Venue: Development Communications (DevComs) Network Zoom Meeting
By Professor Josiah Mutihir
The Global Corona virus (Covid–19) pandemic is no news to any one anymore including the rising infection rates, isolation centres, cure/discharge rates and unfortunately significant deaths ravaging the whole world. The pandemic has had and still has enormous effects on all economies worldwide. Individuals, families, communities are hard hit by poor resources to meet basic needs including feeding. Someone has said: if you stay indoors, you die of hunger and if you stray outside the house, you die of coronavirus!
Covid-19 has also had a negative impact on access to family planning information, and services.The other side of the pandemic is the accompanying preventive measures that necessitate restriction of movement, and the stay home order culminating in ‘partial or total lockdowns.
Families are compelled to stay home, day and night for periods of between 1 to 12 weeks depending of the country or state. This has brought the husband and wife or spouses face to face for long periods. Idleness has set in, and increased sexual desires and activity result.
Where the woman is not protected, unwanted pregnancy is the likely outcome in most instances where the woman is still in the reproductive age and is not on any method of contraception.
As of 22nd April, more than 182,000 deathshave been reported from Covid-19 globally, and health systems have concentrated on ONE thing namely the limiting of the impact of the pandemic. There are, however, other important health issues with far reaching consequences that cannot be ignored, notably family planning and Reproductive health.The need for family planning does not disappear during a pandemic and therefore should not be ignored or neglected.
Already, there has been the disruption of supply chains of contraceptive commodities, closure of health clinics providing FP information, counselling, and public fear about visiting health facilities at this time of lockdown.
The gains in uptake of modern FP methods in the country over the years is likely to be lost during the pandemic with serious short, medium and long-term consequences.
Family planning is a life-saving intervention mitigating increased morbidity and mortality resulting from unintended pregnancies.
It is estimated that a 10% proportional decline in the use of contraceptive methods (caused by reduced access worldwide) would result in additional 49 million women with unmet need for FP, and 15 million unintended pregnancies within the course of the year.
The Restriction of Movement:
– Everyone is home and of importance, husband and wife
Nothing doing (idleness), sex, sex, pregnancy mostly unwanted / undesired. Sex, a ubiquitous daily meal on the human menu list, and an ancient narrative in human discourse whose narration is as old as humanity, is to blame
– Gender-based violence has increased– wife battering, rights abuses, etc, husband wanting to have his way whenever he wants sex; wife afraid of pregnancy and refuses to give in, and therefore problems.
Contraceptive access and family planning are essential services and also a human rights issue.Access to FP services have been limited since the beginning of the pandemic. Lockdown and quarantine orders have meant that women, girls and men are unable to access family planning and RH needs as they cannot leave their homes. The lockdown orders have led to massive job losses, school closures, and the fear of seeking out anything but the most urgent (emergency) medical care.
The main reasons whyaccess contraception is critical at this very time are:
- The chain of contraceptive supplies have been disrupted
- Health facilities providing contraceptive services have closed (most hospitals attending only to mainly emergencies)
- Restricted movement of health care providers providing family planning services
- Lack PPE for health care providers to offer services
- General restriction of movement of clients seeking family planning services
- Women seeking information,counseling, initiation, follow-up, renewal or replacement of methods are unable to do so
- Absent resources to purchase contraceptive methods
- The threat to peace and harmony in the home (between husband and wife)
- Imminentunwanted pregnancy and its consequences
- The prevention of maternal morbidity and mortality
- The reduction in gender violence arising from sex related issues
Nigeria enjoys a robust modern contraceptive method mix. Fortunately, non-prescriptive methods are available as over-the-counter products in Pharmacies which are open during the lockdown e.g. condoms, OCPs, Emergency Contraceptives, injections, etc.The emergency contraceptive methods where available should be used such as the Post pill (one 1.5mg tab), EllaOne tab, and other emergency contraceptive pills.
The prescriptive methods are in Family planning clinics which have been closed down, considered as non-essential service.
In the absence of the modern methods of contraception being handy, the natural methods can be brought to bear particularly at this time when health care workers are unable to also move to provide services.
The pandemic has not stopped child bearing in pregnant women. This creates an opportunity for the provision of postpartum or post-miscarriage insertion of intrauterine device.
Information sharing of messages about FP in addition to online or hotline counselling are also available. Fortunately for this internet age, Mobile Apps exist for family planning and can be accessed freely. The Apps determine the fertile period of the woman and then the couple abstain for a period or usemale or female condoms, vaginal spermicidal agents, or the use of non-penetrative sex. We all know that abstinence at this time is a challenge.
Family Planning Apps
- Period calendar
- Fertility Friend
- Fertility Friend Ovulation App
- Glow fertility
- Natural cycles
- Heperian Health Guides
And still counting
The Federation Internationale de Gynecologie Obstetrique (FIGO) has made a statement on Family Planning Services during the Covid-19 Pandemic as follows:
- Social distancing and limitations on mobility speaks to an urgent need to expand postpartum family planning services,particularly long-acting reversible contraceptives [LARCS] such as postpartum IUDs, contraceptive implants or
- Self-care family planning methods should be promoted and supplied to women and men proactively
- Barriers to accessing contraception need to be lifted
- Implement telemedicine using mobile phones and social media as an adjunct to improving information and access tocontraception
- The need to anticipate and address likely supply chain needs and challenges
- Health care workers must be provided adequate Personal Protection Equipment (PPE)
Continuing to offer long-acting, reversible contraceptives, such as intrauterine devices and contraceptive implants to new users where possible, with counselling being done through telehealth, and with adequate safety preparation for the procedure would be helpful.
The use of digital tools for sharing self-care and family planning information through FP Apps would help clients make FP decisions on their own, or with remote support from a trained counsellor. It includes interactive exercises of FPcounselling and ‘method choosing’; to help women select the best contraceptive for their individual needs.
There is the willingness of many partners and government, service providers and the clients to make these services available and utilised for the benefit of all.
Conclusion: Since the onset of Covid-19, partners around the world – including governments, donors, and service delivery groups – have affirmed the critical importance of ensuring that women and girls have reliable access to high-quality contraceptive services during the pandemic. Nigeria faces unprecedented challenges on how this can be achieved.
In addition, gender-based violence which has increased, probably related to sexual issues for which the woman is not comfortable for fear of unwanted pregnancy.
There is therefore the need to sustain family planning information provision, available and affordable services, and uptake at this critical period.
Adequate and clear information for the public on family planning methods, using telehealth, particularly the natural / other methods that can be practiced at this time of dire need when the other methods cannot be accessed
Public enlightenment that many Contraceptive Methods are available in the Pharmacies, which are not closed at the moment
Relevant authorities to put ACESSING family planning service as Essential Serviceand therefore should be on the exemptionlist for restricted movements
Reproductive Health department of FMOH to come up with strategies to provide commodities using the last-mile distribution network to get as far as possible to the grassroots at this time
Free commodities in addition to free consumables at this time to make unfettered access to all clients (transporting these should be put on essential list.) to include Private Clinics, Not-for Profit health Facilities, Private Pharmacies, etc
Strategies or device ways of reaching out to the sexually active persons in particular, with various contraceptive methods
Encourage the use of family planning Apps where nothing else is available. Use in combination with the condoms, spermicides, etc
Family planning clinics to re-open and treated as essential service, and clients seeking FP be allowed unfettered access. Supported by the MEN
Where the opportunity presents, women should be offered long-acting methods to desiring women after due counselling and informed counselling
Women having deliveries in health facilities be given postpartum or post-miscarriage IUDs before discharge after counselling and informed consent.
- Sunday Tribune, 13 October 2019: UNILAG and the sex narrative in the Villa, 2019
- Statement on Family Planning Services during the Covid-19 Pandemic from FIGO. Accessed 20th April 2020.
- Ensuring quality FP Services during Covid-19 Pandemic. Jhpiego, 16th April 2020.
- Desmon S. Family Planning still needed during pandemic. Johns Hopkins Center for Communication Program, 2020; accessed 21st April 2020.
e. Gender-based violence. Heperian Health Guides: WHO cares about your health 2020.