Approximately 1.8 billion people live in fragile contexts around the world, including 168 million people in need of humanitarian assistance. About a quarter of people in fragile contexts are women and girls of reproductive age.
| Experience from past epidemics in these settings has shown that disruption of health care services considered unrelated to the epidemic response caused more deaths than the epidemic itself. |
Issues
Those related to sexual and reproductive health are among the main causes of mortality and morbidity among women of childbearing age, and countries affected by fragility and crisis represent 61% of maternal deaths worldwide.
Poor health outcomes will arise from the absence or disruption of life-saving services, including emergency obstetric and neonatal care, contraception to prevent unwanted pregnancies, and management of abortion complications.
Gender-based violence and sexual exploitation and abuse may increase during outbreaks due to confinement, increased exposure to perpetrators at home, economic precariousness, and reduced access to protective services.
Caring for children and other homebound people further reduces women’s ability to adequately care for themselves.
In the context of pandemic preparedness and response, members of the Interagency Task Force for Reproductive Health in Crisis have issued several guidance documents on sexual and reproductive health and coronavirus disease 2019 (COVID-19).
Building on the overall need for humanitarian actors to coordinate and plan to ensure that sexual and reproductive health is integrated into pandemic preparedness and response, there are four points on how to mitigate the impact of COVID-19 on mortality and morbidity due to sexuality. and reproductive health conditions in crisis and in fragile environments.
1 . First , with the understanding that the risks of adverse outcomes from medical complications outweigh the potential risks of COVID-19 transmission in healthcare facilities, the availability of all critical services and supplies, as defined in the Minimum Initial Services Package for sexual and reproductive health, should continue.
These services include intrapartum care for all births and emergency obstetric and neonatal care (cesarean sections should only be performed when medically indicated, a positive COVID-19 status is not an indication for a cesarean section), post-abortion care, safe abortion comprehensive law enforcement care, contraception, clinical care for rape survivors, and prevention and treatment of HIV and other sexually transmitted infections.
Early and exclusive breastfeeding and skin-to-skin contact for newborns should be promoted , and the mother and newborn should not be separated unless one or both are critically ill in cases of suspected or confirmed infections. COVID-19.
2 . Second , comprehensive sexual and reproductive health services must continue as long as the system is not overloaded with COVID-19 case management. For relevant consultations and follow-up, remote approaches should be considered where feasible (e.g. telephone, digital apps, text messaging).
In addition to the Minimum Initial Service Package, these comprehensive services, i.e. all prenatal care, postnatal care, newborn care, breastfeeding support and cervical cancer screening, as well as care for people experiencing intimate partner violence, They must remain available to all people. those who need them, including adolescents.
3 . Third , clear , consistent and up-to-date public health information, developed with representatives of the target audience, must reach the community and health workers. This information should reinforce that medical complications outweigh the potential risk of transmission in health facilities and that community members should continue to seek and receive care during childbirth and for all other essential sexual and reproductive health needs or emergencies that arise. They result from other illnesses, traumas or violence.
The community must understand that any changes to routine services are in the best interest of patients to ensure support for the COVID-19 response, avoid undue exposure to the risk of contracting the virus in a healthcare facility during the outbreak, or both. . However, coordination and planning to restore these comprehensive services should occur as soon as the situation stabilizes.
4 . Fourth , COVID-19 infection prevention and control precautions, including hand hygiene, physical distancing, and respiratory etiquette, should be applied to patients (and accompanying family members if their presence is necessary). ).
Additionally, personnel must be protected with appropriate personal protective equipment. Facilities must also establish a patient flow that incorporates triage before entering the facility, and an isolation area and a separate consultation room for suspected or confirmed cases.
To minimize preventable deaths, crucial health care services, including sexual and reproductive health services, must remain accessible during public health emergencies, even as resources from already fragile health systems are often redirected to response. outbreak.
The COVID-19 pandemic will increase the risks inherent in reorganizing resources at the expense of other services; However, sexual and reproductive health cannot be seen as a luxury.
On March 31, 2020, the United Nations Secretary-General highlighted in relation to COVID-19 that "we are only as strong as the weakest health system in our interconnected world." To echo this statement, we have provided guidance on sexual and reproductive health and COVID-19, and called on health authorities to prioritize these life-saving services in humanitarian and fragile settings.
Such interventions should be considered indispensable components of health services that do not strain, but strengthen health systems during COVID-19 preparedness and response efforts. The collective health of women, girls and the broader community depends on these services.
*The authors declare no conflicts of interest.
