviewed SRHR and GBV laws, policies, and implementation practices during the pandemic response in six countries in the Asia-Pacific region, namely Bangladesh, Fiji, India, Indonesia, Nepal, and the Philippines.
On the upside, UNFPA and APDA research also identified promising practices that emerged during the pandemic. The report makes extensive recommendations to governments to mitigate the impact of emergencies like the pandemic.
“The failure to classify appropriate sexual and reproductive health rights and gender-based violence services as essential, in line with international human rights law, compounded challenges to accessing such services during the pandemic,” the report states. The Asia-Pacific region’s findings mirrored the global trend which, according to the Special Rapporteur on the right to health, non-COVID-19 related healthcare services had been less available during the pandemic, including sexual and reproductive healthcare services.
“Reduced access to ante- and postnatal care and skilled birth attendance during the pandemic has led to increased maternal mortality,” the study found. For example, in July 2021, Nepal reported a considerable increase in maternal deaths, with 258 women dying due to pregnancy or childbirth between March 2020 and June 2021 – 22 of whom had COVID-19. In the year before March 2020, Nepal recorded 51 maternal deaths.
The barriers women met included not being able to access ante- and postnatal care and safe delivery health services. Women feared getting COVID-19 at hospitals or health centers. There was a lack of transport, and financial and human resources were diverted from SRHR services to manage the COVID-19 outbreak.
“Midwives and birth center workers reported an increase in the number of pregnant women considering delivery options outside hospital settings owing to a fear of infection, overcrowding, supply shortages, and visitor restriction,” according to the findings. This resulted in unsafe and unskilled birthing practices, which could lead to maternal and infant deaths.
This trend was especially problematic for women and girls in disadvantaged and hard-to-reach areas.
There were several promising practices.
Bangladesh developed guidelines for essential maternal health services and provided virtual training for healthcare professionals. It also implemented midwifery mentoring to establish and monitor safe maternity services for women.
There was public interest litigation to establish access to maternal health rights for pregnant women in India and Nepal.
Indonesia improved and expanded midwifery care.
The Philippines implemented cash voucher assistance and established obstetric triage tents for pregnant women.
The report suggests that governments regard antenatal care, skilled birth attendance, and postnatal care as essential services.
Sexual and Reproductive Health Services
The report recommends that workers in the SRH and maternal, newborn, child, and adolescent care shouldn’t be re-deployed to other areas. Surveillance systems should alert health ministries of increases in deaths so emergency preventive measures can be put in place and information systems updated to capture declining or missed antenatal and postnatal care appointments. These efforts would prevent maternal and neonatal mortality and morbidity.
The research found an “unmet need for family planning and contraception because health facilities are closing or limiting services, and women are refraining from visiting health facilities due to fear of COVID-19 exposure or because of travel restrictions.”
Vital supplies for SRH, including modern contraceptives, were less readily available given the closure of production sites and global and local supply chains disruption.
In Fiji, India, Indonesia, Nepal, and the Philippines, advocacy prompted governments to develop guidelines on contraceptive availability and continuity of family planning services during the pandemic.
The Philippines also set up virtual family planning and delivered contraceptives.
Nepal created community-based family planning services in remote quarantine centers.
Indonesia developed a model policy to include women and girls with disabilities in the COVID-19 response, and Bangladesh set up mobile phone messaging known as m-health for family planning.
Apart from declaring family planning an essential service, the researchers recommended that governments move services from clinical settings to communities, such as community-based family planning services.
HIV and STI prevention
HIV and other STI prevention also suffered setbacks during the pandemic. Testing and treatment stalled due to travel and transport restrictions, the prohibitive cost of courier services for delivering antiretroviral drugs, and inadequate stock due to global supply chain disruptions.
“Restrictions in place to limit the spread of COVID-19 not only increase the risks of gender-based violence but also limit the ability of survivors to distance themselves from their abusers and access GBV response services,” the research found.
There were a range of problems, including accessing help if women were locked down with their abusers, while support services struggled to meet demand.
“Judicial, police, and health services, which are the first responders for women, are overwhelmed, have shifted their priorities, or are otherwise unable to help. Civil society groups are affected by lockdowns and the reallocation of resources. Some domestic violence shelters are full; others have had to close or have been repurposed as health centers,” the research found.
Despite the dire consequences of lockdown on gender-based violence, numerous examples of innovative solutions included revising GBV referral pathways.
Fiji created one-stop service centers, and the Philippines made the clinical management of rape an essential service.
Bangladesh created one-stop service centers in their hospitals and multiple free 24-hour psychosocial counseling hotlines.
In Jammu and Kashmir, India, empty hotels and education institutions were designated safe spaces for violence survivors.
The researchers recommend that information on operational multisectoral gender-based violence response services and referral mechanisms is available and adapted to the COVID-19 context.
They also recommend that the clinical management of rape is classified as an essential service.
Trained counselors should also operate multiple free 24-hour psychosocial counseling hotlines.
Finally, the report noted that it was necessary to “ensure that no one is left behind, for example, people with disabilities; indigenous people; ethnic minorities; lesbian, gay, bisexual, transgender, queer and intersex people; internally displaced people and refugees; people in humanitarian settings; and people facing multiple intersecting forms of discrimination, by ensuring that vulnerable groups have the information they need to respond to GBV and have access to essential life-saving services.”