Ensuring access to essential sexual and reproductive health products during COVID-19: Challenges and future directions

By Hamsadvani Anand Kuganantham, MBBS, MSc, HPPF; Independent consultant, Sexual and Reproductive Health

In this blogpost, we focus on maintaining access to key Sexual and Reproductive Health (SRH) products included in the Minimum Initial Service Package, essential maternal care medicines such as Tranexamic acid for prevention of postpartum hemorrhage and Prevention of Mother-to-Child HIV Transmission (PMTCT) kits. COVID-19 has affected health systems in an unimaginable way – but how does this affect the sexual and reproductive health (SRH) of women and their partners, and what are the implications for the future. This blogpost aims to explain the long-lasting effect COVID-19 will have on the supply chain of key SRH products and thereby, the health of women and their partners.
This blog is part of our Voices from the Front Line during COVID-19 blog series. These posts seek to facilitate timely cross- learning by sharing opinions, insights and lessons on the challenges and actions taken by those on the COVID-19 front line.

Many health systems across the world have been adversely affected by COVID-19. The global health security index shows that most countries were not prepared for new disease outbreaks. The procurement and supply chain systems for medicines, diagnostics and medical devices have also been significantly disrupted due to obstructions in usual routes of supply. Products are being stalled at the import country site due to delayed customs clearances. The manufacturers face barriers in procuring raw material. Many skilled workers from these sites are forced to find new employment causing a huge challenge. This has led to an unforeseen deficit of contraceptive medicines and devices and has put a huge strain on women and their partners from accessing essential SRH services including family planning. The effects of such disruptions are felt acutely in weak health systems, and places where there are ongoing humanitarian crises.  It also exacerbates the existing gender and socio-economic inequalities in several lower- and middle-income countries that negatively affect the access to SRH services.

It requires prioritizing the most marginalized and vulnerable populations such as refugees, immigrants, informal workers, undocumented domestic workers etc.

According to estimates, a 10% proportional decline in contraceptive use would result in an additional 49 million women with an unmet need and an additional 15 million unintended pregnancies in LMICs. If 10% of women who would opt for safe abortion in normal circumstances, undergo unsafe abortions instead (because medical abortion is considered a non-essential service during the pandemic), it would result in additional three million unsafe abortions in a year – which translates to an additional 1000 maternal deaths[1].

Responses needed in the short term

Strengthening data management systems: Many countries do not have a comprehensive data architecture to monitor their medicines and related supplies. There are issues around data quality and fear of being held accountable for poor performance. There is a need for investment in health information systems in many LMICs. Countries may need to consider aligning their communications at the National and subnational level on data sharing to understand inventory needs. This should involve setting up data systems to monitor the stock levels of key SRH commodities including those required for the delivery of the Minimum Initial Service Package for Sexual and Reproductive Health and for the provision of essential maternal care medicines such as Tranexamic acid for PPH prevention and Prevention of Mother-to-Child HIV Transmission (PMTCT) kits.  One way of strengthening data systems is by strengthening electronic health records and making it mandatory for private health care givers to share their prescription data – this is especially relevant for countries where private health spending is considerably high.

Collaboration and Partnerships: Engaging within ministerial departments, intersectoral collaboration within government (e.g. Transport ministry, social welfare, etc.), public private partnerships and even with nongovernmental organizations (NGOs) can improve access to key SRH commodities[2].

For instance, most young women in India use only one or two types of contraceptives. NGOs can use their community presence to increase awareness about different methods of contraception other than condom use, the morning after pill and tubal ligation. Nutrition and grassroots health workers (example, Anganwadi workers in India), who bridge social welfare and health care departments can help reduce the gap in access which has widened because of the pandemic.

Lastly, women who approach the health facility seeking care should be received with respect and empathy. Many times, judgmental attitude and stigma shown by health care workers present huge barriers in access to essential health care services in many settings.

Responses needed in the long term

Strengthen logistics channels at the National level – establish a robust global network

  1. One suggestion to mitigate the challenges of lockdowns is to focus on regional procurement of bulk generics (especially for chronic diseases like diabetes and hypertension) and streamlining distribution channels at the national level.
  2. Many international organizations have adapted to the new ‘normal’ and realigned their distribution hubs. Governments may consider tapping into these resources to fulfill their population needs. For example,
    • United Nations Population Fund (UNFPA) is donating reproductive health supplies, including contraceptives through their country offices.
    • The International Planned Parenthood Federation (IPPF) has established a microsite where the commodity needs are indicated to the supply team in London to take appropriate action through their local agencies.
    • The Pandemic Supply Chain Network (PSCN) is engaging with national authorities and UN partners to support the procurement, storage and distribution of critical supplies.

Conclusion

COVID-19 continues to teach us the importance of global cooperation on pooling resources, data and technology, to ensure that countries are better prepared for pandemics and other emergency situations. Better systems need to be set up to ensure a resilient procurement and supply chain structure. It is critical to understand the importance of good data systems to understand the impact of the pandemic on access to all services, especially essential SRH services and commodities, so that it would support policy and programme decisions and ensure that SRH will not be left behind.


[1] Even though it is hypothetically assumed that there is a 10% decline, messages from many frontline workers and local member organizations estimate an 80% decline in use of services

[2] However, this also requires safe-guarding the public and consumers from potential harm where necessary through amending existing regulatory laws.

Photo by Reproductive Health Supplies Coalition on Unsplash