By Letícia Plaza
In times of crisis, the rights of the most vulnerable are often threatened. When these situations are analyzed through a gender lens, the negligence becomes even more evident. Sexual and reproductive health and rights (SRHR) are always affected in crisis scenarios, such as the current moment of the COVID-19 pandemic (CARUANA-FINKEL, 2020), and are more than likely to be the first ones to be targeted. The situation of SRHR across the world has been consistently critical throughout History due to gender biased politics that aim to control female bodies and marginalize LGBTI persons, but COVID-19 has turned it into a catastrophe (SALOMÓN; ALFORD, 2020).
Over the past several months, already high rates of sexual violence (besides other forms of domestic and gender-based violence) have increased exponentially around the globe, following the economic crises, high unemployment rates and severe income insecurity. As a result, women and girls are isolated with their abusers without access to a phone, a computer or any person or service they could contact for help or support (SALOMÓN; ALFORD, 2020), leading to a rise in the numbers of unwanted pregnancies, as well as sexually transmitted infections (STIs). In addition to a worldwide shortage of contraceptives and safer sex products [1], the circumstances highlight the urgent need to ensure SRHR services everywhere (CARUANA-FINKEL, 2020).
Nonetheless, the pandemic has been capitalized by far-right politicians to promote their anti-human rights agenda (CARUANA-FINKEL, 2020), undermining SRHR milestones, using the COVID-19 crisis as an excuse to refuse access to the few existing sexual and reproductive health services by classifying them as non-essential (AHMED et al, 2020). Lockdowns and social distancing, although necessary to slow down the COVID-19 pandemic, have added more barriers to the access of SRHR services (SALOMÓN; ALFORD, 2020), which include sexual and reproductive health care, menstrual hygieneproducts, antiretroviral therapy, contraceptive (such as the pill and the IUD — the intrauterine device), and safer sex products (such as condoms and lubricants), self-testing kits for STIs, and safe abortions (WORLD HEALTH ORGANIZATION [WHO], 2020). To help to illustrate the proportion of these concerns, the United Nations Population Fund (UNFPA) (2020) has estimated that, after six months of lockdown, due to compromised access to SRHR services, more than 47 million women would be left unable to use modern contraceptives, which, in addition to 31 million cases of gender-based violence, would lead to a projected 7 million additional unintended pregnancies.
However, these figures vary across the world, since the pandemic has exposed and intensified many social inequalities between countries and social groups (CARUANA-FINKEL, 2020). Because SHRH laws and access vary across the globe, low- and middle-income countries, as well as marginalized groups everywhere, such as black, indigenous and latino communities, the LGBTI population, people living in poverty, people with disabilities, undocumented migrants, refugees, adolescents, and survivors of domestic and sexual violence are at elevated risk of having their sexual and reproductive rights jeopardized.
According to an analysis carried on before the pandemic by the United Nations International Children's Emergency Fund (UNICEF) (2019), in Africa, Asia, Latin America and the Caribbean, more than 5 million families had already spent more than 40 percent of their annual non-food household expenditures on reproductive (especially maternal and neonatal) health services. Alongside the pandemic's negative economic outcomes, the poorest families are likely to encounter even more barriers to access these resources (CASAS, 2020).
In the United States, 11 states have tried to block access to abortion since the beginning of the COVID-19 crisis. Similarly, Poland is considering passing new legislation in order to eliminate legal access to abortion in the few cases where it's permitted, and to criminalize sexual education (CASAS, 2020). Poland is one of the six European countries where abortion is illegal or severely restricted (along with Andorra, Liechtenstein, Malta, Monaco, and San Marino), which were called by a joint civil society statement in Europe, signed by 100 organizations, to urgently reform their conservative laws, which place women’s health and lives at risk, especially in the context of travel bans and limitations during the pandemic. The joint statement also urges countries where abortion is legal but where services are unavailable to urgently eliminate barriers to ensure access (AMNESTY INTERNATIONAL, 2020).
Marie Stopes International, an organization that works providing access to sexual and reproductive health services in many countries, has reported that, because of the pandemic, supplies have never arrived in Uganda and Zimbabwe and that this shortage of contraceptives is expected to happen in many other African countries (CASAS, 2020). The International Planned Parenthood Federation, on the other hand, was forced to close thousands of their facilities around the world due to government orders or social distancing needs in Colombia, El Salvador, Pakistan, Germany, Ghana, Malaysia, Sri Lanka, Sudan, Uganda, Zambia, and Zimbabwe (each had to close at least 100 facilities) (CASAS, 2020).
In Latin America alone, it is estimated that the rise in poverty levels, in addition to the shortage of medical supplies, will leave more than 18 million women without access to any contraceptive method (UNFPA, 2020). Whilst governments such as Argentina's and Mexico's have released official statements, in alignment with WHO, demanding that sexual and reproductive health services are characterized as essential, in Venezuela, due to travel restrictions, thousands of women are prevented from traveling to Colombia to obtain contraceptives or legal abortions (BRUNO, 2020).
In Brazil, the federal government's negligence towards the pandemic, along with a historical inquiry against sexual and reproductive rights that has become even more extreme during the current political landscape, the situation is cataclysmic. Whereas last year, in 2019, only 76 hospitals performed legal abortions [2] in Brazil (a country of 210 million people) - out of 176 institutions that were officially registered -, currently, in 2020, after the impact of COVID-19, merely 42 facilities keep performing the procedure - which represents a decline of 55% (DA SILVA; FERREIRA, 2020).
The urgency of this situation was made evident last month, in August, when a 10-year-old child in Espírito Santo State, in Brazil, became pregnant after 4 years of repeated rape by her uncle. Although legal abortion was guaranteed by law, since she fit two of the three exception criteria to which it is permitted (pregnancy resulting from rape and endangerment of her life, being pregnant at such a young age), the hospital where she was admitted refused to perform the procedure, claiming they did not have the authority to do it. After the judiciary interveined, she had to travel to another state (Pernambuco), almost 2000 km away from home, so she could finally get the abortion done, which happened on August 17th. But her suffering did not cease there - after the judge's order, Sara Fernanda Giromini, known as Sara Winter, an anti-abortion self-proclaimed activist, published on the internet the girl’s name and the name of the hospital where the procedure would take place thus committing a crime under Brazilian law, according to which nobody may mention the name or image of a child without permission. As a result, anti-abortion protesters tried to block access to the hospital and harassed its personnel. The child victim had to enter the facility hidden in the trunk of a minivan, where she was holding on to two stuffed animals (STARR, 2020). The Brazilian Minister of Women and Human Rights, the evangelical pastor Damares Alves, is accused of having been involved in the attempts to prevent the girl's legal right to the procedure, as well as leaking confidential information about the girl's name and whereabouts, according to Brazil's most influential newspaper, Folha de São Paulo (VILA-NOVA, 2020).
Unfortunately, this was not an isolated incident, and this case represents the reality of many women, children and LGBTI persons in Brazil. It was estimated, before the pandemic, that 4 girls aged up to 13 were raped every hour in Brazil, but these numbers are believed to have increased during the lockdown, since, in most cases, the rapist is a close relative that lives in the same house as the victim (STARR, 2020).
In May, anticipating this scenario, in the same week when the first meeting of Generation Equality was scheduled, marking the 25th anniversary of the landmark Beijing Declaration and Platform for Action (cancelled due to COVID-19), 59 governments [3] decided to issue a statement urging governments to protect SRHR in the context of the pandemic. The document encourages that, in the absence of a global meeting to reaffirm the global commitment to gender equality, the governments should commit to ensure that this crisis does not reverse progress already made on guaranteeing human rights for women and girls. They also include the recommendation that governments should prioritize “sexual and reproductive health needs, including psychosocial support services, and protection from gender-based violence”, and recognize the central role of Universal Health Coverage (UHC) in health emergencies such as the COVID-19 pandemic (KLASING, 2020). They also call on the efforts of multilateral organizations, including by the UN, UNFPA and UN Women, WHO, the World Bank and IMF, and regional development banks, as well as the G7 and G20 declarations, towards a coherent and global response to COVID-19 that are sensitive to SRHR (SWEDEN, 2020).
Non-discriminatory access to inclusive health services, which include sexual and reproductive health, is a human right protected under international law (and domestic law, in most countries). Sexual and reproductive health concerns are fundamental aspects of the pandemic, and should be addressed as such - which means their categorization as an essential service. Denying these services leads to undermining millions of people, especially women and girls, to recover from this pandemic (CASAS, 2020). Concurrently, denying or delaying abortion access for rape survivors is categorized as torture, which is also criminalized by international human rights law (STARR, 2020). Notwithstanding, the increased numbers of pregnancies and consequent unsafe abortions, as well as the rates of infections by HIV and other STIs, as a direct consequence of the negligence of SRHR, will certainly increase pressure on already overburdened health systems (CASAS, 2020). It is the governments' responsibility to ensure that all of these services are accessible in every way possible (which includes the coverage of expenses by the state) (CASAS, 2020).
COVID-19 turned the world upside down, reshaping humanity's ways of dealing with pretty much everything.. Although the human cost is immeasurable, this moment may pose an opportunity to learn and reshape the health system in general. This might include universal health coverage, and also the use of telemedicine in sexual and reproductive health services. Contraceptives, safer sex products and even abortion methods can be delivered at home and used in a safe manner, and health care professionals are able to assist and monitor their patients remotely. Expanding access to medical abortion at home has already been done in England, Scotland and Wales, and it has shown successful results. In regions with limited access to technology, the state should be even more cautious and make sure that both health professionals and patients are safe, by providing them with the needed resources (CASAS, 2020). The international community and multilateral organizations, especially UN agencies and WHO should also commit to providing financial and logistical support to countries in need.
[1] Shortages of medications — such as contraceptives, antiretrovirals for HIV/AIDS and antibiotics to treat bacterial STIs — are observed worldwide due to disruptions in supply chains overall. China, the world' second-largest exporter of pharmaceutical goods, has shut down several drug-manufacturing sites, delaying Indian factories production of generic medicines (AHMED et al, 2020). Manufacturers warn of a global condom shortage as consequence of manufacturers being locked down. The shortages of contraceptive supplies increase the risk of STIs, unplanned pregnancy, and the need for abortion (CASAS, 2020).
[2] In Brazil, abortion is not criminalized in cases of pregnancy resulting from rape, when it is necessary in order to save a woman's life, or when the fetus suffers from anenceephaly. However, even in these situations, bureaucratic and social barriers are put upon women and girls to prevent them from undergoing this time-sensitive procedure (DA SILVA; FERREIRA, 2020).
[3] Albania, Argentina, Armenia, Australia, Austria, Belgium, Bolivia, Bosnia-Herzegovina, Bulgaria, Canada, Cabo Verde, Costa Rica, Croatia, Cyprus, Czech Republic, Denmark, Ecuador, Estonia, Fiji, Finland, France, Georgia, Germany, Greece, Guinea, Ireland, Iceland, Italy, Japan, Latvia, Lebanon, Liberia, Liechtenstein, Lithuania, Luxembourg, Madagascar, Mexico, Moldova, Montenegro, Namibia, Netherlands, North Macedonia, New Zealand, Norway, Peru, Portugal, Republic of Korea, Romania, Serbia, South Africa, Slovenia, Spain, Sweden, Tunisia, Tuvalu, Switzerland, United Kingdom, Ukraine and Uruguay.
References
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