Obstacles in Access To Reproductive Health Services in Pandemic Covid-19 at Sindh

By Abdul Ghaffar Thaheem – Hyderabad

Coronavirus pandemic has shaken the world economy with an elevating pace that led to rapid declines, especially in developing countries. Regardless of exceptional financial support and rescheduling loans by international monetary institutions, it will require a very long time to overcome the adverse impacts on the socio-economic conditions of those countries. People around the world are experiencing the adversity of the 4^th wave of the pandemic. This global outbreak has also intensified the health vulnerability of people particularly in underdeveloped counties, even the advanced health systems were not prepared to accept the challenge of the pandemic.

For the last so many years Pakistan has achieved extraordinary experience to manage assorted disasters however by one way or another our response needs comprehensiveness with regards to an integrated disaster response approach. Numerous facts-based analytical reports presented the cases of abuse and exploitation against women in disaster situations triggered reproductive health-based gender violence in Pakistan.

In Pakistan, the government’s vague policy towards pandemic Coronavirus and feeble health system appeared to be a hurdle in responding pandemic adequately, ultimately it pushed the country’s economy towards a sharp corner. The most vulnerable population had to confront the adversative impacts of economic deprivation caused a huge reduction in household income led to deprioritize survival needs of vulnerable women, girls, and children. It further increased women’s vulnerability who as of now mistreat under belief-based misconception and cultural barriers in their attempt to avail basic health services.  In country’s constitution the suspension of reproductive health services counts as an infringement of the right to life (Article 9).

At starting, In Pakistan the pandemic seemed, by all accounts, to be the main concern for the federal and provincial governments with diverting immense resources to manage in different inclines.  Sindh was the leading province to impose complete lockdown and mobility restriction, although the proactive decision had brought positive results in halting the pandemic towards further escalation, the integrated rights-based approach in dealing with the outbreak seemed missing.

Because of a break in the supply chain, the women and adult girl’s access to reproductive health services were subverted somehow that include contraception, safe abortion, PAC, MVA, and MA both in urban and rural settlements. In Sindh province, during the first wave of a pandemic, it was raised from some corners on the restraint supplies and inadequate stock to address the needs of family health clients.

Sindh contraceptive prevalence rate (24.4%) is the second-highest amongst the country’s four provinces, with higher usage in urban (28%) than rural areas (20.4%). The Women’s total fertility rate is higher in rural (4.7 births) than urban (2.9) in Sindh that indicates a huge difference in rural-urban rates amongst provinces.  Government-run family health facilities halted their service as they were not declared as essential services by NDMA during the pandemic, even when, family health services offices opened most of the staff were either directed to follow work from home policy or were unable to reach because of confined mobility

Some very hard realities unveiled during the implementation of the GCC project ” Addressing barriers to young people’s access to MR/PAC services ” at Karachi-Sindh by Rahnuma Family Planning Association of Pakistan, one of the oldest and spearheading organization in the area of reproductive health services. In stakeholder engagement during the project execution, most communities even private health service providers observed to be completely unapprised upon prevention and adversative effects on reproductive health. During the pandemic period, the Family Planning Association of Pakistan continued family healthcare services by following WHO guidelines across Pakistan to ensure the basic right of health service for most vulnerable women and adult girls.

Some private family health service providers shared that in their handling area insufficient contraceptive supplies made it difficult for many family planning method user client women to maintain the FP cycle especially long-acting reversible contraceptives (LARCs) that were not effectively accessible at government family planning facilities even at private chemist outlets. An extended lockdown situation made a large number of people jobless, they were limited to homes, resultantly many women who were using family without of consent of partner had conceived due to discontinuing family health facility.

Young persons are also affected by supplies chain interruption due to supply and demand variance that increased the price of imported contraceptives and reduced family planning clients. This supply chain interruption additionally made difficult someway the availability of Manual Vacuum aspiration (MVA) kits, misoprostol, and other related supplies eventually affected post-abortion care services

Few Women medical officers working at private family healthcare services shared that extensive chaos and fearful situation scared women to visit the facility for normal antenatal check-ups and other health complaints, they scared to get Coronavirus if they would visit the center, eventually an enormous number of women deprived of the counselling and regular check-ups. Many private family health service providers exploited the situation by increasing service charges to make further challenging for vulnerable women and adult girls to avail reproductive health services.

As per feedback by some community persons and clinical staff of private Family health care services, many pregnant women went into high depression as they couldn’t maintain the antenatal check-ups because of restricted movement under the total lockdown. Pregnant women experienced deferrals and complications also due to inaccessibility towards healthcare facilities, as a result, either these pregnant women had to counsel overpriced distant private healthcare facilities or to depend on unqualified service providers exposing their health further.

This entire adversative occurrence undermines the inclusive undertakings to prepare vulnerable women and young girls towards government facilities, it considers one policy level gap of our health system for not tracking and evaluating facts-based pandemic impacts on access to unmet needs of reproductive health. There is a critical need to rationalize our disaster management approach further by guaranteeing the right to access basic health from a gender perspective due to disparity and unrecognized socio-economic status within society.

Sindh has been acted as the leading province in introducing diverse laws to protect basic human rights.  Reproductive Healthcare Rights Act (Sindh Act) is one of them passed in 2019 to declare RH as a fundamental right includes the early child marriage restraint act.   Sindh government has been exceptionally proactive in connecting different segments of civil society and health experts to develop inclusive reproductive health policy, nonetheless, still, comprehensiveness appeared to be the lacking factor to address Coronavirus that might guarantee reproductive health needs of the population both in urban and rustic settlements.

There is also a dire need to align the professional and conceptual capacity of health service providers with an integrated reproductive health approach in a diverse disaster situation to ensure vulnerable women and girls’ access to required services.