It is a well-established fact that health and humanitarian emergencies differentially impact vulnerable population groups, particularly women and girls. They are often the first to suffer the consequences of overburdened health systems and a limited resource envelope, as governments realign their policies and programmes to address emerging challenges. The COVID-19 pandemic is no exception and it continues to have an unequal, compounding, and devastating impact on women and girls.
Despite global consensus on sexual and reproductive health and rights being essential components of comprehensive healthcare, persistent challenges in ensuring the provision of these services have existed even prior to the pandemic.
For centuries, socio-cultural norms have put women at a disadvantage and inhibited their ability to make decisions regarding their own body. Although family planning and sexual and reproductive health are predominantly considered a ‘woman’s business’, the number of children women have and when they have are often not decisions women make for themselves. Social norms, taboos and prejudices act as barriers and prevent women from accessing social and reproductive services as well as negotiating contraception with their partners.
According to the fourth National Family Health Survey (NFHS-4 2015-16), 13 per cent married women had an unmet need for family planning. Only 18 per cent female respondents said a health worker had spoken to them about family planning and 8 per cent of all women between 15 and 19 years of age were already mothers or pregnant at the time of the survey. As a result, many women are compelled to resort to abortion, often as a proxy for contraception. To quote a 2015 study published in the journal The Lancet, 15.6 million abortions took place in India in 2015.
Several studies projecting the impact of the pandemic on women’s sexual and reproductive health needs and rights have forewarned grave consequences, if timely measures are not taken. COVID-19 has reportedly restricted access to abortion services for nearly 1.9 million women and could limit access to contraceptives for more than 25 million couples in India. Not only has COVID-19 exacerbated pre-existing challenges, but it could also potentially undo years of progress, given that ensuring access to sexual and reproductive health services is fundamental to reducing maternal and neonatal mortality, reducing poverty, and attaining gender equality.
Sexual and reproductive health rights have a direct bearing on women’s bodily autonomy and integrity, and a fundamental bearing on their wellbeing, as does the decision to stay in school instead of getting married young. It influences women’s empowerment and their ability to reject domestic violence, participate in the workforce and decision-making.
A range of social and economic factors influence a woman’s decision-making abilities. Gender-unequal norms and power imbalances in relationships restrict women’s health and fertility decisions. For instance, in many Indian homes, the notion of consent in a marriage is considered irrelevant because sex, even if forced, is thought to be a marital duty and not a matter that requires consent. Universal access to sexual and reproductive health services is dependent on overcoming barriers in laws, policies and social norms that keep women and girls from accessing information about sexuality and reproduction and using necessary healthcare services.
Going forward, efforts must be made to ensure that women’s sexual and reproductive health and rights don’t remain on the fringes. Targeted, evidence-based social behaviour change communication strategies are critical to transform gender-unequal attitudes, deeply engrained beliefs and societal values pertaining to women’s sexuality.
Comprehensive sexuality education (CSE) aimed at sensitizing young people regardless of gender is key to fostering healthy discussions and attitudes at a foundational level. Age-appropriate CSE that encompasses gender identities, bodily autonomy and integrity as well as disease prevention, among other issues, is widely recognised an effective way of enabling young people to become aware of personal hygiene, gender identities as well as safe sex practices.
Prioritizing women and girls’ sexual and reproductive health and rights necessitates a shared vision among key stakeholders, which includes the government, civil society organizations and private providers. In light of the pandemic, the government must re-evaluate its priorities and ensure system preparedness to combat health emergencies without compromising access to essential sexual and reproductive health services. COVID-19 response and recovery efforts must be inclusive and ensure that no one is left behind.