New essential norms must include reproductive health services. By Anjali Roy, Ankit Kumar, Anurag Ratan, KS Lakshmi Naraayan, Kaustubh Jain, Sartaj Singh

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The bottom line of today's world, which applies to every person on this planet - irrespective of their social, economical or geographical positions - can be simply jotted down in a few words: "COVID-19 pandemic has significantly changed our lives" as said by Dr Jameel Zamir, Director of Programmes at International Planned Parenthood Federation (IPPF), East and Southeast Asia and Oceania region.

Dr Jameel Zamir was among the panelists for World Health Day Webinar which also launched the Sustainable Development e-Talks (#SDGtalks), co-hosted by Indian Institute of Management (IIM) Indore and CNS.

Menstruation does not stop during pandemics

During emergency or other crisis situations, safe pregnancy care, safe abortion or menstrual hygiene becomes even more vital, so we have to ensure that women's health and wellness does not slip down the priority in responding to the crisis. Products related to menstrual hygiene, such as, sanitary napkins, tampons, etc are very important for ensuring women's menstrual hygiene. Hence, they ought to be considered as essential commodities. In many societies, openly talking about menstrual hygiene is still considered a taboo and many a young girls and women in countries like India still use unhygienic products (rags, paper, etc) during menstruation. Many organisations like Sustainable Health Enterprise (SHE), Goonj, Code Red, among others, are working towards providing women with proper affordable and accessible sanitary napkins. During the lockdown to contain COVID-19 pandemic in India, several local groups had to step up their efforts to address the need for sanitary napkins and contraceptives. One such group is Asha Parivar led by Ramon Magsaysay Awardee Dr Sandeep Pandey.

While the world eagerly and desparately waits for scientific breakthroughs to prevent and cure COVID-19, we also need to review the reasons for not being able to fully translate earlier scientific breakthroughs into public health gains without delay. For example, even routine immunization is not reaching every child in the country. That is why it becomes even more critical to address these barriers which prevent communities across the nation to access quality healthcare in a rights-based manner.

 When it comes to sexual and reproductive health, there are gender-specific barriers that aggravate the disparaties in access to options to prevent unintended pregnancies, sexually transmitted infections and HIV. In National Family Health Survey (NFHS-IV), the unmet need for family planning was 12.9% and contraceptive prevalence rate was 47.8%. Teenage marriages were 26.8% and teenage pregnancies were 7.9%. Despite male sterilization being a non-surgical reversible procedure, only 48,000 male sterilizations were done during 2018-2019 as compared to over 33 lakhs female sterilizations. Abysmally low utilization of male condoms and very poor programmatic uptake of female condoms is yet another reminder of deep-rooted gender-disparities and stereotypes.

In these unprecedented times of COVID-19 pandemic, it becomes far more important to outline what actually are essential services for us as human beings. As said by Dr Jameel to Citizen News Service (CNS), some services which are essential in our day-to-day lives are being neglected because of excess demand and shortage of supply- such as availability of contraceptives and other essential reproductive health services have taken a backseat. Indeed it is important and rather quintessential to put the sexual and reproductive health services under the essential services' list, though these are swept away under the carpet many times as a non-essential service.

The lockdown has proven to provide some sort of relief to stopping humongous spread of COVID-19 but it is a double-edged sword, especially when one sees that healthcare for non-COVID-19 related illnesses or conditions is severely impacted. Children and women's health is also an essential part of health security.

"With the continuance of lockdown, the importance of midwives, nurses, and doctors who assist the birth of children is also highlighted. In a dire situation like this, infants and mothers can be at risk if not treated properly", said Dr Zamir.

The International Planned parenthood federation(IPPF) has constituted a task force for COVID-19, especially for 121 countries where sexual and reproductive health (SRH) services have been severely affected. This task force is working to strengthen community education and awareness about COVID-19, ensure continuity of essential SRH services, secure essential supplies of SRH related products and ensuring safety of suppliers and agents who provide these services. In order to analyze the results, they did a survey in 121 countries. In 25 countries, across the East and Southeast Asia and the Pacific, shortage of SRH services was reported.

Dr Zamir shared that IPPF, which is a federation of national family planning associations, has several member associations (like those in Philippines, Australia, New Zealand, China) which are finding solutions to advance rights-based access to sexual and reproductive healthcare in the pandemic situation. Such innovations include tele-medicines and even home delivery of sexual and reproductive healthcare services/ products in Malaysia (such as contraceptives).

The World Health Organization (WHO) has released multiple guidelines for the people to be aware of the problems they could face during the time of the pandemic and how to combat them. One of the most important aspects of these guidelines is the act of self-care. Along with regular measures such as social distancing and respiratory hygiene, people are also advised to maintain proper sexual and reproductive health without the help of any external support- such as a health worker- in a pandemic related lockdown situation. These guideline address multiple issues such as family planning, pregnancy, childbirth, newborn care, safe abortion etc.

The WHO also highlights the importance of proper care and nutrition of pregnant women and new mothers, along with proper hygiene and precautions while breastfeeding. It also suggests the use of contraceptives to reduce unintended pregnancy, and other lifesaving measures to avert maternal mortality.

The COVID-19 related lockdown has also precipitated a deeply entrenched human rights violation in the form of sexual and other forms of gender-based violence. In the initial few weeks of the lockdown itself, the government of India's National Commission of Women (NCW) reported, "From February 27 to March 22, a total of 396 offences (including all types of abuses) related to women were reported to the NCW, while from March 23 to April 16, as many as 587 such complaints were received."

Dr Zamir rightly points out that those suffering due to sexual and gender-based violence struggle to report it. Reporting it during the lockdown becomes even more difficult. In such days of lockdown, which is implicitly a home quarantine, it becomes rather more difficult for women who face domestic violence to come out.

Healthcare for non-COVID-19 related problems has slipped down the priority. Routine immunization came to a halt and services for non-communicable diseases (NCDs) became more difficult to access. People living with HIV or those on anti-TB medicines were struggling to ensure uninterrrupted treatment during the lockdown.Dr Zamir shared that "One of the biggest impacts of COVID-19 is that it has profoundly impacted on the accessory family planning information, services and sexual and reproductive health and rights."

The COVID-19 pandemic has proven to be a test for not only the basic structures of society but also of the complex social and health networks that need to bear the brunt more than any other industry which have direct implications on people, especially women. Sexual and reproductive health services are always at the centre of health responses and become even more critical during crisis situations.

Anjali Roy, Ankit Kumar, Anurag Ratan, KS Lakshmi Naraayan, Kaustubh Jain, Sartaj Singh

(authors are students of Indian Institute of Management (IIM) in Indore, India and part of the internship at CNS (Citizen News Service) currently)

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