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.