Pandemic limits poor women’s birth-control care

As coronavirus lockdowns continue to restrict movement around the world, organizations working on family-planning initiatives in developing countries have found female patients facing an uncomfortable paradox — the measures intended to keep them safe from the pandemic could have dangerous long-term effects on their health.

When Lucy Shoniwa’s mobile family-planning clinic arrives in a rural Zimbabwean village, hundreds of women often line up for help. She and her team can now insert about 70 birth-control implants and 20 intrauterine devices, hand out 6,000 condoms and consult with dozens of women on shortterm contraceptive methods like the pill — all in a single day.

But when Zimbabwe went into lockdown in March, many of her patients disappeared.

Shoniwa, an experienced nurse working for Marie Stopes International, one of the world’s largest family-planning organizations, said it’s not because they no longer need her services. Some are afraid to visit the clinic because they don’t want to catch the virus. Others, she said, have reported being turned away at checkpoints by security forces or fear upsetting local leaders who have instructed residents to stay at home.

Marie Stopes warned last month that disruptions in service in 37 countries where the organization works could prevent 9.5 million women from accessing contraceptives and safe abortion. The organization projected that such disruptions could lead to up to 3 million unplanned pregnancies, 2.7 million unsafe abortions and thousands of pregnancy-related deaths.

A recent United Nations Population Fund study suggested that if the pandemic continues to disrupt care in more than 100 low- and middle-income countries over the next six months, 47 million women could lose access to contraceptives, leading to 7 million unplanned pregnancies.

Although it’s too soon to determine what long-term consequences the pandemic could have on women’s health care access globally, experts pointing to the lessons of past outbreaks say the impact could be substantial, even as some countries begin to roll back their social-control measures.

If Zimbabwean women continue to face obstacles seeking care, “we are going to be in very big trouble and have very big problems,” Shoniwa said. Already women are missing out on crucial care to replace expired long-term contraceptives or pick up new supplies, she said. Callers flooding the Marie Stopes hotline are almost all asking the same questions: When and where can we get services?

In a male-dominated society like Zimbabwe, Shoniwa said, many women face pressure from their husbands to have sex, even if they have run out of contraceptives. Those pressures have only intensified in quarantine.

“Men have not got any other activities. They can’t watch soccer, they can’t go to social places where they used to,” she said. “They are spending most of their time at home, and what is the activity that is happening there?”

Anushka Kalyanpur, a gender specialist at the humanitarian organization CARE, said she is alarmed to have seen a reduced focus on programming for gender-based violence and access to sexual and reproductive health resources.

Even before the coronavirus, there were “so many barriers to accessing those services” in marginalized communities around the world, she said. “With further restrictions on mobility, that’s even more concerning.”

Abebe Shibru, country director for Marie Stopes Zimbabwe, said that while his organization applauds government efforts to fight the virus, he is concerned that disruptions to health care could cause unplanned pregnancies that will lead to unsafe underground abortions. Zimbabwe already faces high maternal mortality and teenage pregnancy rates. The coronavirus restrictions, he said, should not come “at the expense of women’s health.”

Zimbabwean health officials did not immediately respond to a request for comment.