Project Syndicate (USA): sexual and reproductive health during a pandemic

NEW YORK- the Crisis caused by сovid-19, disrupted the normal flow of life in almost all aspects, but not sexy. During a pandemic happens as the desired and undesired intimacy. And therefore, in terms of reduced mobility and reduced access to clinics and hospitals is more important than ever to ensure quality and timely reproductive health care.

Virus exposed stark inequalities in health care — and not only in urgent care. Even before the pandemic сovid-19 adolescent girls, migrants, minorities, people with disabilities and LGBTQI people+ faced discrimination in the halls of the waiting doctor. The crisis gives the authorities the chance to support initiatives that expand opportunities for women and girls to cope with their pressing needs and will improve access to these critical services in the long term.

The first priority is to make available without a prescription oral contraceptives. This will increase the security, availability, and use. In most regions require a prescription, and it does not allow women to control their bodies. In addition, it prevents the access of patients to medical care without harassment or breaches of confidentiality. This is especially true for adolescents, people with gender nonconformism, victims of domestic violence and others who fear discrimination and rudeness in healthcare institutions.

The benefits of expanding access to contraceptives far outweigh the small associated risks. Studies show that women and gender nonconformity can check themselves for contraindications using simple checklists, which are accompanied by medication. If you allow people to create stockpiles of drugs, so that they are able to inject yourself, such as “Depo-provera”, it will benefit those who find themselves in a situation of violence, and those who find it difficult to access health services. In addition, it would be useful to eliminate the requirement of third party consents and to reduce the cost of contraceptives.

Second, we must increase the availability of abortion. Regressive politics, and more recently another mode of quarantine reduced the availability of abortions in clinics, though this is an extremely important medical procedure. Authorities can and should take steps to eliminate unnecessary barriers to abortion using pills that will help to expand the freedom of women and to reduce the number of visits to the clinic.

Abortion with pills is safe and effective. Each year millions of women end a pregnancy by yourself, or using a combination of mifepristone and misoprostol or misoprostol alone. There is no need to walk through the rooms. People who want to have an abortion, you can assess the suitability of this method to execute instructions on the correct dosage, and then to determine whether the abortion is successful. All they need is accurate information, medication and access to medical care if necessary.

The best way to increase the availability of abortions is to make mifepristone and misoprostol available without prescription. At least the authorities should simplify their purchasing by using telemedicine. It’s real and safe provided that consumers are informed about what we should expect, and they have the opportunity to get help after an abortion without judgment, stigma or fear of persecution. People who own an abortion can not be a nightmare or be punished.

Quality of maternal care is also extremely important for women in the era of coronavirus. Pregnant women experience the same stress as everyone else during a pandemic. They risk the loss of work and income, they can change the terms of health insurance, the risk is their own health. Finally, they have a unique alarm — the health of the fetus and newborn.

In many regions of the overwhelmed health care system unable to provide pregnant women the maternal care they expected to receive — and received — before the pandemic. To solve this problem, doctors should help pregnant women to actively practice self-care by providing them the right tools and information. Among these tools, telemedicine, online training, visits to midwives and other health workers at home, psychological support, an extensive screening.

Such measures will help to ensure that pregnant women can better monitor their own health, to control the overall symptoms to identify the signs of complications, to know when to ask for help. And when they call for it, they should be able to reach a health facility even during the quarantine. This means that it is necessary to provide emergency transport and personal protective equipment for pregnant women and those who accompany them.

In addition, the government should expand initiatives that help to reduce medical intervention in childbirth (de-medicalization). Home births for pregnant women with low risk under the obligatory supervision of midwives, specialized maternity hospitals, home visits to provide prenatal care will help to ensure a safe delivery and to mothers and health workers. Many countries put emphasis on institutional care, although the de-medicalization of childbirth benefit and in the best of times, and not just in a crisis.

We must avoid the instinctive, hasty measures. Regressive would be measures to restrict or prohibit partners or carers to attend the birth; separating newborns from mothers who are sick covid-19 (or it is suspected); preventing the first tactile contact, including breast-feeding. The world health organization encourages health care workers to refrain from such measures in the provision of assistance to pregnant women, parents and infants. It is extremely important to prevent the growth of obstetric violence and degradation against women and their newborn.

Governments that do not eliminate barriers to health care, the risk of overload health care systems, unable to satisfy the needs of everyone. In the long term investment in the autonomy of patients will strengthen health systems and quality of care. With proper training and support people are able to cope with their needs in sexual and reproductive health care. But the authorities must give them opportunities and tools to do this.

Director of protection and policy of the International coalition for women’s health.