Recently, my work phone rang and on the other end was a woman called Tendai (not her real name). Tendai needed to get a replenishment of her contraceptives. She tried to go to the women’s clinic that morning.
Our clinics were deemed essential and are open, but Tendai could not reach one as there was no public transport running in her area. Quickly, I assured Tendai that I would call her back with a solution. Fortunately, Women’s Action Group, the organisation I work for, is part of a coalition working on sexual and reproductive health and rights (SRHR) and I was able to connect her to a service provider who helped her obtain her contraceptives as they could offer transport within a given radius and she lived close enough to receive that help.
Tendai is not alone in facing challenges accessing contraceptives and other services offered at women’s clinics. Since the lockdown, the number of clients has dropped by 70% in many clinics. The organization Marie Stopes provided more than 400,000 women last year with family planning. But now the organization’s outreach services, which is how they reach more than 60% of clients, are suspended. Failure to get the contraceptives will result in unwanted pregnancies. Evidence has shown that if women find themselves pregnant and they decide they don’t want the pregnancy they choose to abort. Women do not really care how they carry out the abortion when they are desperate.
Tendai’s story and these statistics made me think about the response strategies for COVID – 19. Most of the African countries were quick to implement the lockdown strategy to try to prevent the spread of the COVID-19, while ignoring many of the needs for women and girls. For instance, there was no thought given on how women could access contraceptives and other SRHR services. In Zimbabwe there is no transport to go to health centers right now – and that will continue as our lockdown was extended by two more weeks. Another issue is that too often the police and soldiers who have been put on the streets to monitor people and ensure they do not leave for reasons deemed non-essential may not agree that accessing the SRHR services is essential.
According to UNICEF, however, even though most health resources including personnel and facilities are being diverted to the COVID 19 response, there are some services such as institutional deliveries, immunization and contraceptive services that cannot be interrupted. They are essential. If such services are interrupted, there will be an increase in unwanted pregnancies and maternal mortality, as well as outbreaks of other diseases such as measles.
With this in mind, as African countries consider extending the lockdown periods, I ask them to be guided by the fact that sexual and reproductive health services should be considered essential and they must not be interrupted by the lockdown. There should be clear information about where and how to access the services. Transport to get to these services should be in place. Emergency contraception should be made available to all who need it in this period where women are likely to engage in unprotected sex.
Safe abortion care and post abortion care also should be made available. Indeed, the latter is crucial, and African countries should learn from other regions, like in Virginia, USA, where the governor put abortion under essential services during the lockdown period.
Of course, this is not an easy ask. What I have observed across my 25-year career is that it is easier for people to refer to contraception, menstrual hygiene when talking about SRHR services. No one is mentioning abortion because of the stigma it carries. Even though it is common and the Guttmacher Institute in Zimbabwe (2016) revealed that 40% of the pregnancies were unintended and 1 in 4 of the unintended pregnancies end up in abortion.
The truth is, if women fail to access abortion services, they will to go to traditional or untrained health personnel to procure abortions. This will be costly to the nations as it costs more to treat someone who has had an unsafe abortion compared to offering a safe abortion. Complications happening as a result of unsafe abortions will force women to come back to the formal health delivery system which is already under strain. Unsafe abortions might also result in an increase in maternal mortality.
Now it is time for those who stand for choice to raise our voices and call for the provision of safe abortion and post abortion care. I am calling for countries such as Zimbabwe who have restrictive laws on abortion to allow for termination even without the certificate from the courts that allows termination in cases of rape.
It is in everyone’s best interest to help women access contraceptives, as well as an abortion should they need it.
Edinah Masiyiwa is a women’s rights activist. She is the Executive Director of Women’s Action Group and an Aspen Institute New Voices Senior Fellow.