As global health leaders, governments, civil society and NGOs grapple to overcome the COVID-19 pandemic, the voices of women and girls remain largely unheard. The Coronavirus Global Response launched by the European Commission has raised €9.8 billion to date to combat the pandemic; however, allocations explicitly for the protection and continued provision of routine services for women, adolescents and children have not materialised (the majority of funds are earmarked for vaccines development, deployment and diagnostics).
Some support to health and nutrition services for women and girls has come from some countries – for example, the Netherlands, and under the UK government’s commitment to the global coronavirus response, £10 million will go directly to United Nations Population Fund’s (UNFPA) response to COVID-19.
But more funding is needed to reverse the disastrous effects of COVID-19 on women and girls.
The threat to women and girls' health
We know that despite the ongoing pandemic, women and adolescent girls will become pregnant and require timely, comprehensive reproductive and paediatric health services. And during this crisis, women and adolescent girls still need access to sexual reproductive health (SRH) services.
We have learnt from past disease outbreaks, such as Ebola in West Africa and more recently in the Democratic Republic of Congo, that disruption to these routine health services can lead to sharp increases in maternal mortality and can have detrimental effects on women and adolescent girls who are at risk of sexual violence, exploitation and unintended pregnancies. During the Ebola outbreak in Sierra Leone, a significant decrease in access to routine maternity services was followed by a 34% increase in facility-based maternal mortality and 24% increase stillbirth rate. Further, the country experienced an alarming rise in the rate of adolescent pregnancy.
Increase in child and maternal deaths
A recent study in the Lancet modelled three scenarios, using the Lives Saved Tool (LiST) tool, concluding that reductions in coverage of routine essential health services due to COVID-19 would cause a 9·8–44·7% increase in under-five mortality per month and 8·3–38·6% additional maternal deaths per month. In the most extreme case, disruption to routine health services predicted more than 1 million child deaths and 56,700 maternal deaths over six months.
Given that pregnancy and childbirth-related complications are the leading cause of death for young women aged 15–19, a spike in maternal mortality will include adolescent girls.
Missing out on healthcare
Several months into this pandemic, government-mandated ‘lockdowns’ have disrupted access to routine essential health services across the world. Maternal, newborn and child health practitioners in Nepal, Bangladesh, Nigeria and Brazil have reported fewer women accessing antenatal services as shutdowns of public transport, curfews and unclear public health messaging have discouraged women from accessing facility-based services.
Further, diversion of health personnel and resources from reproductive health services to the COVID-19 response has diminished the level of services available. In many countries frontline health workers, who are disproportionately made up of women nurses and midwives, are left exposed to the virus due to the lack of personal protective equipment (or PPE). Healthcare workers are also fearful for their own safety as they are forced to work without proper protection and guidance.
Governments must prevent these grave disruptions to the care of the community. Facility-based care is essential for the treatment of pregnancy-related complications and illnesses.
Rising violence against women and girls
UNFPA predicts that lockdown-related disruptions could lead to an additional 2 million cases of female genital mutilation and an additional 31 million cases of GBV after six months. In April, UN Secretary-General Antonio Guterres called for a domestic violence ceasefire following the global surge in violence against women and girls.
Disruption to counselling services provided through SRH clinics has come at a time where reports of gender-based violence (GBV) have risen globally. These services are an important safety net for vulnerable women and girls and a key entry point for women and their children to receive critical reproductive and paediatric healthcare.
What must change?
Prior to the outbreak of coronavirus, women and girls already bore a heavy burden of health inequality. Now the pandemic will deepen existing gender inequalities. Only the prioritisation of the health and rights of women and girls will offset this.
- Governments must define routine reproductive and paediatric health care as essential life-saving services that should be funded and maintained throughout the crisis, free at the point of use.
- There is a critical need to address financial barriers that exclude the most vulnerable women and girls from accessing these services and a need to sustain adolescent-friendly services.
- Frontline health workers providing health services to women and children must be protected with the necessary PPE to maintain their work.
- Access to reproductive and paediatric health services should be facilitated throughout the crises. This includes clear public health messaging to inform the public and frontline health workers; sustained provision of reproductive and paediatric health commodities to be used in facilities or at home; and preventing the diversion of resources away from reproductive health services to the COVID-19 response.
As donors pledge commitments to the global COVID-19 response, they must collaborate with world leaders to prioritise reproductive health services and address the most pressing needs of women and girls globally. COVID-19 has rocked our world, yet the secondary impact on population health threatens to destabilise us even further and will disproportionately affect people in low-resource settings.
Governments must look beyond the acute need and invest in essential primary health care services to maintain the health of their people, particularly women and girls.
Essential healthcare