COVID-19: Moving toward new global practices

Women around the world are calling on health systems to respond to their needs in a fashion that respects their interests and enhances essential care in challenging times. Moreover, they are looking for affordable care that doesn't make them choose between their own care and that for their family.  

However, ensuring access and quality of care to contraception during the pandemic remains one of the key elements for expanding reproductive rights and investments in universal health coverage, as well as effective protection against the impacts of unplanned pregnancy in uncertain times. As effective vaccines show promise for lessening the burden on health systems, we need to assess where change is required to better serve clients, and what innovations can be integrated permanently into the routine delivery of care. 

Over the last several months, this column has highlighted how COVID-19 has affected the delivery of care in contraception and family planning, as well as exposing the flaws, inequities, and unanticipated costs in our health systems. The overall news is not good, with many countries seeing decreased access to services and increased violations of sexual and reproductive rights.

Bringing these facts and others to light provides an opportunity for renewed commitment to address the structural weaknesses and disparities. This will not happen overnight, but we now have a springboard and new tools for rethinking how quality care can be delivered in a range of settings across health facilities, across health communities and even clients’ homes and by a range of health care professionals, including midwives and pharmacists.

For an excellent summation and discussion of these challenges and innovations, please watch the podcast:  Innovations in quality service delivery in Family Planning that may become best practices in the time of COVID-19.

Some key messages:

• The disruption to care during COVID-19 has demonstrated what happens when girls and women do not have access to contraception. UNFPA predicts up to 7 million unintended pregnancies worldwide and thousands of deaths from unsafe abortion and complicated births will occur, as a result of the disruptions to care. Data and more analysis are needed, but the pandemic has and will continue to provide the evidence about the consequences of inadequate reproductive health care in general, and specifically during crises. Now is the time to incorporate what we learned into our advocacy efforts for universal health coverage.
• Resilience and adaptation have mitigated some of the effects of COVID-19. The healthcare community has been quick to innovate, experiment and to advocate for policy changes. These innovations have included a mix of task shifting, telemedicine, self-care, and suspensions of the regulations that constrain access to medical abortion and to contraception by type of provider, locations of services, and method options.
• COVID-19 exacerbated disparities and inequality, and fuelled an increase in the incidence of gender-based violence. Breakdowns in social and protective networks, lockdowns, and economic stresses resulted in an increase in gender-based violence, which was already a global health problem. A number of governments increased funding to combat GBV. Other steps included media campaigns and telephone hotlines, and new guidelines and training for helping GBV victims during the pandemic. Advocates can capitalise on the increased awareness to push for reform in eliminating barriers to access among underserved groups, and addressing the fundamental issues associated with financing health services for the most vulnerable. They can continue to encourage and support coordinated efforts to tackle GBV.
• Use of telemedicine took a giant step forward during COVID-19. After decades of incremental growth of technology in medicine, the pandemic has spawned innovation, as well as increased patient and provider acceptance. Even service areas with low bandwidth have increased use of screening and patient follow-up via cell phone or text, using simple feature phones.
• Self-care accelerated during COVID-19. The movement toward self-care was given a push by the pandemic as providers were stretched to the limit, and patients were fearful of or unable to travel to health care settings. Some of the policies, which allowed self-care such as those surrounding medical abortion, were put in place temporarily. Early evidence suggests that many of these innovations are indeed beneficial. The goal now is to make them permanent.

There is much more that is happening because of COVID-19. Please share your experiences, including stories from colleagues and patients, regarding safe and effective contraceptive and abortion services during the pandemic with us so we can share them with the membership. Share lessons from advising governments to ensure that SRH and Maternal Health services are on the Essential Services List in your country, in support of universal health coverage.