The United Nations (UN) data estimates that 168 million people worldwide will need assistance in 2020 to deal with humanitarian crises, including natural disasters, extreme climate events, conflicts and infectious disease outbreaks. 25% of these will be women and girls of reproductive age. And they are the ones who are disproportionately affected during any humanitarian disaster - from being more likely to die from pregnancy and childbirth related complications, to facing increased risks of unintended pregnancies, unsafe abortions, sexually transmitted infections, as well as sexual and gender-based violence.
"60% of the preventable maternal deaths and 53% under five deaths take place in conflict and natural disaster settings, as life-saving family planning interventions are too often deprioritised in a crisis situation," said Aditi Ghosh, Deputy Director of Humanitarian Programme, at International Planned Parenthood Federation (IPPF), who was a keynote speaker at the 7th #APCRSHR10 Dialogues, co-hosted by the 10th Asia Pacific Conference on Reproductive and Sexual Health and Rights (APCRSHR10) and CNS.
Health services for women remain crucial even in a crisis
Aditi cites the real life example of Amelia, who was 7 months pregnant when an earthquake hit Indonesia's Sulawesi island in 2018. Amelia had to literally run for her life (during that advanced stage of pregnancy) to safer grounds where she gave early birth. This life threatening experience shattered her. She was desperate to get some contraceptive to prevent another pregnancy. This was a daunting task as all the family planning clinics had either been damaged or were closed, and she was living in a displacement camp high up on a hill. But luck was on her side. She was able to receive an injectable contraceptive from Indonesian Planned Parenthood Association (IPPA), which had launched a humanitarian response through mobile health clinics and had started providing family planning services, operating from tents located near the displacement camps. Over the course of this response, IPPA provided more than 15,000 contraceptives and reached out to more than 20,000 people. This is just one example of why sexual and reproductive health services are so important in a crisis situation.
And yet, too often these services are overlooked and underfunded in emergency situations. In any humanitarian crisis - food, water, and shelter take top priority, with very little focus on women's reproductive health needs. We seem to forget that 4% of any disaster affected population will be pregnant and 15% of them will experience pregnancy related complications. So women's sexual and reproductive health needs do not suddenly stop or diminish during an emergency - in fact they become greater! Family planning is one of the most lifesaving, and cost effective interventions for women and girls. However there remains an overwhelming gap in an emergency response due to lack of prioritization and funding. Consequently many women and girls are forced to contend with unmet needs for family planning, unplanned pregnancies, in addition to the trauma of conflicts, disaster and displacement, rues Aditi.
Double whammy of COVID-19 in disaster settings
As it is, Asia Pacific is a very disaster-prone region and faces a daunting spectrum of natural hazards. Lack of access to healthcare and social welfare services further exacerbate the situation. Infectious diseases, like coronavirus disease (COVID-19), are harder to control during humanitarian crises, especially in congested camp settings. With all human and financial resources directed towards managing COVID-19, it has been a double whammy for the women. Essential reproductive health services needed by them have got deprioritized. Due to the lockdown, many family planning clinics and outreach services have closed down, seriously affecting access to regular contraception and other sexual and reproductive health services.
A recent research paper by Guttmacher Institute paints a very grim picture. It estimates that even a modest decline of 10% in reproductive healthcare (use of short and long acting reversible contraceptives) due to COVID-19 would have disastrous implications for the lives of women and their new borns. It would result in an additional 49 million women with an unmet need for modern contraceptives, an additional 15 million more unintended pregnancies, 168,000 more new born deaths, 28,000 more maternal deaths and 3 million more unsafe abortions over the course of one year.
According to Aditi, "Disasters exacerbate pre-existing gender-based discrimination and inequalities and block access for women and girls to basic services and rights, livelihood, and decision making in cases of gender based violence. COVID-19 has escalated these existing inequalities for women and girls living in disaster settings, along with discrimination of the already marginalized populations, displaced persons, refugees and migrants. With a near closure of informal workplaces, families are resorting to negative coping strategies to bring in money. This can (and has) lead to sexual exploitation of women who are forced into sex work in order to provide for the families. This is particularly prevalent in refugee settings where there is little opportunity to find paid work. Moreover, women and girls in abusive relationships are now confined in their homes with their abusers and more exposed to gender-based violence, with little or no recourse to seek support."
Zahra Fathi, Executive Director of Family Health Association Iran said that "unfortunately, the wide outbreak of COVID-19 in Iran has affected our performance. All the educational and training workshop, as well as seminars have been cancelled and the number of people who want to seek sexual and reproductive health services from our centres has sharply decreased. Two of our centres are closed and four of them are providing services to the people through the outreach team. Currently, we mostly provide services which are related to prevention of coronavirus. One of our centres, in collaboration with the Ministry of Health, provides online screening of COVID-19 through hotlines and a website."
The additional complexities arising out of any new disaster in the current times is like adding the proverbial last straw. The recent category-5 cyclone Harold that hit the Pacific islands of Vanuatu and Tonga in early April 2020 during the lockdown period, brought in a spate of newer problems. It damaged houses and buildings and destroyed crops, impacting the shelter, food security, nutrition, and health of the people. In such cases, disaster response mechanisms have to be refocused to respond quickly.
Aditi makes a case for the IPPF humanitarian model, that works in coordination and partnership with several humanitarian agencies, across the entire disaster management cycle - from prevention and preparedness to response and recovery. It connects humanitarian action with long term equitable, sustainable development goals, aiming to bridge the divide between humanitarian response and development. Its 'Minimum Initial Service Package for reproductive health' is a set of life-saving activities to be implemented at the onset of every humanitarian crisis and can mean the difference between life and death for people affected by disasters.
Governments will have to ensure that lifesaving sexual and reproductive health services are an integral part of national and provincial disaster management plans and that women, girls, young people and other vulnerable people have access to them in humanitarian crises or public health emergency situations. Aditi hopes that this pandemic will prompt governments to increase investments in healthcare and make it inclusive and accessible for all through innovative approaches, included digital health, self-care and community based services.
Anisur Rahman Khan, a returnee Bangladeshi migrant, and Director (Migration), Awaj Foundation, shared that the government in Bangladesh has allocated incentives for different sectors due to the impact of COVID-19 but not for migrants. Despite migrants and foreign remittances contribute significantly to the economy, people are being left out during this crisis.
Shadow pandemic of domestic violence during COVID-19
Sanna Johnson, Regional Vice President for Asia at International Rescue Committee (IRC), said the Asia Pacific region is struck by conflicts and emergencies constantly. IRC initiated since mid-January 2020 efforts to ensure all its staff of over 6000 in Asia and the Pacific is acutely aware of and practising all evidence-based COVID-19 prevention standards, including personal protective equipments for those who need it. Then we had to adjust IRC health programmes spanning from those which are providing safe abortion to other sexual and reproductive health services, or those doing outreach or helping with referral collaboration with partners, so that not only the staff but all those who are seeking care from these centres are protected from COVID-19. "We have a shadow pandemic as we see acutely increased numbers of domestic violence" said Sanna Johnson, highlighting women and girls are more at risk of sexual and gender based violence during humanitarian crises.
Older people are at greater risk of discrimination
Deepak Malik, Regional Programme Manager, Disaster Risk Reduction and Humanitarian Response, HelpAge International, underlined that the COVID-19 pandemic is causing greater suffering for older people globally. Beyond its immediate health impact, the pandemic is putting older people at greater risk of poverty, discrimination and isolation. But older people were facing severe brunt of emergency situations before COVID-19 too. "In the last two years alone, HelpAge has responded to 23 emergencies in the Asia Pacific, including in Myanmar, Indonesia, the Philippines, India, Pakistan, Bangladesh, Nepal and Sri Lanka. It is now known that older persons (especially those aged over 80) face a much higher risk of severe outcomes of COVID-19 (including death) than the general population, as do those with underlying health conditions. An early study from China's National Health Commission suggested that about 80% of people who died from the virus in China were over the age of 60, and 75% had pre-existing conditions. In many countries, more than half of older people are affected by multi-morbidity, and the prevalence of multi-morbidity rises sharply with age and with backgrounds of poverty. This puts them at great risk in the current crisis." It is therefore critically important for national and local governments and humanitarian agencies to provide adequate and timely care for older persons, without increasing their risks of contracting the coronavirus.
And last, but not the least, the COVID-19 response must be gender responsive and inclusive, recognizing the needs and rights of women and girls and vulnerable populations, including the elderly, people with disabilities, refugees and migrants.
(Shobha Shukla is the Managing Editor of CNS (Citizen News Service) and coordinator of APCAT Media (Asia Pacific regional media network to end TB & tobacco and prevent NCDs). Follow her on Twitter @shobha1shukla or visit www.citizen-news.org)