COVID-19 and Reproductive Health
The arrival of the COVID-19 pandemic
has come to stop the world. It has shaken and shocked, confused, convalescent,
the global population, with dramatic consequences for the lives of many people.
At the same time that it wreaks havoc at the health, social, and economic levels,
and that is leaving a trail of damages of costly recovery, it has also created
a scenario in which to analyze some substantial dimensions of human nature,
such as sexuality and reproduction. Sexuality can not only provide well-being,
but it defines us, unfailingly accompanies us like our shadow, and allows us
self-recognition and recognition of the other. And the biological and social
reproductive capacity is a universal constant, indispensable for our
perpetuation as a species. Therefore, taking proper care of this area of life
is an obligation of the first order. In times when the adversity that
accompanies COVID-19 reminds us that ensuring survival and physical security is
a priority in the hierarchy of human needs, it is also urgent not to forget the
importance of adequately attending to the sexual and reproductive health of the
world population, because it means as much as caring for our identity and
guaranteeing our continuity as human beings.
Multiple factors interact with each
other, determining the physical, psychological, and social dimensions of sexual
health and reproductive health. Some factors operate at the individual level
(biological, environmental issues, lifestyles, or psychological characteristics
and personal strategies), and others intervene at the group level mediating the
influence of individual factors (education, employment, income). Cultural
gender relations, closely linked to other social conditioning factors, strongly
affect sexual and reproductive health. All the social burdens and the expected
roles in one or the other sex, and the power hierarchies built around it,
affect unequally and unfairly the healthy experience of sexuality and
reproduction, with special and negative consequences for women. and girls.
SARS-CoV-2 has come to disrupt such
individual and social conditions of the population. In just a few weeks, the
disease caused by this coronavirus has changed the biological status of many
people and has altered their immediate environment. Globally, our lifestyles
have been forced to change. Each individual's particular psychological reactions
to the sudden disturbance of everyday reality have had to be adjusted. Also,
the force with which the pandemic is transforming our socioeconomic context,
with hardly any contemporary precedents, is acting more or less silently and
unevenly on the sexual and reproductive care needs of the diverse world
population. The rules of the game have changed on the international scene,
while the need for sexual health and reproductive planning is constant.
Therefore, it is worth asking how is the pandemic affecting the field of
sexuality? How is it affecting the care of related diseases? Does contraception
harm?
According to the United Nations
Population Fund (1), the situation of stress and health saturation is leading
health systems to redirect resources from sexual and reproductive health
services and to limit access to family planning. This poses a fundamental risk
for women, who continue to need access to contraception. Poor access to
treatment for sexually transmitted infections also aggravates the health situation
of either sex. During this health crisis, the United Nations calls for precise
and supportive attention to the needs in this area, protecting sexual and
reproductive health rights, with an emphasis on safety and dignity, and
avoiding perpetuating gender norms. harmful, discriminatory, and unequal to women.
Faced with the multiple uncertainties
that have arisen regarding attention to sexual and reproductive health, the
institutions that monitor the fulfillment of human rights, make a call to redirect
health perspectives to this essential area of life. As a background, it appeals
to a greater consideration of the increase in gender inequalities about other social determinants, such as, for example, disability or poverty.
Effective and equitable interventions are called for, from a not only clinical
but also a social perspective. As Clare Wenham, Julia Smith, and Rosemary
Morgan have pointed out, in their publication in the Lancet (2) “the experience
of past outbreaks shows the importance of incorporating gender analysis into
preparedness and response efforts to improve the effectiveness of health
interventions and promoting gender equity objectives ”. Under these premises,
and in response to the currently emerging questions, different national and
international organizations have drawn up recommendations to address the sexual
and reproductive health of people who experience the disease in the first person or as people affected secondarily or expectantly. Some of these are
reviewed below in the areas of sexual health, sexually transmitted infections,
and contraception.
Sexuality
One of the keys to healthy sexuality
is its full, safe, dignified, and responsible enjoyment from making free and
informed decisions. As far as information is concerned, the State Family
Planning Federation disseminates the Guide on sexual relations in times of
COVID-19 (3) prepared by the International Family Planning Federation. It is
noted in this that there is little evidence that indicates that the coronavirus
is found in fluids such as semen or vaginal discharge, although there is a
possibility of transmission of the virus through physical contact and saliva.
In the case of living as a couple, avoid contact and isolation if any of the
people have symptoms. If you are not living as a couple, information on sexting
and the necessary conditions for its safe practice is offered through the link
"Connect with your head" (4). In any situation of coexistence, the
general rules of hygiene and prevention of the contagion of the virus are
insisted upon, before and after sexual practices.
Sexually Transmitted Infections
Regarding the prevention of sexually
transmitted infections or HIV, the International Federation for Family Planning
(3) advises the use of condoms. Given the presentation of symptoms, it is
recalled that health centers could attend urgent cases after a telephone call
to assess assistance. In the case of people with HIV, it is recommended to
make a forecast of three months or more when acquiring the medication, to avoid
unnecessary trips.
Contraception
A report published on March 11, 2020,
by the Guttmacher Institute (5) (a leading international research and policy organization committed to advancing sexual and reproductive health and rights),
points out some negative effects of COVID-19 in the field of contraceptives and
sexually transmitted infections: 1) The shortage of contraceptives or
antiretrovirals to treat sexually transmitted infections due to the reduction
in their production, and the current difficulties in the supply chain; 2) The
insufficiency of personnel dedicated to attending to sexual and reproductive
health and the increase in waiting times; and 3) The loss of funds to attend to
sexual and reproductive health or the increase of economic and physical
barriers. Given the situation raised, in terms of contraception, also from the
International Federation of State Planning (3) it is recommended: 1) Try to
have provisions for more than 30 days in the case of using the daily pill, the
patch, or the ring; or 2) Carry out medical consultations by the available
means or start using the condom until the situation returns to normal, in the
case of the use of long-term contraceptives such as implants or IUDs.
Non-intercourse sexual intercourse options are also recalled, it is noted that
emergency contraception is dispensed in pharmacies without the need for a
medical prescription, and information is offered on the clinics available for
voluntary termination of pregnancy for those who need safe care, according to
Organic Law 2/2010, of March 3, on sexual and reproductive health and voluntary
interruption of pregnancy (6). The access route to these services is carried
out through primary health care.
Sexual and reproductive health
services are especially vulnerable to neglect or postponement, considering how
social and gender inequalities act in this area of great repercussion for
women. In the current pandemic situation, it is a challenge to protect the
rights of sexual health and planning and management of reproductive capacity,
promoting universal access to adequate care from gender equality, as proclaimed
in the Report on COVID-19, a gender approach and sexual and reproductive rights
(7) prepared by the United Nations Population Fund.
References
2. Wenham, Clare; Smith, Julia;
Morgan, Rosemary. COVID-19: the gendered impacts of the outbreak. The Lancet.
March 14, 2020; 395 (10227): P846-48.
3. International Federation of Family
Planning. Sexual relations in times of COVID-19, what do you need to know?
(Consulted April 14, 2020)
4. State Family Planning Federation.
Connect wisely: enjoy without risks with your mobile (Consulted April 14, 2020)
5. Ahmed, Zara; Sonfield, The
COVID-19 Outbreak: Potential Fallout for Sexual and Reproductive Health and
Rights. Guttmacher Institute (Consulted April 14, 2020)
6. Organic Law 2/2010, of March 3, on
sexual and reproductive health and voluntary interruption of pregnancy
7. United Nations Population Fund.
COVID-19 Technical Report: A Gender Approach. Protect sexual and reproductive
health and rights and promote gender equality. March 2020 (Consulted April 14,
2020)
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