In the response to COVID‐19, we can’t forget health system commitments to contraception and family planning

Jill Sheffield, Chair, FIGO Contraception and Family Planning Committee

Jill Sheffield is the founder of Women Deliver, an international advocacy organization that convenes global leaders to galvanize action on maternal health and women’s empowerment. Jill is also the founder of Family Care International (FCI), a distinguished non‐governmental organization, and winner of the 2008 United Nations Population Award for outstanding work in sexual and reproductive health and rights. She received the American Public Health Association’s Lifetime Achievement Award in 2008 and the International Center for Research on Women’s Lifetime Achievement Award in 2016. She currently serves as a Senior Advisor at Global Health Strategies, is Chair of FIGO’s Contraception and Family Planning Committee, and serves as Chair of the WomanCare Global Board of Directors.

Contraceptive and family planning services and supplies are core components of essential health services, and access to these services is a fundamental human right. This standard must continue to be respected and protected as such by governments prioritizing scarce resources during this COVID‐19 pandemic. But with many health systems currently focusing on the response to the pandemic, the provision of basic contraception counselling, the delivery of contraceptive products and services, and the functioning of supply chains have been disrupted. As a result, women, men, and adolescents are often unable to obtain these services from their regular providers.

The UN Secretary General, António Guterres, recently highlighted the pandemic’s devastating consequences on women and girls, which cross every sphere: from health and the economy to security and social protection. ¹ Globally, more women and children may die due to the consequences of inaccessible and inadequate health services than will perish from COVID‐19 itself. In addition, the Secretary‐General reminds us that nearly 70% of frontline health workers are women, who shoulder a disproportionate share of unpaid care work and are critical actors in the sustainable development of all countries. Hence the need to consider our response in a larger context.

There are three perspectives and timeframes that should be kept in mind in planning a response to the pandemic.

The first priority is to understand the contexts in which we work by listening to the voices and understanding the needs of the clients. Responding to their needs should be foremost and continuous. We must foster integrated responses to contraceptive needs and ensure that the proposed solutions in the short‐ and long‐term are ethical, equitable, and support reproductive justice. Also, our responses need to be integrated, considering the work of physicians as well as the crucial roles of nurses, midwives, and community health workers. The principles of ethics and justice also demand that the public health response focus on those who are most vulnerable, and that solutions proposed are based on evidence. Given the challenges children and adolescents face for healthy growth and development, we need to consider the impact of schooling disruptions, domestic violence, and loss of opportunities for learning.

The second priority calls for health care systems to continue to respect and plan holistic response strategies to the pandemic, including not labelling basic reproductive health services (contraception/family planning, abortion services, prenatal and postpartum care and breastfeeding support) as ‘non‐essential’. It is unconscionable to consider these services as anything but essential given both countries’ human rights commitments and the well‐documented health risks for women and their infants should services be denied. Major investments in health infrastructure and supplies need to consider the Sustainable Development Goals (SDGs), which seek to enhance the wellbeing of families who could be out of work, out of funds, and out of support for some time due to the pandemic.

Within this response, innovation remains a key feature of developing health systems, in terms of how staff are deployed, how the public and private sectors work together, and how to sustain supply chains for critical contraception and other products. We must focus on new ways of delivering services, changing norms for more equitable practice and organizing new human resources for health. Powerful examples of innovation can become generalized due to the pandemic, including the enhanced use of telemedicine (e.g., through video, cell phone apps and electronic medical records), the increased use of social media for basic contraceptive information, counselling and referral, and doorstep delivery of contraceptives and medical abortion supplies through private and civil society channels.

Transportation remains critical in many settings, as even getting to a facility for delivery becomes a challenge in countries in sub‐Saharan Africa and parts of Asia, where the media has reported deaths among women walking long distances for birthing support. Local waiting homes for pregnant women have emerged in many countries as a safe place for delivery without the risks of emergency transport and infection transmission.

FIGO, through its Contraception and Family Planning Committee, calls for the increased use of long‐acting, highly effective, reversible contraceptives (LARCs), as the lack of transport and access to facilities during the pandemic places a premium on products that do not require a hospital visit or demand frequent contact with skilled providers. Increasingly we see government support for and community acceptance of self‐care methods such as condoms, oral contraceptives, self‐injection (DMPA‐SC), intravaginal rings under the control of users, as well as medical abortion. With innovation comes the need for evidence, in the form of data that demonstrate that the innovation meets the standard for promising, if not proven, best practice in changing health systems. Besides being a commitment within the SDGs, evidence‐based medicine is the surest way of providing quality care to the growing numbers of care‐seekers.

The third priority is the commitment to sustainable and continual progress. To secure the gains made in the coverage of respectful maternal care, sound investments in Sexual, Reproductive, Maternal, Newborn, Child and Adolescent Health (SRMNCAH), increased access to safe and affordable contraceptive methods, fully enabled health care providers and more equitable health systems must be sustained during the COVID‐19 outbreak and beyond. Poor and marginalized social groups (whether due to age, religion, or ethnicity) and care givers are those that suffer most with the stress of lockdowns and stark increases in workload. We should take the time to ensure that our response does not further marginalize those that are in greatest need of effective health system responses, whether in Nigeria, Bangladesh, or New York. By keeping our focus on people and communities, we can improve efficiency, enhance social and financial risk protection, increase system responsiveness to changing needs and contexts, and above all improve health and equity. The key challenge will be to keep the development of health systems present in our policy planning, investments in human and financial resources, integration of responses across health providers, and ensuring the availability of data on the adequacy of our response. We must keep critical data for decisions in front of the service users, communities, and leaders to whom we are accountable. We expect no less from FIGO and its members at this critical time—never forget that contraceptive and family planning services and supplies are core components of essential health services, and access to these services remains a fundamental human right, now and in the future.

In the words of the UN Secretary General, from this larger perspective of reproductive justice, “gender equality and women’s rights are essential to getting through the COVID‐19 challenge together, to recovering faster, and to building a better future for everyone”. ¹