The COVID-19 pandemic has had and will continue to have a profound impact on the lives of people across the globe, as well as health and social systems, and national economies. This upheaval will also have a profound impact on access to family planning information and services, as well as sexual and reproductive health more broadly. Thus there is a need to address the possibility of an unintended baby boom among poor and vulnerable groups.

Despite this disruption, the need for family planning will not change. For most women, family planning is critical, basic health care. As health systems shift to prevent and treat people with COVID-19, it is essential they also protect access to family planning services.

Globally, the unmet need for contraception remains too high. It’s estimated that 214 million women and girls are not using modern contraception, despite wanting to avoid pregnancy. And this was before the COVID-19 pandemic, which is set to further derail access to contraception for women and girls around the world.

The International Planned Parenthood Federation (IPPF) surveyed its member associations in 121 countries to produce the largest global dataset so far on how the COVID-19 pandemic is affecting sexual and reproductive healthcare.

“Millions of women and girls across the world now face an even greater challenge in trying to take care of their own health and bodies, “ said IPPF’s Director General Alvaro Bermejo in a statement. “They have needs that cannot wait, but they are facing a lack of time, lack of choice and lack of access to essential services.”

“Unless governments act now, up to 9.5 million vulnerable women and girls risk losing access to our contraception and safe abortion services in 2020 due to the COVID-19 pandemic,” warned the organisation in a statement.

According to this group’s estimates, service disruptions related to COVID-19 in the 37 countries where they operate could lead to an additional 3 million unintended pregnancies, 2.7 million unsafe abortions and 11,000 pregnancy-related deaths.

Interrupted supply chains

Lockdown measures taken globally to respond to COVID-19 are bringing major disruptions to contraceptive supply chains. Large manufacturers of contraceptives in Asia have had to halt production or operate at reduced capacity, and we may see similar developments in other regions as COVID-19 takes hold.

For example, the world’s largest condom producer – Malaysia’s Karex Bhd – which makes one in every five condoms globally, was forced to close for a week in March and only given permission to reopen at 50% capacity. Production of intrauterine device (IUD) in India – a major global producer of IUDs – has come to a standstill with the Indian government also curtailing export of any product containing progesterone, a key component of a number of contraceptives. In addition to this, the closures of borders and other restrictions imposed in the face of COVID-19 further affect the shipping and distribution of commodities.

Delays in the production and delivery of contraceptive supplies at global and national levels will lead to stock outs of supplies, severely impacting contraceptive access.

Obstructed access

Beyond this, at country level, sexual and reproductive health services, staffing and funds may be diverted to support COVID-19 responses, leaving women and girls unable to access contraceptive and other sexual and reproductive health care. Provision of sexual and reproductive health services will also be affected by infection prevention measures, including health workers’ access to personal protective equipment (PPE).

Even where contraceptives are available and continue to be provided through clinics or pharmacies, the impact of COVID-19 on women’s and girls’ lives will curtail their access in multiple other ways. Quarantine measures and mobility restrictions will affect women’s and girls’ ability to seek out contraceptive services. Financial insecurity and additional caregiving burdens brought on by lockdown measures will be further impediments. Marginalized populations will face additional barriers.

Beyond covid-19

Government and NGO should be working to understand the stresses being placed on our doctors and nurses, thus to deliver as much direct support as possible, they should actively monitor the impact of COVID-19 on the supply of contraceptives and other sexual and reproductive health commodities, and to work with partners and manufacturers to do what we cannot do to solely to meet the needs – to ensure continued availability of supplies.

Both government and NGOs should also work to identify opportunities to modernize their service offering to respond to the rapidly changing landscape, with a view to expanding no touch and digital services and self-management of care, and make a strong case for additional resourcing in these challenging times.

 National governments, donors and international agencies – to recognize sexual and reproductive healthcare, including contraceptive services, as essential in this crisis, and to take measures to address disruptions in supply chains and ensure continued service provision at different levels.

If women, girls and marginalized communities cannot access contraceptive care in this crisis, we can expect to see a rise in unintended and forced pregnancies, an increase in sexually transmitted infections, including HIV, and, ultimately, a sharp rise in unsafe abortions. The impacts on women’s and girls’ lives now, and beyond this crisis, will be unthinkably severe.