Impact of Covid-19 on Sexual and Reproductive Health Rights in Kenya

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The COVID-19 (Coronavirus Disease 2019) pandemic has directly or indirectly affected the advancements in almost all sectors globally, including the health sector. Since its outbreak in December 2019, healthcare systems across the world have been negatively affected and overwhelmed. Developing nations are further affected considering the prevailing poor health facilities and outcomes. They are left with few options to manage the spread and treatment of the virus owing to lack of medical supplies, expertise and facilities.

The prevailing pandemic brings about unprecedented challenges that threaten a decline in the developmental and health gains made globally. This includes advances made in the arena of Sexual and Reproductive Health Rights (SRHR), where progress was never easy to begin with. If anything, the current public health crisis signals a predicament for girls and women on their SRHR. The advent of the pandemic has had its fair share of negative impacts on Sexual and Reproductive Health (SRH) service provision in Kenya. Many women and girls are not able to access the necessary SRH services during the crisis, such as emergency contraception and safe abortion in a timely manner. The health supply of family planning products at healthcare and community facilities are often inadequate and unaffordable. 

Bleak Public Health Outlook

Estimates by the United Nations Population Fund modelling suggest that up to 51 million women in low and middle income countries might not be able to access modern contraceptives due to health service disruption, resulting to close to 15 million unintended pregnancies. In Kenya, all health efforts have been re-directed towards management and prevention of Coronavirus cases with little or no attention given to other health needs. This shift means that SRH commodities’ prices have increased significantly due to funding cut from SRH that has been redirected to respond to and manage the pandemic. Further, re-allocation of priorities and resources by the government and international actors towards response to COVID-19, has by extension been used by certain actors to abrogate their responsibility of provision of SRH information and services.

In a Tweet Chat hosted by HakiJamii on June 17th dubbed ‘Lessons from COVID-19 to Inform UHC Provision’, part of the conversation was intended to find out the general status of Adolescent Girls and Young Women (AGYW)’s access to SRH services and resources amidst the COVID-19 pandemic; and the lessons learned as a result. It was noted that the SRH needs for AGYW have not been given much attention lately because more efforts have been channeled towards management of COVID-19 pandemic. This has negatively impacted both access to and utilization of SRH services and commodities, the result of which is catastrophic; an increase in teenage pregnancies, unintended pregnancies and pregnancy complications, increased maternal and newborn mortalities, increased unsafe abortions and abortion complications, and early marriages, just to mention a few.

Generally, there is a reduction in use of the health facilities due to several reasons, among them, fear of COVID-19 infection, and increased cost of transportation to access the health facilities. The access to and utilization of essential SRH services and commodities such as family planning, maternity services, cervical cancer and STI screening among others have significantly reduced. To contain the spread of COVID19, the government of Kenya announced various measures including quarantine of people with travel history, encouraging people to stay and work from home, and putting in place a national curfew from dawn to dust. Despite the efforts put in place to contain the novel Coronavirus, adolescent girls and young women continue being at a higher risk on matters SRH. While these preventive measures have been designed to manage the spread of COVID-19, they trigger further discrimination and violence against women and girls.

Use of Data for Decision Making

According to the World Health Organization, women comprise more than 70 percent of the global health workforce, but during health emergencies such as the advent of the Coronavirus pandemic, gender is often ignored, leading to crises having a disproportionate impact on women. As evidenced in previous similar situation, crises do exacerbate age, gender, and disability inequalities and place women, girls, and other vulnerable populations at increased risk of Sexual Gender-Based Violence (SGBV) and intimate partner violence. An article titled Democratizing data is key for addressing inequalities during COVID-19 that was jointly written by Hakijamii and International Network for Economic, Social and Cultural Rights (ESCR-Net) argued that a gender lens in data used for decision making would highlight specific vulnerabilities and risks faced by women and girls due to deep-rooted inequalities that currently exist in Kenya. It concluded that data related to specific needs of women health service providers including adequate training and access to equipment to protect their own health and offer mental health; and women’s sexual and reproductive health issues need to be collected, analyzed and used in a participatory manner with women as the rights holders.

However, the Kenyan government is not adequately equipped to make data driven solutions because it has not invested in timely and accurate data on important consequences highlighted by the pandemic on other gender related issues faced by women and girls. It has not conducted an impact assessment to establish the extent of of the implications of COVID-19 on access to hospitals by women and girls, and the extent of the negative outcomes such as possible spread of HIV, increased sexually transmitted infections, increased unintended pregnancies as well as unsafe abortions. The unfortunate and costly consequence of this is that reliable evidence about the impact of COVID-19 on other areas of healthcare is not available to policy makers to formulate inclusive responses to address the different needs of women.

A Case of UHC in Kenya

As Kenya gears towards the roll out of Universal Health Coverage (UHC), the focus must be on ensuring a functional and effective Primary Health Care for all, especially the poor and marginalized, including adolescent girls and young women. UHC is currently being delivered as a uniform package. However, AGYW are disproportionately faced with SRHR issues that need undivided attention to deal with. According to the Kenya Health Policy 2014-2030, perinatal conditions are the second leading cause of death in Kenya. Building people centered health systems, developing gender responsive health policies, and centering universal access to sexual and reproductive health for adolescent girls and young women will lead not only to availing adequate resources towards AGYW SRH needs, but also ring-fencing the availed resources to ensure they are not committed to any other purposes. However, there has to be a clear structure for both achieving this, creating demand for these services, and holding the government accountable towards this commitment, and that is the aim of this project.

In the Budget estimates for FY 2020/2021 presented in the National Assembly this June, UHC received more than half of the Ksh. 111.7 billion allocated to the health sector, begging the question of ensuring transparency in resource allocation and utilization to minimize or alleviate deficits and misuse of funds. But the need for UHC implementation to be gender responsive must not be overlooked. However, for this to be achieved, there has to be parameters that oversight entities, such as advocates and activists can use to benchmark this model.

HakiJamii’s Work

The Economic and Social Rights Center – Hakijamii, with support from Planned Parenthood Global, has embarked on a project that seeks to address some of these challenges. The project is being implemented in Mombasa, with an aim to contribute towards the reduction of maternal morbidity and mortality by safeguarding pertinent constitutional gains that allow access to safe abortion services in Kenya. The organization spearheads opposition mitigation on SRHR and champions legal and policy reforms to safeguard these rights, and advocates for the full realization of the right to health as a whole.

The organization recognizes that the global understanding of transmission patterns, severity, clinical features and risk factors for infection remains limited. However, it cautions that a response that is not transparent has the potential to increase fear, ignorance, stigma, discrimination, misinformation, exclusion, violence, and could also lead to a perverse increase in the spread of disease. It advises on the need to ensure that the response is guided by laws specifically the Constitution, Health Act and the Public Health Act; and the established international principles that the country has ratified.

Way Forward

Reorganization of the public health system at county and national levels in response to COVID-19 would require adequate resourcing to meet sexual and reproductive healthcare needs of women and girls. The Kenyan government needs to act in accordance with human rights standards in its response to COVID-19 and uphold the principles of equality and non-discrimination, with a special focus on the most marginalized people. These efforts should be informed by the lived experiences of people in vulnerable position, especially women and girls that endure a disproportionate impact due to their sex, gender, and sexual orientation – to steer policymakers toward solutions that do not exacerbate their vulnerabilities or magnify existing inequality and ensure their human rights.

Civil Society Organizations and other stakeholders need to work in solidarity to advocate for comprehensive SRHR including safe abortion options. Additionally, there is need to document and expose SRHR violations and injustices caused to adolescent girls and young women. Conversations need to take place to draw lessons learnt from COVID-19 to advance ways in which various stake-holders are responding to COVID-19 on matter SRHR. Through the stories and actions, stakeholders will demand a more comprehensive, better, gender-sensitive, rights-based, just and sustainable response to COVID-19. The existing corona virus disease may continue to impact on the lives of millions of people for a long time, but despite the pandemic, health still remains a fundamental human right and the attainment of at least the minimum standards of health by all individuals must remain a commitment of the duty bearers.

Since it is the primary role of the government to protect the health and well-being of AGYW, it must offer quality and comprehensive services and commodities that meet their needs. Furthermore, health is a multifaceted sector, thus there is need for other stakeholders not only to offer an oversight role on what the government is doing, but also to support in actual delivery of services where necessary. Most notably, avenues for offering SRHR services and commodities to AGYW must be increased, for instance, through the use of Community Health Volunteers to ensure their increased and sustained access and utilization.

Consequently, there are different ways in which the government can strengthen public health systems to be gender responsive and cater for the needs of AGYW, including training of frontline healthcare workers on offering youth-friendly services to AGYW, generation of disintegrated gender and age specific data, increase of funding to the health sector, a gender responsive hiring and budgeting process, and increasing the number of Youth Friendly Centers.

In conclusion, there are still major gaps in the implementation of UHC that are proving to be obstacles toward meeting the SRH needs of AGYW in Kenya. COVID-19 pandemic has magnified the situation as the attention of the government and other entities has shifted to addressing the pandemic. This has not only instilled fear among the AGYW in accessing the healthcare facilities, but also led to reduced uptake and utilization of essential SRH services and commodities. As a result, the following have been noted; increased teenage and unplanned pregnancies, unsafe abortion and its complications, and increased maternal deaths, just to mention a few. Therefore, we are calling on the government and all the relevant stakeholders to ensure gender responsiveness in the implementation and roll-out of UHC to ensure the SRH needs of AGYW are fully met.

The author is the Programme Officer, Health Water and Sanitation at Hakijamii. brian@hakijamii.com

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1 reply added

  1. Very informative article. In the next 7-9 months, healthcare will be struggling again with upsurge of mothers seeking skilled delivery services across Kenya and Africa. We are seeing a possibility overstretched health care resources including human resource leading to a possible of maternal and child mortality. Governments and stakeholders should therefore put an action of plan to mitigate these impending occurrences in advance.

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