FAILURE by young women and girls to access modern contraceptives and reproductive health services during the lockdown could spell doom and possibly reverse the gains that have been attained in terms of reducing Early Unintended Pregnancies (EUPs).
By Michael Gwarisa
According to the Zimbabwe Demographic Health Survey (ZDHS) 2015, sexually active unmarried women are more likely to have the highest risk of unintended pregnancy. This is because more than 70% of them are on short-acting contraceptives, condoms, and orals. Under a lockdown scenario as ours, supply can easily be disrupted resulting in unwanted pregnancies and Sexually Transmitted Infections.
Sexual and Reproductive Health (SRH) experts who spoke to HealthTimes Indicated that there is a possibility of unintended pregnancies skyrocketing after the lockdown restrictions would have been lifted. They indicated that even though it was still early to quantify the volume of unwanted pregnancies, indications on the ground point towards an increase in EUPs.
Parliamentary Portfolio Committee on Health Chairperson, Dr Ruth Labode said the groups at high risk of unwanted pregnancies during this lockdown were youth and married women.
The number of unwanted pregnancies during this time of lockdown is unquantifiable, but anecdotal evidence on the ground points to an increase in Early Unintended Pregnancies (EUPs) teenage pregnancies due to lack of access to Contraceptives,” said Dr Labode.
She added that access to contraceptives during the lockdown was a challenge but was also quick to point that it was too early to shift to long term contraceptives for girls because the process of doing so was long and cannot be implemented during a lockdown.
“There are legal concerns about the age of Consent to SRHR and the beliefs among women that long term contraceptives can make the user barren.
“It would be very difficult to convince young people because of all the myths, cultural, religious and legal barriers. And the cost of long-term contraceptives. Who picks the bill? The other challenges with long term contraceptive methods is that one of the commonly used method has some worrying side effects that a young person would not tolerate i.e bleeding between periods.”
The United Nations Educational, Scientific and Cultural Organization (UNESCO) Zimbabwe Programs Officer Mr Masimba Nyamucheta said the risk of EUPs and violation of adolescent girls and young women’s rights is very high, and a reality under the current lockdown environment.
[pullquote]“Evidence shows that getting and keeping young people in school, particularly girls, dramatically lowers their vulnerability to HIV and other associated risks such as EUP. By itself, merely attending primary school makes young people significantly less likely to contract HIV and getting pregnant.[/pullquote]
“When young people stay in school through the secondary level, education’s protective effect against HIV and EUP is even more pronounced. This is especially true for girls who, with each additional year of education, gain greater independence, are better equipped to make decisions affecting their sexual lives, and have higher income earning potential – all of which help them stay safe from HIV and EUP,” said Mr Nyamucheta.
According to the National Fertility Study Report of 2016, adolescents from low socio-economic status or wealth quintiles were more likely to get pregnant compared to those from the highest wealth quintile. In addition to that, orphans are more likely to be at risk of pregnancy compared to non-orphans, with double orphans having the greatest risk. Adolescents aged 15-19 years in rural areas are more likely to be at risk of pregnancy compared to their urban counterparts, with the risk being twice higher among girls with primary education than among those who attained secondary education
“With the likelihood of a lockdown extension very high, there are also higher chances that once the school calendar is disrupted, chances of unwanted transactional sex will increase, and many adolescent girls will not return to school. During Sierra Leone’s Ebola outbreak, “a reported increase in adolescent pregnancies during the outbreak has been attributed largely to the closure of schools (UNDP 2015).
“It remains to be seen but from literature and studies in emergency or humanitarian situations, girls and young women are at high risk of engaging in transactional sex, sexual abuse and exploitation. COVID-19 pandemic presents a unique situation in which young and married women may be at risk of unwanted pregnancies should they run out of their contraceptives due to the lockdown,” added Nyamucheta.
He also said even though health facilities remain open, the fear of covid 19 means that many women will not dare go to the health facilities or may be turned back by health service providers. Key sub-groups at heightened risk of unwanted pregnancies include Girls and young women with disabilities, Adolescents and young women in child headed households, Orphaned girls, Adolescent girls and young women in high density, peri urban, mining and farming settlements.
“Correct and consistent use of condoms (both male and female) remains the most effective contraceptive in the dual protection against pregnancy and sexually transmitted infections, including HIV. This is important because HIV remain a huge problem in country and reducing new infections require adopting effective prevention methods.
“The lockdown also means limited or no access to critical sexual and reproductive health services, including quality, age-appropriate, and evidence-based comprehensive sexuality education and related contraceptive products. The decision to adopt long term contraceptive for adolescents and young women should be purely a personal decision and based on professional advice by health service providers.”
In Zimbabwe, adolescents are free to access contraceptives, short or long term, after the age of 16. This means that at age 16 and above young people are able to independently seek family planning services whereas before that they need the consent of parents or guardians, and that health service providers are allowed to provide such services to all young people who need them, in the best interest of child following their professional assessment.
“Long acting reversible contraceptive methods (LARCs) such as the implants and Intra-uterine Contraceptive Devices (IUCDs) are the most effective available reversible contraceptive methods; and once inserted, last for several years; eliminating the need for daily contraceptive action. Although the utilisation of implants more than doubled in the past 5 years as a result of national efforts to promote LARCs, greater efforts are required to increase their uptake, especially the IUCD, UNFPA (2016).”
He however said there were a number of factors which need to be taken into consideration to increase the uptake of long term contraceptives by young people and these include Social barriers such as restricted dialogue about sex and sexuality among adolescents and young people, Lack of accurate knowledge, coupled with fear of the side effects of contraception, Patriarchy and culture.
“There are various challenges towards adoption of long-term contraceptives and these include Limited family planning budget allocation from the Treasury (falls short of the 3% FP 2020 Zimbabwe Commitment). User fees for Family Planning (FP) present a major barrier to accessing FP services especially for adolescents and young people with parents and peers are also a barrier.”
Katswe Sisterhood Director, Talent Jumo said the Lockdown was a fertile ground for Early Unintended Pregnancies (EUPs) and there was also risk of a dual burden of EUPs and Illegal abortions post the lockdown.
“There is the issue of stigma that is associated with contraceptive use by unmarried women because that would just be proof that they are engaging in unsanctioned sex and in our society, that is something that is frowned upon and something that only women of loose morals would do. You find that many young women if they are not married, they tend to shy away from SRHR services and don’t want to openly be using contraceptives.
“Ideally you would want them to opt for long term contraception because sometimes if they are having to take family planning pills for example, those in terms of storage, it is very easy for them to get caught but on the other end, they can’t just opt on their own to say I am going on a long term contraception. This is not only because of stigma but because of some myths and misconceptions about the effect long term contraception have,” said Jumo.
She added that government should have added contraceptives in the group of essential services as it is also a critical need during times of disaster.
“The probability that women will not have access to contraceptives during this time and fall pregnant and get unintended pregnancies is quite high. At the end of it all, we will have a double burden of Unintended Pregnancies and a rise in illegal abortions.”
Embassy of Sweden in Zimbabwe National Programme Officer Memory Mutsaka said effects of Covid-19 will be uneven and unequal and will likely affect urban areas where health systems are already vulnerable and social protection is generally low.
“It is likely that the COVID-19 pandemic will worsen existing inequalities for women, adolescents, children and sexual minorities, and as a result, it may impact how they receive treatment and care, including for matters concerning their sexual and reproductive health (SRH). The economic effects of the COVID-19 outbreak can also lead to exacerbated risk of sexual exploitation for women and children and other marginalised groups.
To safeguard access to essential Sexual and Reproductive Health Care, including contraception during this emergency period and beyond, Sweden is adding on 10 million Swedish Kronos to existing support for Population Services Zimbabwe and Population Services International. The support will enable services to go where people are and will also introduce an Emergency Mobile Response Unit to strengthen humanitarian and disaster responsiveness,” said Mutsaka.
She added that there were several factors that can affect the quantification of risk of unintended pregnancy and predicting the effects of lockdown was also difficult as this phenomenon is new and not comparable with the anecdotal surges in pregnancies following past events in history.
“It is good to note that our Partners including Population Services International and Population Services Zimbabwe are characterised as essential services therefore able to provide these services at their clinics. We only need to ensure that we create an environment that allows women and young girls that need the services to go and access them.”
She also said if the lockdown is being really observed, risk depends on whether they live with their sexual partners, or at least in the same neighbourhood. For those staying apart, sexual exposure will be reduced, hence reducing the risk of unintended pregnancy. For those living with a partner, sexual exposure is likely to increase, and the risk of unintended pregnancy depends on the effectiveness and efficacy of their method. For those on LARCs, risk shouldn’t change.
“The prospect of an extended lockdown combined with a lack of access to contraceptives could fuel an increase in unintended pregnancies for those on short-acting methods, e.g. condoms, orals. The factors that can increase the risk of unintended pregnancy include: disruption of access/supply as women struggle to collect contraceptives and access other reproductive healthcare services, change in routine e.g. for orals can lead to missed or delayed doses. Some could have left the bulk of their supplies at their workplaces. for condoms increased exposure can lead to possible fatigue in the maintenance of correct and consistent use.”
Mutsaka said some women using short-acting methods like orals might find it difficult to take their method consistently, if they were doing so clandestinely, resulting in unintended pregnancy. Most partners like Saywhat are however continuing SRHR awareness us including linkages to services. There are reaching young women through existing social media platforms.
“The traditional myths and misconceptions about LARCs continue to make the adoption of LARCs difficult. These are usually addressed with the correct information and allay any concerns, though this may also mean longer contact time. Unmarried AGYW do not expect to have sex very often because they don’t always live with their partners and thus sexual encounters may be sporadic. For that reason, they usually opt for the barrier or emergency contraception rather than LARCs or orals.”
Other factors that can increase the risk of unintended pregnancy according to Mutsaka include disruption of access/supply as women struggle to collect contraceptives and access other reproductive healthcare services, change in routine e.g. for orals can lead to missed or delayed doses. Some could have left the bulk of their supplies at their workplaces.