Endler M, Al-Haidari T, Benedetto C, Chowdhury S, Christilaw J, El Kak F, Galimberti D, Garcia-Moreno C, Gutierrez M, Ibrahim S, Kumari S, McNicholas C, Mostajo Flores D, Muganda J, Ramirez-Negrin A, Senanayake H, Sohail R, Temmerman M, Gemzell-Danielsson K
Acta Obstet Gynecol Scand - (-) - [2020-11-11; online 2020-11-11]
We aimed to give a global overview of trends in access to sexual and reproductive health and rights (SRHR) during the Covid-19 pandemic and what is being done to mitigate its impact. We performed a descriptive analysis and content analysis based on an online survey among clinicians, researchers and organizations. Our data was extracted from multiple-choice questions on access to SRHR services and risk of SRHR violations, and written responses to open-ended questions on threats to access and required response. The survey was answered by 51 people representing 29 countries. 86% reported that access to contraceptive services was less or much less due to Covid-19, corresponding figures for surgical and medical abortion were 62% and 46%. The increased risk of gender-based and sexual violence was assessed as moderate or severe by 79%. Among countries with mildly restrictive abortion policies, 69% had implemented changes to facilitate access to abortion during the pandemic, compared to 0 among countries with severe restrictions (p<0.001), 87.5% compared to 46% had implemented changes to facilitate access to contraception (p= 0.023). The content analysis showed that i) prioritizations in health service delivery at the expense of SRHR, ii) lack of political will, iii) the detrimental effect of lock-down, and iv) the suspension of sexual education, were threats to SRHR access (theme 1). Requirements to mitigate these threats (theme 2) were i) political will and support of universal access to SRH services, ii) the sensitization of providers, vii) free public transport, and viii) physical protective equipment. A contrasting third theme was the state of exception of the Covid-19 pandemic as a window of opportunity to push forward women´s health and rights. Many countries have seen decreased access to and increased violations of SRHR during the Covid-19 pandemic. Countries with severe restrictions on abortion seem less likely to have implemented changes to SRHR delivery to mitigate this impact. Political will to support the advancement of SRHR is often lacking, which is fundamental to ensuring both continued access and, in a minority of cases, the solidification of gains made to SRHR during the pandemic.