Protecting women’s reproductive health during Corona crisis
Betty Muindi @BettyMuindi
“Three years ago when I was 14, I got pregnant for our landlord. He raped me while my mother was away at work. I hated myself for it and did not want the baby.
I attempted to abort it several times by taking concoctions from a herbalist friend of my mother.
At once I almost died of haemorrhage,” 17-year-old Maria Anyango* from Mathare slums narrates.
One in five teenage girls between 15 and 19 years in Kenya are either pregnant or already a mother, often due to sexual violence.
Covid-19 pandemic is putting girls like Anyango at even greater risk. While the nationwide curfew and travel restrictions are helping with curbing the virus spread, they also lead to increased sexual violence in homes and communities, causing increased unwanted pregnancies and unsafe abortions.
Important areas of healthcare, such as sexual and reproductive healthcare seem to be left out as they are not addressed in the same depth and breadth.
Access to family planning services, delivery services, among other sexual and reproductive health services has become increasingly difficult.
Case in point is the pregnant woman from Makueni county who last month bled to death for fear of flouting the nationwide night curfew and harassment by police.
Lydia Mueni, a mother of seven, endured a whole night of labour pains, with her family also afraid to go outside.
“The pains started at around 11pm. I tried to reach several boda boda operators to help us rush her to the hospital, but they all refused stating it was past curfew hours,” said her 50-year-old husband Mati Nyamai.
It wasn’t until 5am at the end of the curfew that they left the house for Kibwezi Sub-county hospital only to be told that they had already lost the unborn baby. Mueni later bled to death at the facility.
Makueni County Referral Hospital has been greatly affected by the pandemic, recording 15 maternal deaths in 2019, but has since registered four deaths in one week, owing to the pandemic.
Mueni is one among three women in the county who experienced severe bleeding labouring at night as they waited for morning.
A new analysis by the United Nations Population Fund (UNFPA) and partners shows economic and physical disruptions caused by the disease could have vast consequences for the rights and health of women and girls.
It reports that significant levels of lockdown-related disruption over six months could leave 47 million women in low- and middle-income countries unable to use modern contraceptives, leading to a projected seven million additional unintended pregnancies.
Six months of lockdowns could result in an additional 31 million cases of gender-based violence.
Further, the report shows the pandemic is also expected to cause significant delays in programmes to end female genital mutilation (FGM) and child marriage, resulting in an estimated two million more cases of FGM over the next decade than would otherwise have occurred.
These delayed programmes, on top of growing economic hardships globally, could result in an estimated 13 million more child marriages over 10 years.
Nelly Munyasia, executive director of Reproductive Health Kenya (RHNK), a network of health professionals within private and public facilities agrees with the prediction.
She says gains made in women and girl’s sexual reproductive health and rights has taken several steps backward in the midst of the ongoing pandemic.
Expectant women are refraining from visiting health facilities for regular antenatal clinics for fear of Covid-19 exposure, due to lack of transport and for fear of police harassment when they leave the house outside curfew hours.
“A pregnant woman cannot plan or decide when labour pains strike. They start any time, and in case of an emergency, it is a matter minutes before losing a mother and her child.
Transport to hospital is also another big deal because no vehicles are operating at night,” she explains.
She says many health facilities are closing or limiting their services and those who are still operating are not observing proper safety measures.
Hospitals are using the same points to triage all patients who come in including pregnant women, thus putting them at great risk.
Further, she cautions that the country could soon face widespread disruption in contraceptive supply chains leading to increase in unplanned pregnancies and unsafe abortions.
UNFPA anticipates significant delays in planned efforts to scale-up access to family planning for the most vulnerable and marginalised populations during this crisis.
A minimum three-month duration of lockdown, with minimal service disruptions, would leave an estimated 13 million women unable to use modern contraceptives, resulting in 325,000 unintended pregnancies.
In the most severe scenario, with significant service disruptions lasting for a full year, 51 million women would be unable to use modern contraceptives, resulting in 15 million unintended pregnancies.
“Most health services such as family planning counselling and commodities were stopped in public hospitals as part of the larger effort to preserve personal protective equipment (PPEs) for medical professionals caring for Covid-19 patients,” Nelly explains.
Covid-19 also poses an increased risk of women experiencing complications after a miscarriage or an incomplete abortion procedure, because it is time-sensitive and cannot be delayed without profound consequences for women and their families.
Marie Stopes, a non-governmental organisation that offers reproductive health services estimates that up to 9.5 million vulnerable women and girls risk losing access to their contraception and safe abortion services in the wake of this pandemic.
Nelly raises concern over health workers being mistreated by police officers during the government’s dusk to dawn curfew as most of them are also being restricted from effectively performing their duties during the curfew period, despite the health professionals presenting proper identification to the police.
In a factsheet titled, Disaster Risk Management for Health – Sexual and Reproductive Health, the World Health Organisation points out negative outcomes including increase in sexually transmitted infections, possible spread of HIV, increased unintended pregnancies and unsafe abortions as well as maternal and neonatal deaths.
UNFPA, in its publication Reproductive Health for Communities in Crisis describes how in times of crisis, reproductive health needs are likely to be overlooked.
Nelly calls on all levels of governments to ensure that the public health sector, at the very minimum should be able to address complications of pregnancy and delivery, the transmission of sexually transmitted infections, adolescent sexual and reproductive health concerns, and access to contraceptives.
This is in cognisant of the fact that even before the onset of the pandemic, the country was still grappling with sexual and reproductive healthcare issues.
Preventable maternal death rates are still alarmingly high with 362 per 100,000 live births according to the Kenyan Demographic and Health Survey (KDHS), 2014.
On their part, RHNK has seized the opportunity of their strong collaboration with the Ministry of Health by providing technical contributions to the development of the National Guidelines for Continuity of Reproductive, Maternal, Newborn and Family Planning Care and Services during Covid-19.
These Guidelines now include a section on Post Abortion Care, safeguarding that these services can continue during this crisis.
“The coronavirus crisis and movement restrictions have forced us to expand on our already existing online solutions to train, monitor and coach providers in our network.
We are using WhatsApp to reach our network of service providers via their mobile phones, for continuous engagement, learning and peer-consultation,” says Nelly, who has experience as a health provider and an advocate, with her training as a nurse and her continued drive to make sure the voices of the patients her organisation serves are heard.