Can She make her safe choice in times of Covid-19?

Since mid-2018, Rutgers is implementing the programme She Makes Her Safe Choice, funded by the Dreamfund of the Nationale Postcode Loterij and in partnership with DKT International and several other partners. The programme applies a multi-component approach and works to prevent unsafe abortions in different geographic locations and at various levels, with complementary activities on Supply, Demand, and Support. While it is early days and everyone is struggling how to deal with the Covid-19 crisis, it is clear that also for the She Makes Her Safe Choice programme, impacts will be felt and the reality on the ground will forever be changed.

Impacts on Supply

A global shortage of contraceptives and safe abortion products, and disruptions in the supply chain of reproductive health supplies are expected, as DKT International already warned in early March. In Asia, manufacturing of contraceptives was halted or disrupted, international shipments by air and sea have come to a standstill, shipments are quarantined at ports of entry and clearance procedures are delayed, and in-country distribution of products to clinics and pharmacies is difficult or impossible due to local restrictions on movement and transport. In early April, stocks are still available in Kenya and Ethiopia, but these will soon run out. In Francophone West-Africa, where our programme started in January of this year, the Covid-19 crisis is already causing stockouts of all kinds of medical products and equipment. With no new supplies entering these countries, long-term stock-outs are expected.

As lockdowns and government restrictions on movement, transportation and meetings persist, patient flows to clinics will decrease for our service providing partners such as FGAE, Ipas and RHNK. And when patients do come, facilities might be urged to give priority to Covid-19 cases. Women’s access to contraceptives and safe abortion services will be severely limited, which will result in increased numbers of unintended pregnancies, STI and HIV infections, and increased mortality related to unsafe abortions. To the best of our partners’ ability, service provision in clinics and pharmacies currently continues, but we also note that service providers, for example in Kenya, have insufficient Personal Protective Equipment (PPE) for them to provide quality care to (potentially) infected patients. Social distancing measures also mean that our partners are unable to provide field supervision to local distributors, and movements of medical sales personnel are restricted or impossible. Also, training and mentoring support to service providers and pharmacists have been postponed, as partners search for alternative ways to reach out to them.

Impacts on Demand

In-person contact is the key element of many demand generation activities in our programme. Social distancing measures because of Covid-19 mean that our partners are unable to organise community outreaches, public events, peer-educator sessions and awareness-raising campaigns. DKT, known for its billboards with contraceptive ads along main roads, has limited reach with this marketing strategy, as most people are confined to their homes. FGAE mass awareness campaigns on safe abortion and family planning have been postponed, as universities, factories and plantations in Ethiopia are closed. While some demand creation and awareness raising can be done via traditional and social media, such as Triggerise’s Tiko system, the impact of these campaigns will be less if the subsequent referral to health services cannot take place as planned. For our partners this means that a decline in service uptake is expected.

Impacts on Support

Understandably, government’s priority in many countries is now on fighting the Covid-19 pandemic. However, reallocation of resources towards Covid-19 may limit government’s attention and funds for SRHR interventions. Our partners’ concern is that reproductive health service, in particular safe abortion services, will be regarded as less or non-essential. There is a strong plea from our partners in different countries not to forget about SRHR, contraceptives, and safe abortion care and services.

Governmental restrictions on meetings and gatherings, coupled with social distancing measures, also prevent our advocacy partners in the programme to engage with policymakers to advance guidelines and regulations for better access to safe abortion and contraception. Partners are facing delays in planned advocacy activities at national and sub-national levels; SRHR and safe abortion advocacy forums are postponed, and community advocacy activities cannot take place. In Kenya, the scheduled launch of the Post Abortion Care guidelines end March was compromised, which means that providers have to wait longer to receive the subsequent trainings on the guidelines. Together with our partners, Rutgers is investigating means of continuous advocacy for safe abortion and contraception to remain accessible and recognised as essential services, even as resources and mobilization are dedicated to Covid-19.

Alternative strategies being explored

Despite the impact on our partners’ staff and activities, and the complexity of the situation, our partners quickly started sharing alternative strategies. Most partners already play a role in the provision of information and combating Covid-19, for example by communicating on social media with Covid-19-related messages, by sharing simple platforms (developed in local languages) to help people evaluate their exposure to the virus and identify their risk level, or by printing and disseminating information posters and leaflets within health facilities.

The respective DKT offices try to stock up on products as much as possible, and DKT Kenya focuses on online purchase and tracking of commodities during this period. DKT WomanCare Global provides information on how safe abortion care can take place in times of Covid-19 with the Ipas MVA aspirator in out-patient services. Our partners are also preparing for testing of virtual training options for service providers and pharmacists, and preparing information packages with safe abortion information on USB flash drives.

Partners are also planning to invest more in radio and TV promotions of contraceptives to reach people at home, and partners are increasingly turning to online channels to reach women and young people with SRHR information, for example through digital health talk shows, tweet-a-thons, and social media engagements. Rutgers supports its partners in setting up more online activities, and in integrating Covid-19 information into their various messaging. At the same time, while online training and outreach alternatives are being explored, we realize that these cannot be the solution for all foreseen trainings and activities under the programme.

Innovation & Opportunity

Our partner Shujaaz Inc. in Kenya has responded swiftly and proactively to the crisis by setting up a special Covid-19 prevention campaign #LindaFam (Protect Your Family), engaging 7.5 million young people in Kenya and Tanzania. Information on Covid-19 is shared, key themes such as unintended pregnancies continue to be addressed, and the young audience is encouraged to become positive actors of change in their communities.

The Covid-19 crisis also provides an opportunity, as increases in self-care and the use of telemedicine are expected. In Kenya, our partner RHNK is preparing their providers with up-to-date information on self-care with Medical Abortion. And overall, our programme’s mHealth component will contribute to these developments and expand online options for providers and women to access information, Medical Abortion pills, counselling, and referral to physical care when needed.

Apart from the necessary prevention and care around Covid-19, donors and development partners must continue to invest financial and technical resources in civil society and public and private health care providers, so that they do not collapse. This ensure that when this pandemic is over, there still exist service delivery points with trained providers and quality products, advocates, trainers, distributors, counsellors, educators, researchers, campaigners and trained safe abortion providers who can ensure together that She Makes Her Safe Choice.

Best practices to avoid contamination and transmission by She Makes Her Safe Choice partner DKT WomanCare Global

Further Reading

• WHO COVID-19 website
• IPPF Covid-19 page
• UNFPA’s Covid19 resources – news and technical briefs
• CRR statement
• FIGO statement
• CNN opinion article by Serra Sippel, Centre for Health and Gender Equity
• International Campaign for Women’s Right to Safe Abortion – Call to Action
• Inter-Agency Working Group on Reproductive Health in Crises – Covid-19 resources page

Author: Saskia Hüsken – Senior Technical Advisor