THE Covid-19 pandemic may have spared many women from directly getting infected, but in many ways it has exacerbated the impact on their sexual and reproductive health. Giving birth already comes with its own set of risks but during the Covid-19 pandemic the delivery process is complicated manifold.
Many have to face a difficult decision — whether to give birth in a hospital setting or opt for a home birth. The former comes with the risk of infection, the latter may mean limited equipment if the delivery turns into a medical emergency — bleeding after giving birth is one of the leading causes of maternal deaths in Pakistan.
The United Nations Population Fund looked at three sexual and reproductive health services affected by the pandemic in 14 countries including Pakistan: births assisted by skilled healthcare providers, including midwives; births taking place in health facilities; and access to contraception. All the countries surveyed have high maternal mortality ratios — over 100 deaths per 100,000 live births.
Is family planning on the government’s radar?
Even if things were fairly good, there would still be a 20 per cent decline in the use of the three key services, leading to a 17pc increase in the maternal mortality ratio, or 25,493 additional deaths this year alone. But if things were bad, it would mean a 50pc decline in the use of services, leading to 43pc increase in maternal mortality, or 68,422 additional deaths.
Experts agree the pandemic may lead to a significant increase in maternal deaths mainly due to reduced access to contraceptive services. Already the use of contraceptives by Pakistani couples is low as is the discontinuation rate.
About 45pc of women in Pakistan who use any of the modern methods of family planning (FP), get their supplies from a government health or an FP facility. A sizable proportion, particularly those in urban/semi-urban areas, get their supplies from NGO-run clinics, Lady Health Workers (LHWs) or directly from pharmacies (condoms and oral pills).
When the government announced a lockdown in April, FP services were the first casualty and women were unable to get either supplies, or antenatal or delivery care. This was particularly true for rural women relying on government facilities. With a disruption in FP services, it is not hard to imagine a spike in unexpected pregnancies, unsafe abortions, pregnancy-related complications and maternal deaths.
The country’s population, already increasing at an annual rate of 2.3pc, will double in less than 35 years to 440 million by 2055! If FP services and supplies remain disrupted, the economic burden of a runaway population will increase.
It is imperative that the government consider the provision of women’s reproductive health as an essential service and ensure the population welfare department’s FP centres are not only opened, but that they also have an adequate number of service providers and supplies.
The country has a huge brigade of LHWs and community midwives that are the main providers of FP information and modern contraceptives. But they seem reluctant to make house visits for fear of getting infected by the coronavirus. The fear is not unfounded. The government must find innovative ways and train them to carry out their work in the present circumstances. For instance, instead of entering homes, interactions can be conducted at the doorstep.
But before that, these front-line workers, some of whom will be providing antenatal and post-natal care as well as delivery services, need to be equipped with proper personal protective equipment (PPE). Because of the risk they are exposed to, they should also be provided incentives to encourage them to continue their services.
No doubt, over the years, LHWs have been burdened with many tasks that they had not signed up for initially, but given that they have built up trust and made inroads within the communities they work in, it may not be a bad idea to use their services for mass awareness about Covid-19. They can be trained to advise their clients on containment strategies, explain what isolation and quarantine mean, and dispel myths and misconceptions, while addressing stigma associated with the infection.
It is also a good time to set aside differences and for the federal and provincial governments to come together, partner with the private sector and seek support of donor organisations such as UNFPA, WHO and Unicef in terms of technical assistance or to get uninterrupted supplies of medicines, equipment and PPE for healthcare providers.
If this pandemic has taught us one thing it is to think out of the box. There is huge potential in digital technology. This may be an opportune time to train healthcare providers in telemedicine. Already quite a few women doctors have returned to work using the telehealth platform and this may open up a new world for scores of others like them.
The writer is a freelance journalist based in Karachi.
Published in Dawn, June 24th, 2020