Delivery of CSE and SRHR during COVID 19

Words by Stephen Kangwa Chilobwa

As the world grapples with COVID-19 everyone is being affected by the pandemic, the Zambia Men’s Network is deeply concerned about the adverse and disproportionate effects that the COVID-19 pandemic will likely have on women and girls around the world, particularly in development and humanitarian settings. As the healthcare systems in developed countries are overwhelmed by the spread of novel corona virus CSE and SRHR remains as important as ever and crucial in ensuring a human-rights based response to COVID-19 that recognizes the gendered impacts of the pandemic and the importance of sexual and reproductive health and rights (SRHR) and CSE at this time. Comprehensive Sexuality Education and Sexual and reproductive health and rights underpin gender equality and are pivotal to good health. As a network we are looking at COVID 19 from a gendered lens seeking to protect sexual reproductive health and rights and comprehensive sexuality education to promote gender equality.

Disease outbreaks affect women and men differently, and epidemics make existing inequalities for women and girls and discrimination of other marginalized groups such as persons with disabilities and those in extreme poverty, worse. This needs to be considered, given the different impacts surrounding detection and access to treatment for women and men, as well as for their overall wellbeing.

Women can be less likely than men to have power in decision making around the outbreak, and as a consequence their general and sexual and reproductive health needs may go largely unmet. Drawing lessons from the Zika virus outbreak, differences in power between men and women meant that women did not have autonomy over their sexual and reproductive decisions, which was compounded by their inadequate access to health care and insufficient financial resources to travel to hospitals and health care facilities for check-ups for their children, despite women doing most of the community spread control activities. Many times, there is also an inadequate level of women’s representation in pandemic planning and response, which can already be seen in some of the national and global COVID-19 responses. In terms of other risks, men may exhibit less health seeking behavior as a result of rigid gender norms, wanting to be viewed as tough rather than weak, implying a delay in detection and access to treatment for the virus. Within the context of such norms, men may also feel pressure in the face of economic hardship resulting from the outbreak and the inability to work, causing tensions and conflict in the household. During quarantine, women and men’s experiences and needs will also vary because of their different physical, cultural, security, and sanitary needs.

The closure of schools to control COVID-19 transmission has a differential effect on women economically, given their role in providing most of the informal care within families, with consequences that limit their work and economic opportunities. In general the outbreak experience means that women’s domestic burden becomes exacerbated as well, making their share of household responsibilities even heavier, and for many while they also work full time. Additionally, travel restrictions cause financial challenges and uncertainty for mostly female foreign domestic workers or those in service related industries impacted by travel limitations.

Pandemics compound existing gender inequalities and vulnerabilities, increasing risks of abuse. In times of crisis such as an outbreak, women and girls may be at higher risk, for example, of intimate partner violence and other forms of domestic violence due to heightened tensions in the household. They also face increased risks of other forms of gender based violence including sexual exploitation and abuse in these situations. Life-saving care and support to gender based violence survivors (i.e. clinical management of rape and mental health and psycho-social support) may be cut off in the health care response when health service providers are overburdened and preoccupied with handling COVID-19 cases. Systems must ensure that health workers have the necessary skills and resources to deal with sensitive gender-based violence related information, that any disclosure of gender based violence be met with respect, sympathy and confidentiality and that services are provided with a survivor centered approach. It is also critical to update gender based violence referral pathways to reflect changes in available care facilities and inform key communities and service providers about those updated pathways.

Surveillance and response systems must also take sex, gender, occupational status and pregnancy status into consideration. Given the toll such outbreaks and pandemics can have on all affected individuals, families and communities, the provision of mental health and psychosocial support must be a critical part of the overall response.

Emergency response of COVID-19 outbreak also means that resources for sexual and reproductive health services may be diverted to deal with the outbreak, contributing to a rise in maternal and newborn mortality, increased unmet need for contraception, and increased number of unsafe abortions and sexually transmitted infections. Around the world, women make up seventy percent of health and social service workers. Midwives, nurses and community health workers are on the front lines of efforts to combat and contain outbreaks of disease and require personal protective equipment (PPE). Safe pregnancy and childbirth depend on sufficient numbers of skilled healthcare personnel, midwives in particular, and adequate facilities for providing essential and emergency quality care 24/7. Respiratory illnesses in pregnant women, particularly COVID-19 infections, must be treated with utmost priority due to increased risk of adverse outcomes. Infection control measures must include proper segregation of suspected, possible and confirmed cases from antenatal care, neonatal and maternal health units. Surveillance and response systems for women of reproductive age and pregnant women should be in place, including in antenatal clinics. There is currently no evidence to support vertical mother-to-child transmission of COVID-19. Provision of family planning and other sexual and reproductive health services and commodities, including those related to menstrual health, are central to women and girls’ health, empowerment, and dignity, and may be impacted as supply chains undergo strains from COVID-19 pandemic response.

How can we deliver SRHR and CSE during Covid 19?

  • Provide accurate and supportive care and messaging with the intention to enhance people’s safety, dignity and rights.
  • Ensure policies and interventions around response speak to everyone’s needs, which is a fundamental step to understanding the primary and secondary effects of a health emergency on different individuals and communities. At the same time the protection needs of women and girls must be at the center of response efforts.
  • Ensure the response to COVID-19 does not reproduce or perpetuate harmful gender norms, discriminatory practices and inequalities. It is important to recognize that social, culture and gender norms, roles, and relations influence women’s and men’s vulnerability to infection, exposure, and treatment.
  • Ensure that high attention is given to sexual and reproductive health and rights during COVID-19, given these issues can be severely impacted during outbreaks, including by adhering to strict guidance for infection prevention for safe pregnancies and childbirth, among other measures.
  • Consider how these may differ among groups of women and men, particularly those most excluded such as those living in poverty, persons with disabilities, indigenous people, internally displaced persons or refugees, LGBTIQ individuals, and others who face intersecting and multiple forms of discrimination.
  • Consider how the quarantine experience can be different for women and men, such as whether women’s and men’s different physical, cultural, security, and sanitary needs are being met. Recognize that the home may not be a safe place for some women and may indeed increase exposure to intimate partner violence.
  • Update gender based violence referral pathways to reflect changes in available services.
  • Prioritize women’s participation as their roles within communities typically place them in a good position to positively influence the design and implementation of prevention activities. Given their proximity to the local level, their surveillance and insights can help signal the start of an outbreak and improve the overall health situation.
  • Include women in decision making for outbreak preparedness and response, and ensure women's representation in national and local COVID-19 policy spaces. Incorporate the voices of women on the front lines of the response including health care workers and of those most affected by the disease within preparedness and response policies or practices going forward.
  • Support meaningful engagement of women and girls at the community level, including their networks and organizations, to ensure efforts and response are not further discriminating and excluding those most at risk.
  • Ensure that governments and global health institutions consider the direct and indirect age, sex and gender effects of the COVID-19 when conducting analysis of the impacts of the outbreak.
  • Prioritize the collection of accurate and complete age and sex-disaggregated data to understand how COVID-19 impacts individuals differently, in terms of prevalence, trends, and other important information
  • Apply the humanitarian, development and peace nexus approach through organizational coherence, collaboration, synergy and partnerships to assist governments’ response; and to make the most of the comparative advantages of governments, NGOs and other aid agencies working toward jointly agreed goals

Stephen Kangwa Chilobwa is the Country Director for the Zambia Men’s Network.