The COVID19 pandemic, and our response to it, has lessened access to sexual health and rights services, but we have the power to change that, says Deepshikha Chhetri.
In March many of us thought the pandemic would pass. Six months on and the situation has only worsened. Melinda Gates was right when she said “COVID-19 is Gender-Blind, but not Gender-Neutral”. Although the Ministry of Health and Family Welfare declared sexual and reproductive healthcare services “essential” during the pandemic, this has not been reflected on the ground.
Healthcare workers are still overworked, routine services remain hampered and young people and women are still unable to access essential services, like sexual and reproductive health (SRHR) services, maternal, newborn and child health services. The growing health crisis is putting young girls and women at greater risk of exploitation, child-labour and gender-based violence.
As a Youth Accountability Advocate I have met with many women in the urban slums of North Delhi. These women are plagued by poverty, inaccessibility to quality healthcare, widespread illiteracy and irregular employment opportunities. My team and I have been helping them to mobilise, running group discussions, research surveys and gathering evidence-based data to use for advocacy and digital campaigns.
Sanitary pads, and contraceptives
India is home to nearly 365 million young people (aged 10-24), many have limited access to sanitary products, contraceptives and abortion care. Only around one third of menstruating women in India are using sanitary pads. The pandemic has not only affected the supply chain, but also the manufacturing and distribution of menstrual hygiene products. Public-private partnerships (PPP) should be encouraged by allowing private-sectors to come forward and strengthen the national and regional supply chains to make sexual and reproductive health medicines and supplies more accessible to both providers and patients.
The lack of privacy and confidentiality at home has erected another barrier to access. Even where provisions exist, many girls’ access is restricted by economic dependence and male family members that prevent them moving around freely. It is a taboo to speak about menstruation openly in many households. Therefore, many women in India are still using cloth sanitary items and ineffective traditional methods of contraception. Contraception needs to be made easily available without a prescription, through decentralised distribution, and facilitated through multi-month dispensing. This would help to adress the rising rates of child marriage, sexual and financial abuse.
Despite India’s efforts to provide Adolescent Friendly Health Clinics (AFHCs), the uptake of the services by young people is very low as our policies do not take into account the access barriers young people face. Taboos, legal barriers, stigma and embarrassment, lack of comprehensive sexuality education, means there is a reluctance to discuss or address these issues. This is particularly acute for adolescents, unmarried young people, LGBTQI+ people and young people living with disabilities who do not conform to the socially and culturally accepted norms of behaviour. the unique needs of vulnerable and marginalized populations, must be addressed, as barriers are exacerbated by the pandemic.
It is time that we prepare health facilities, especially the providers, to support young and adolescent people with family planning counselling, irrespective of their marital status. Engaging doctors, especially obstetricians and gynaecologists is a great place to start. Strategic efforts should be made to integrate the adolescent and youth-friendly services into the public health system. Policymakers and implementers need to reach out to young people and women in remote areas with the poor health care systems. Local and state-level government administrations need to ensure that young people and women are heard, and their needs are met as an essential part of the COVID19 response. And there is a need to adopt innovative models of care like telehealth that can get around the problems lock down has unearthed.
It’s in our hands.
Epidemics, outbreaks and natural disasters are inevitable, and beyond our control, but the barriers to sexual health and reproductive rights are mostly man-made. However, if given the opportunity to learn about their rights and exercise them, these young people are proven to be the most effective advocates for their own rights. We need to create more enabling environments and a more holistic approach, to tackle sexual and gender‐based violence, sexual diversity, discrimination, relationship issues, and fears and concerns about sex and sexuality. COVID19 might be gender-blind but we can’t afford to be blind to its unequal impacts.
Photo by Reproductive Health Supplies Coalition on Unsplash