Joint Asian Population and Development Association (APDA) and the United Nations Population Fund (UNFPA) research documented the impact of the COVID-20 pandemic on women and girls. The research also found promising practices emerged during the pandemic. Credit: UNFPA

By IPS Correspondent
Tokyo, Mar 31 2022 (IPS)

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.

Maternal Health

“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.

Gender-Based Violence

“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.”

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Youth activists Peace Umanah, from Nigeria and Aurelia Naa Adjeley Sowah-Mensah from Ghana ensure that young people are made aware of their Sexual and Reproductive Health Rights. Credit: ICFP

By Joyce Chimbi
Nairobi, Kenya, Mar 16 2022 (IPS)

Travelling in northern Nigeria, Peace Umanah noticed teenage girls with multiple children – they would be walking with one strapped to their back, holding another by hand and with a protruding belly.

“These were worrisome sights that got me thinking about whether these young girls knew about contraceptive choices or if they were not given information to make beneficial decisions.”

The same question weighed heavily on young Aurelia Naa Adjeley Sowah-Mensah from Ghana, who grew up in a community where teenage pregnancies are common – mirroring the situation in many developing countries.

These questions set the young women on a trailblazing path to change the trajectory of adolescent and teenage pregnancies in their countries.

The pair have joined forces with other young people, world leaders and actors in Sexual and Reproductive Health and Rights (SRHR) to give young people in every corner of the world much-needed tools to navigate their sexuality. They hope to remove SRHR-related challenges to enable young women to benefit from socio-economic growth and development opportunities.

“Through the International Conference on Family Planning (ICFP) Youth Trailblazer Award, young leaders in the field of family planning and SRHR aged 18-35 years old were invited to submit creative short videos that integrate this year’s conference theme,” says Jose G Rimon II, director of the Bill and Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health.

Jose G Rimon II, director of the Bill and Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health. Credit: ICFP

Rimon II, who is also the chair of ICFP’s International Steering Committee, tells IPS the videos “also highlighted youth perspectives, experiences, and voices in family planning and SRHR”.

The videos reflected the conference’s theme: ‘Universal Health Coverage and Family Planning: Innovate, Collaborate, Accelerate’.

Sowah-Mensah and Umanah were among 50 youth leaders working in family planning and SRHR awarded scholarships to attend ICFP this year in Pattaya City, Thailand, on November 14-17, 2022.

Other award winners include Tanaka Chirombo from Malawi, Alison Hoover from Atlanta, USA, and Muhammad Sarim (Saro) Imram from Pakistan.

Awardees are from countries in Africa, Asia, Europe, North and South America, selected from a pool of more than 300 youth worldwide who applied for the Youth Trailblazer Award. The award recognises youth leadership and innovation in family planning and SRHR.

“Selected youth demonstrated strong ideas and commitment, creative thinking that pushed the field forward and challenged norms, and successfully conveyed a clear and powerful message,” says Rimon II.

Youth Trailblazer Award winners will be integrated throughout the ICFP, the world’s largest scientific conference on family planning and reproductive health, to amplify and highlight the voices of young leaders globally, he adds.

“Awardees will actively participate in planning activities for the ICFP, including integral participation on the ICFP subcommittee(s) of their choice, engagement as speakers and moderators at sessions, as well as other conference engagement opportunities that will magnify the voices, perspectives, and experiences of the youth.”

Youth participation will bring to life ICFP’s stance that countries’ universal health coverage packages should include youth-friendly family planning and SRH products and services.

“As of 2021, the modern contraceptive prevalence rate shows only 17 percent of all women of reproductive age in Nigeria use contraceptives,” Umanah says.

In the absence of youth-friendly services, myths and misconceptions influence young people’s understanding of contraceptives. She says they sometimes use lime, soda, antibiotics, and salt to prevent unplanned pregnancies.

Adolescent and teenage pregnancies are the most pressing issues. Consequences include life-threatening health complications and the risk of missing out on lifelong learning and earning opportunities.

According to government statistics, one in every five girls in Kenya between the ages of 15 to 19 is either pregnant or already a mother. Complications during pregnancy and childbirth are a leading cause of death for 15- to 19-year-old girls in this East African nation.

As a youth champion engaging adolescents and young people, Umanah says the cohort needs safe spaces free of stigma and judgment, where they can find answers and solutions to their SRHR needs.

“For young women and girls, being able to speak up and be heard is critical. Social media tools, such as 9ja Girls Now, gives girls a platform to get connected across distances,” Umanah observes.

“9ja Girls is a Facebook platform and a safe space where girls learn and ask questions about love, life and health and find answers.”

Sowah-Mensah is an SRHR mentor of adolescent girls and young women under the Girl Boss initiative with the Youth Action Movement (YAM) of the Planned Parenthood Association of Ghana.

Without support, Sowah-Mensah says, “some girls exchange sex for food or money, ending up in unplanned pregnancies. To avoid stigma, they turn to unsafe ways (to terminate the pregnancy), such as grinding and consuming glass bottles or drinking a mixture of sugar and alcohol. Some lose their lives.”

A dedicated ICFP Youth Pre-conference will take place November 11-13 to support youth leaders and their programmatic work, advocacy, and research.

Rimon II says youth involvement is the “best way to ensure diverse voices are heard and strategies are developed that are sustainable, inclusive, culturally competent and representative of sexual and reproductive health and rights at the global level.”

SRHR youth experts such as Sowah-Mensah and Umanah agree.

Sowah-Mensah says young people are the demographic majority and a powerful instrument for development because they have many innovative ideas.

“But a large percentage of our leaders are not young and are thus unable to address young people’s most pressing needs for SRHR services. You have one generation making bodily autonomy decisions on behalf of a totally different generation,” she says.

The awardees assert that the status quo must change to achieve a desirable outcome. Umanah says, “In designing solutions to challenges that face adolescent girls and young women, their concerns and voices should be the loudest. They should lead conversations towards desired solutions.”

ICFP is supported by the Bill and Melinda Gates Institute for Population and Reproductive Health at Johns Hopkins University and more than two dozen other public, private, and non-profit sponsors, including the World Health Organization and United Nations Population Fund.

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Millions of women in Pakistan do not have access to family planning services. Credit: Zofeen Ebrahim/IPS

By Thalif Deen
UNITED NATIONS, Sep 19 2014 (IPS)

The U.N.’s post-2015 development agenda has been described as the most far-reaching and comprehensive development-related endeavour ever undertaken by the world body.

But where does population, family planning and sexual and reproductive health rights (SRHR) fit into the proposed 17 Sustainable Development Goals (SDGs), which are an integral part of that development agenda?"We must continue to fight until every individual, everywhere on this planet, is given the opportunity to live a healthy and sexual reproductive life." -- Purnima Mane, head of Pathfinder International

Of the 17, Goal 3 is aimed at “ensuring healthy lives and promoting well-being for all at all ages,” while Goal 5 calls for gender equality and the “empowerment of all women and girls.”

But when the General Assembly adopts the final list of SDGs in September 2015, how many of the proposed goals will survive and how many will fall by the wayside?

Meanwhile, SRHR will also be a key item on the agenda of a special session of the General Assembly next week commemorating the 20-year-old Programme of Action (PoA) adopted at the landmark International Conference on Population and Development (ICPD) in Cairo in 1994.

In an interview with IPS, Dr. Babatunde Osotimehin, executive director of the U.N. Population Fund (UNFPA) said, “Twenty years ago, we were able to secure commitments from governments on various aspects of poverty reduction, but more importantly the empowerment of women and girs and young people, including their reproductive rights.

“But the battle is not over,” he said.

“Today, we are on the cusp of a new development agenda, and we, as custodians of this agenda, need to locate it within the conversation of sustainable development – a people-centred agenda based on human rights is the only feasible way of achieving sustainable development,” he declared.

Purnima Mane, president and chief executive officer of Pathfinder International, told IPS, “We are delighted the final set of [proposed] SDGs contains four critical targets on SRHR: three under the health goal and one under the gender goal.”

The inclusion of a commitment to universal access to sexual and reproductive health care services, including family planning, information and education, and the integration of reproductive health into national strategies and programmes, is necessary and long overdue, she said.

“But we have not reached the finish line yet,” cautioned Mane, who oversees an annual budget of over 100 million dollars for sexual and reproductive health programmes in more than 20 developing countries.

The SDGs still need to be adopted by the General Assembly, “and we must all continue to raise our voices to ensure these SRHR targets are intact when the final version is approved,” she added.

Mane said civil society is disappointed these targets are not as ambitious or rights-based as they should be.

“And translating the written commitment into actionable steps remains a major challenge and is frequently met with resistance. We must retain our focus on these issues,” she said.

Sivananthi Thanenthiran, executive director of the Malaysia-based Asian-Pacific Resource & Research Centre for Women (ARROW) working across 17 countries in the region, told IPS it is ideal to have SRHR captured both under the gender goal as well as the health goal.

The advantages of being part of the gender goal is that the rights aspects can be more strategically addressed – because this is the area where universal commitment has been lagging – the issues of early marriage, gender-based violence, harmful practices – all of which have an impact on the sexual and reproductive health of women, she pointed out.

“The advantages of being part of the health goal is that interventions to reduce maternal mortality, increase access to contraception, reduce sexually transmitted diseases, including HIV/AIDS, are part and parcel of sound national health policies,” Thanenthiran said.

It would be useful for governments to learn from the Millennium Development Goals (MDGs) process and ensure that the new goals are not implemented in silos, she added. “Public health concerns should be addressed with a clear gender and rights framework.”

Maria Jose Alcala, director of the secretariat of the High-Level Task Force for ICPD, told IPS what so many governments and stakeholders around the world called for throughout the negotiations was simply to affirm all human rights for all individuals – and that includes SRHR.

The international community has an historic opportunity– and obligation — to move the global agenda forward, and go beyond just reaffirming agreements of 20 years ago as if the world hasn’t changed,and as if knowledge and society hasn’t evolved, she noted.

“We know, based on ample research and evidence, based on the experiences of countries around the world, as well as just plain common sense, that we will never achieve poverty eradication, equality, social justice, and sustainable development if these fundamental human rights and freedoms are sidelined or traded-off in U.N. negotiations,” Jose Alcala said.

Sexual and reproductive health and rights are a must and prerequisite for the post-2015 agenda “if we are to really leave nobody behind this time around,” she declared.

Mane told IPS, “As the head of Pathfinder, I will actively, passionately, and strongly advocate for SRHR and family planning to be recognised and aggressively pursued in the post-2015 development agenda.”

She said access to SRHR is a fundamental human right. “We must continue to fight until every individual, everywhere on this planet, is given the opportunity to live a healthy and sexual reproductive life. ”

Asked about the successes and failures of ICPD, Thanenthiran told IPS there is a need to recognise the progress so far: maternal mortality ratios and infant mortality rates have decreased, access to contraception has improved and life expectancy increased.

However, much remains to be accomplished, she added. “It is apparent from all recent reports and data that SRHR issues worldwide are issues of socio-economic inequality.”

In every country in the world, she noted, women who are poorer, less educated, or belong to marginalised groups (indigenous, disabled, ethnic minorities) suffer from undesirable sexual and reproductive health outcomes.

Compared to their better educated and wealthier sister citizens, these women and girls are more likely to have less access to contraception, have pregnancies at younger ages, have more frequent pregnancies, have more unintended pregnancies, be less able to protect themselves from HIV and other sexual transmitted diseases, suffer from poor maternal health, die in childbirth and suffer from fistula and uterine prolapse.

Hence the sexual and reproductive health and rights agenda is also the equality agenda of this century, she added.

“Governments must commit to reducing these inequalities and carry these learnings from ICPD at 20 into the post-2015 development agenda,” Thanenthiran said.

Edited by Kitty Stapp

The writer can be contacted at thalifdeen@aol.com