Contraceptive and family planning services and supplies are essential health services, said FIGO (International Federation of Gynecology and Obstetrics), a global non-governmental organization representing obstetricians and gynecologists. FIGO believed that access to such services is a fundamental human right.
The standard of providing contraceptive and family services and supplies need to be respected and protected even if governments are dealing with scarce resources during the crisis. Since many health systems are focusing on managing the COVID-19 pandemic, healthcare centers providing basic contraception counseling, the delivery of contraceptives and services, and the flow of supply chains have been disrupted. This hinders men and women from seeking care from their regular health care providers.
Family Planning Method Choices and Modern Contraceptive Use In Haiti
Wenjuan Wang and Lindsay Mallick of BMJ Global Health, an open-access journal portal about global health, distributed surveys to women aged 15 to 49 years in the selected households for interviews. The authors collected individual sociodemographic characteristics and information, as well as the use of health services. Overall, 14,287 women participated in the interview. Wang and Mallick used data from the 2012 Haiti DHS and the 2013 Haiti SPA.
In Haiti, 29.3% and 3.3% of hospitals in urban and rural areas provide family planning services, respectively. Likewise, health centers with beds in urban areas were more likely to offer these services compared to those in rural areas (22.6% and 12%). This disparity was also evident in health centers without beds in urban (33.5%) and rural (22.6%) areas. However, dispensaries in rural areas were likely to offer family planning services (62.1%) than urban areas (14.6%).
In urban areas, the managing authorities that were likely to offer this service were the government (53.4%), mixed (23.9%), private-for-private (13.3%), and NGO/private not-for-profit (9.4%). In rural areas, the government was likely to provide family planning services (45.6%) followed by mixed (22.8%), private-for-profit (17%), and NGO/private not-for-profit (14.7%). Overall, 77% or more of the facilities provided pills, injectables, and male condoms. 42% of family planning facilities in urban areas had implants available, compared to 23% in rural areas.
The family planning facilities that provide at least three modern contraceptive methods were hospitals (66.7%), health centers with beds (44.6%), health centers without beds (26.9%), and dispensaries (19.9%). Meanwhile, the government provided at least three modern contraceptive methods (33.2%) followed by NGO/private not-for-profit (30.5%), mixed (30.1%), and private for-profit (17.6%).
The authors excluded camp clusters and clusters with missing GPS data in the 2012 Haiti DHS, with only 3,826 women from 241 rural clusters and 1,216 women from 85 urban clusters remaining for the analysis. Married women living in urban areas reported a high availability of facilities that provide three or more methods (42.3%) within the buffer (5 km for urban clusters), though the number was higher for women living in rural areas (54.2%; 10 km for rural clusters). 40.5% of women in urban areas reported a medium availability of three or more methods within the buffer, unlike 29.2% of those in rural areas. Only 17.1% and 16.6% of women in urban and rural areas reported answered “low availability,” respectively.
The Pandemic Exacerbates Barriers to Reproductive Health
Women may want to delay pregnancy until health centers are less overwhelmed with patients in critical condition, explained Melanie Lopez of Devex, a media platform for the global development community. However, those living in low and middle-income countries will struggle due to restrictions in mobility and limited services, supplies, and providers. For Lopez, reproductive health must continue to remain an essential aspect of care, despite struggles to adapt to the pandemic. The provision of family planning services must be heightened, but accessing services and contraception will need to acclimate to change.
Directors for Marie Stopes in Uganda and Zimbabwe narrated that they had waited in vain for supplies to arrive, noted Ximena Cases of HRW (Human Rights Watch), an international non-governmental organization. They added, “We’re expecting a huge shortage of contraceptives in African countries.” Further, thousands of women in Venezuela who previously traveled to Columbia to get supplies of contraceptives are blocked from entering the country due to border closures. Manufacturers have warned of a global condom shortage as they are locked down to curb the virus’s spread. Shortages increase women’s risk of unplanned pregnancy, STDs, and abortion.
The pandemic also exposed and exacerbated social inequities. For example, prior to the pandemic over five million families in Africa, Asia, Latin America, and the Caribbean spent more than 40% of their annual non-food household expenditures on maternal health. Since lower-income households are most affected by economic disruptions, they may find it more challenging to access quality health care. Moreover, denying health services will impair women’s ability to bounce back from the pandemic. Increase pregnancies or unsafe abortions could further overwhelm crowded health facilities.
Facilitating Contraception and Family Planning Services During the Pandemic
In many parts of the globe, the pandemic has caused sexual and reproductive health services to partially or completely close down. For women, they may only have access to contraception via antenatal, delivery, and postnatal care. Prenatal care and messages must offer counseling on birth-spacing. Maternity units must also launch postpartum family planning services that focus on “long-acting” contraceptive methods like postpartum IUD. These methods are more effective and minimize one’s need to return to health centers for supplies. Midwives who serve women may not be able to reach health facilities for delivery.
To address this issue, midwives should collaborate with local health systems to provide contraception messages and products. By encouraging them to work with health facilities, they will be able to facilitate exclusive breastfeeding, birth spacing, and contraceptive methods for women and/or their partners. Barriers to contraception should be lifted by shifting or sharing tasks among health professionals. Telemedicine can also be implemented to improve one’s access to information and contraception. Digital health tools should be capitalized now to enable women and health providers to share information and free women’s time waiting in overwhelmed health centers.
Governments should keep track of supply chains and find solutions should shortages escalate. They could also redistribute available supplies across localities and countries. Governments should ensure that individuals have continuous access to contraceptive information and services, emergency contraception, and abortion care.
The COVID-19 pandemic has prevented women from accessing contraceptive services. Reproductive health centers have partially or completely closed down, and supply chains have been disrupted to manage the virus. Governments must ensure continuous access to services and information to reduce the likelihood of increased pregnancies and abortion.