Mid-April, I was privileged to join the Live webcast on discussions around the Effects of COVID-19 on Sexual Reproductive Health and Rights (SRHR) among young people in Africa. The panelists included experts in the medical, advocacy, and policy fields: Dr. Charlene Biwott (KEMRI, Kenya), Millicent Sethaile (Her Voice Ambassador, Botswana), and Levi Singh (Youth SRHR Strategy Officer, South Africa). The moderator was Evelyne Odhiambo (AfNHi Youth Cohort, Kenya). Important to note were conversations around the vulnerability of young people during this pandemic where the younger populations have so far been the least vulnerable to complications and death from COVID-19 and yet play a very key role in flattening the COVID-19 curve by minimizing transmissions to the vulnerable populations in our society that include the immune-compromised and the elderly.
Currently, there has been a great shift of focus in Africa to cater to the COVID-19 pandemic thereby impacting negatively in other areas including SRHR. Some of the effects on SRHR include:
- Reduced access to family planning services which in turn impairs the women’s ability to exercise choice and control over their fertility. This may lead to unplanned pregnancies, abortions, gender inequalities by reducing women’s opportunities in education, employment, and full participation in society.
- Increase in Gender-based Violence (GBV) where this pandemic puts the young people at risk especially girls and young women by cutting them off from the essential protection services and social networks. This could be in the form of rape, intimate partner violence (IPV), defilement, early and forced marriages.
- Economic stress leading to transactional sex and exploitation, social vulnerability may lead to increased incidences of HIV infections, STIs, and social stigma.
- Increased risks of mental health issues including and not limited to depression, suicidal rates, and psychosocial trauma.
- Global lock-downs and movement restrictions create barriers for young to access health services like youth-friendly clinics, comprehensive care clinics (CCC), and access to pre-exposure prophylaxis (PrEP).
- Social stigma may lead to difficulties in obtaining documentation for instance P3 forms to prove any incidences of social violations. The process of seeking justice has slowed down as well during this period.
- Higher rates of maternal and perinatal mortality due to the reduced access to friendly SRH services like safe abortion services, antenatal care, and skilled attendance during delivery.
There have been negative experiences by young people seeking SRHR in Botswana with their current lockdown as described by Ms. Sethaile where young people who had long term contraceptive methods are finding it difficult to access health care for the management of the side effects since movement is restricted and monitored, there is lack of access to essential medications like ARVs, 7 days into the lockdown there were over 28 reported rape cases and nowhere to report. Lastly, their law enforcement currently not taking up GBV cases as more efforts goes to COVID-19.
Interesting conversations also arose around the intersectionality of COVID-19 and SRHR and these included: First, countries to ensure access to SRHR services. Secondly, the need for political support in availability, accessibility, and security of SRHR commodities. Thirdly, we have existing policies and commitments like the MAPUTO plan of action which guides the African Union States on SRHR policy framework that ensures universal access to comprehensive sexual reproductive health services, Also, there is the recent United Nations summit on International Conference on Population and Development (ICPD 25). These policies and commitments foster the need to hold the member states accountable on matters SRHR. Lastly, it is important to engage the youth so as to understand and have their voices presented so as to effectively meet their needs.
From the above conversations, the COVID-19 pandemic has laid bare the readiness and preparedness of a global epidemic, different systemic and structural gaps exist which include but not limited to lack of or inadequate shelters that can accommodate women who are abused, inadequate human and capital resources on SRHR and mental health all of which will have a massive impact on the rights and access to health care. Countries need to ensure that there is proper balancing of resources and priorities so that not all human and capital resources are geared towards COVID-19 effort at the expense of other health service provisions.