5 sexual and reproductive health lessons from COVID-19
The word unprecedented has been used so frequently over the past four months. Perhaps this is because we have no words for what we have experienced, and very few people in the world would have a point of reference to which they can compare it. In one monumental sense, we are experiencing a global trauma — something that most of us have not experienced in our lifetimes.
When it comes to the impact of COVID-19 on sexual and reproductive health, however, I don’t believe that we can use the term unprecedented. We have seen clients struggle to access healthcare inter and intra state, and physical distancing and personal safety measures have placed additional pressures on clients and clinics and we have spent a considerable part of the pandemic having to justify why our care should be considered an essential health service.
In one instance, for example, we had a supplier of PPE (a term the whole world now knows) cancel an order on the eve of delivery after we had made payment, citing our services as non-essential health services despite the fact we are deemed essential services under all governmental guidelines.
Pandemic barriers have not actually caused unprecedented impacts on sexual and reproductive healthcare. They have exacerbated what have been long standing issues in providing sexual and reproductive health services across a series of federated States and Territories.
In many areas of our society, this pandemic has magnified where there are existing gaps, inequities, and discrimination. For sexual and reproductive health, it has starkly exposed where rights need to be better respected and protected.
These inequities existed long before the pandemic. The question now is will we allow them to exist or increase as we slowly recover?
As we reflect on our nation’s, and indeed our world’s, varying responses to COVID-19, there are several lessons that have emerged in relation to sexual and reproductive health care.
1. We have no idea what happens when it comes to sexual activity during a pandemic.
It is hard to tell what impact this pandemic has taken on our sexual lives during lockdown, something the University of Melbourne is conducting a study to assess. On the one hand, evidence has suggested that sexual activity increases during a pandemic. On the other, some researchers suggest that lockdown measures are likely to decrease sexual activity, particularly casual hook-ups, resulting in a decrease in STI rates.
While the jury is still out on the impact of the pandemic on our sex lives, what we do know is that many people have struggled to access contraception and barrier methods.
Overseas, supply chains of condoms, dental dams and other forms of barrier contraception and protection were significantly interrupted. While this is true for many health products, access to contraception can be a life or death matter for millions of people, particularly women.
2. Contraception should be considered community PPE during pandemics.
In Australia, access to contraception was limited by movement restrictions and access to places that provide free or low cost condoms. Flowing from that, movement restrictions and lockdown measures were responsible for a significant downturn in patient numbers of most sexual and reproductive health services including STI testing and treatment services.
To avoid compounding future public health issues, contraception and barrier methods should be considered forms of PPE for the community during a pandemic and should be freely accessible. This is particularly important as we isolate in our homes.
This means access to condoms, dental dams, gloves, emergency contraception, as well as access to pregnancy testing kits for early detection of unplanned pregnancies.
In fact, this approach to preventative sexual and reproductive healthcare should be part of our local, State, Territory and national pandemic plans. They are simple, relatively low costs ways of decreasing other public health impacts during and after a pandemic.
3. Decisions about pregnancy and parenting become even more complex.
During the pandemic, deciding about a pregnancy outcome is complicated. The economic impacts of COVID-19 have some people rethinking their decision to have children, others have been inspired to have children. What we have seen, however, is that the context in which these decisions are being made has shifted radically over the past four months.
At Marie Stopes, right before elective surgery restrictions came into effect in Australia, we were faced with an incredible dilemma about the urgency and necessity of providing vasectomy and stand-alone contraception services. When restrictions were announced, clients booked in for vasectomies were offered a choice of having their procedure before the elective surgery restrictions or putting them on hold until after the pandemic. Many opted to have their procedure beforehand, citing the need to have some form of certainty as we entered a national lockdown.
One patient, Marcus, was emphatic about going ahead with the permanent contraception method telling me, “I did not want to delay having a vasectomy because I don’t t want my family, especially my wife to have to deal with any further stress and strain from an unplanned pregnancy, especially now when we are all working out what this pandemic means. What we need is some form of certainty when everything is so uncertain.”
While the context of making pregnancy and parenting decisions has changed, the need for support in making these decisions has not.
4. Harmonisation of abortion access is important now more than ever.
Varying gestational limits enshrined in local abortion laws has meant that some people wanting to access abortions have been unable to do so. This particularly impacts women and pregnant people wanting to access abortion from 20 weeks gestation. The lack of parity in Australia’s abortion laws has been a significant long-standing issue in our nation’s sexual and reproductive health provision, most notably highlighted by the United Nations in 2018.
As we have grappled with movement restrictions and border closures, many people have either struggled to access terminations at later gestations or continued a pregnancy against their wishes.
The National Women’s Health Strategy, released last year, commits to universal, equitable access to abortion care, and includes equitable access as one measure of the strategies success. In less than one month’s time, Australia is set to report back to the United Nations under the Convention on the Elimination of All Forms of Discrimination against Women, on how it plans to achieve the harmonisation of abortion laws. While legal and regulatory harmonisation is challenging across a federated model, access to sexual and reproductive health services such as abortion should not be.
5. The disproportionate impacts of this pandemic signal we need to address inequity across the board.
Pandemics have always disproportionately impacted some people more than others and fostered environments of discrimination. This pandemic is no different. COVID-19 has disproportionately impacted women, people of colour, Aboriginal and Torres Strait Islander people, people on temporary visas, non-binary and trans people, people with disability, sex workers, older populations and people experiencing poverty and financial hardship. These populations were already facing higher risks of healthcare discrimination before the pandemic.
Rights-based approaches and conventions are absolutely critical during this pandemic as they refocus and remind governments and communities of our obligations to each other. Conventions that uphold the rights of people to access safe, legal healthcare are critical and should be re-affirmed. A good example of this is the joint statement Protecting Sexual and Reproductive Health and Rights and Promoting Gender-responsiveness in the COVID-19 crisis. However, it is important that such conventions should be afforded equal priority pre and post pandemic.
Equally, we need a national approach to sexual and sexual and reproductive health provision. For many years advocates have lobbied for a national sexual and reproductive health strategy that takes a population health approach to this important area of healthcare. Doing so will help us decrease so many of the inequities in sexual and reproductive health that we have seen during this pandemic and will continue to see as we recover.
Jamal Hakim is Managing Director of Marie Stopes Australia and Board Member of Democracy in Colour. Follow Jamal on twitter @thejamalhakim