Sex and health during the pandemic

The covid-19 crisis has altered almost every aspect of life except sex. During a pandemic, desired and unwanted intimate acts occur. As there is less transportation capacity and less access to clinics and hospitals, it is more important than ever to ensure quality and timely reproductive health care.

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The virus has exposed strong inequalities in access to medicine, and not just in emergencies. Even before the pandemic, adolescent girls, migrants, minorities, people with disabilities, and LGBTQI + people suffered discrimination. The crisis is an opportunity for the authorities to support initiatives to empower women and youth about their immediate needs and to improve access to services of critical importance in the long term.

The first priority is to make it possible to sell oral contraceptives without a prescription, which will increase their safety, access and consumption. In most countries this prescription is required, which prevents women from fully controlling their own bodies. It can also hinder a patient's access to care without abuse or violation of their privacy. This is particularly true for adolescent girls, gender non-conforming people at birth, victims of domestic violence, and others who fear discrimination or disrespect in clinical settings.

The benefits of increasing the availability of contraceptives far outweigh their minor disadvantages. Evidence indicates that women and transgender people can self-analyze for contraindications using simple checklists that are provided with the medication. Enabling people to obtain supplies for a year would benefit those in situations of violence and others who have difficulties in accessing health services. It would also be helpful to eliminate third-party authorization requirements and to reduce contraceptive costs.

Second, we have to make abortion more accessible. Although it is an essential medical procedure, availability has been reduced due to regressive policies and recent confinements. Authorities can and should decide on simple steps to remove unnecessary obstacles to pill discontinuation, which would expand women's freedom and reduce clinic visits.

We have to make abortion more accessible and availability has decreased due to regressive policies and confinement

Medical abortions are safe and effective. They are practiced by millions of women each year, using a combination of mifepristone and misoprostol, or with the latter alone. People looking to abort can assess if they are eligible, follow instructions on the correct doses, and determine if it worked. They need only accurate information, medications, and, if necessary, access to professional supportive care.

The best way to increase access to abortion is to make mifepristone and misoprostol available for purchase. At a minimum, authorities should facilitate obtaining it through telemedicine, which is feasible and safe as long as consumers know what to expect and can receive post-abortion care without trial, stigma, or fear of judicial prosecution. No woman should be harassed or penalized.

Quality maternal care is also crucial in the era of the coronavirus. In a pandemic, pregnant women experience the same stress as others. They face job insecurity, loss of income, changes in health coverage and situations that threaten their own health. And then there are the specific concerns about the health of your fetuses and newborn babies.

In many places, overcrowded public health systems are unable to offer a pregnant woman the level of maternal care that she expected before the pandemic. To address this problem, healthcare professionals should help them practice more self-care, giving them the right information and tools, such as telemedicine, online education, home visits from midwives and other professionals, psychosocial support, and extensive diagnostic skills.

These measures would allow future mothers to better monitor their own health, respond to common symptoms, identify signs of complications and know when to seek professional care. And if they do, they must be able to access clinics and hospitals, even if there are confinements in place, which means having emergency transportation and personal protective equipment for pregnant women and their companions.

Furthermore, the authorities should expand birth demedicalization initiatives. Safer deliveries for pregnant women and professionals could be achieved with measures such as home births for low-risk pregnancies, guaranteed presence of midwives, specialized delivery facilities linked to tertiary care, and home visits for prenatal care. In many countries the emphasis has been on institutionalized care, despite the fact that demedicalized childbirth is advantageous most of the time, not just in a crisis.

We must avoid taking thoughtless measures. It would be a sign of involution to restrict or prohibit the presence of partners or birth attendants, to separate the newborn from mothers who have (or are suspected of having) covid-19, or to interfere with early skin-to-skin contact, including lactation. The World Health Organization has warned healthcare professionals to refrain from doing so when caring for pregnant women, parents and newborns. That is essential to prevent an increase in obstetric violence or worse outcomes for women and their babies.

Governments that do not remove barriers to care risk ending up with fractured health systems that are unable to meet everyone's needs. In the long term, investments in people's empowerment will strengthen the health system and the quality of care. With proper education and support, people can meet their sexual and reproductive health care needs on their own. Authorities must give them the power and tools to do so.

Shannon Kowalski is Director of Advocacy and Policy at the International Women's Health Coalition. Translated from English by David Meléndez Tormen. Copyright: Project Syndicate, 2020.

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