Contribution from UNFPA, the United Nations Population Fund, to the International Development Committee inquiry on: Humanitarian crises monitoring: coronavirus in developing countries: secondary impacts

Written evidence of 30 October 2020. Submitted by Matt Jackson, Director of UNFPA London Office mjackson@unfpa.org

1. This input follows previous UNFPA submissions to the International Development Committee inquiry into coronavirus in developing countries submitted on 17 April 2020 and 8 May 2020. These earlier submissions covered UNFPA’s mandate and priorities in responding to the COVID-19 pandemic, and highlighted UNFPA’s on the ground response. Given UNFPA’s mandate, this new input will focus on the third IDC topic:  the treatment of women and children; domestic abuse and gender-based violence, including child marriage.

The risks to women, adolescents and girls

2. On 28 April 2020 UNFPA launched new data on the immediate and longer-term impacts of COVID-19 on family planning, gender-based violence (GBV), female genital mutilation (FGM) and child marriage. UNFPA research conducted with Avenir Health, Johns Hopkins University (USA) and Victoria University (Australia) shows how the COVID-19 pandemic could critically undermine essential healthcare services and derail achieving the SDGs. The Technical Brief shows that:

• 6 months of stay-at-home restrictions or high levels of disruption to health services could mean 47 million women are unable to access contraceptives leading to 7 million unplanned pregnancies
• As reported by many countries around the world, domestic violence increased rapidly since lockdowns began, with rising numbers of calls to domestic abuse hotlines. Research indicates that 31 million extra GBV cases are likely during the first 6-months of lockdown 
• The pandemic is also disrupting programmes to end FGM and child marriage. This disruption could add 2 million FGM cases and 13 million more child marriages by 2030, taking us way off achieving the target set by the UN Sustainable Development Goals (SDGs).

Sexual and Reproductive Health Services

3. Protection of healthcare workers has been a key issue for the provision of maternal healthcare. Increasing demand for personal protective equipment (PPE) due to community spread of COVID-19 is a challenge in many countries. There is a need to address the increased vulnerability of health workers through the provision of more PPE and training on home-based care. Specific groups need to be targeted with appropriate SRH services, including adolescents, persons with disabilities, LGBT+, the elderly and people living with HIV. Antiretroviral therapy (ARV) treatments are scarce and many patients are unable to access medication for more than 3 months. Limited data is available on COVID-19 in pregnancy, but current data does not show an increased risk of severe disease in late pregnancy or substantial risk to the newborn. Movement restrictions and limited public transportation combined with a fear of contagion and restricted access to protective masks continue to limit access to Sexual and Reproductive Health (SRH) services. Moreover, health services are being diverted to respond to COVID-19 which has a greater impact on low-income women who also face economic pressures hitting the informal sector. Examples include:

• Angola: 50 health providers were infected with COVID-19 by the end of August. PPE shortages could reduce the health system’s capacity in the next few months
• DRC: the absence of PPE and infection prevention and control (IPC) measures makes health workers very reluctant to continue working, affecting an already decreased use of maternal health facilities
• Kenya: protection of healthcare workers has impacted continuity of SRH intervention. Containment measures have severely curtailed antenatal care, postnatal care and family planning
• South Sudan: delays in procurement and shipment of PPE and IPC materials has severely impacted frontline workers. Movement restrictions have affected and delayed transportation of reproductive health commodities with some field supervision halted
• Zambia: UNFPA has intervened through technical support to Government authorities to sustain provision of SRH services as part of essential services including providing ‘mama kits’ to women from poor households.

Safe childbirth

4. UNFPA partner countries continue to note a negative impact on institutional deliveries (childbirth that takes place at any medical facility staffed by skilled delivery assistance), while in other countries data shows some recovery. Observations to date confirm the results of UNFPA’s survey on the health facilities of countries that are part of the Global Humanitarian Response Plan (GHRP), showing a slight decrease in institutional deliveries. Further contextual information is needed to interpret all findings given that some institutions show increases in institutional deliveries, but the figures are nonetheless concerning for some countries, where more than half of health facilities show a drop of over 25% compared to the 2019 average in the same locations. Since early March 2020, 45 countries have requested consignments of reproductive health kits and other pharmaceuticals, medical devices and supplies to implement lifesaving SRH services. Trends also indicate that access to institutional births in African countries has become more negatively impacted since June 2020. We are yet to see the impact of potential ‘second waves’.

5. Detail: As part of the COVID-19 GHRP report, UNFPA reports against the indicator “Proportion of countries where pre-COVID-19 levels of institutional births are maintained”. As of 30 September 2020, UNFPA reported a decline in the number of institutional births in COVID-19 affected areas in 15 out of 32 countries. Of these 15 countries where institutional births were not maintained, 9 countries showed declines in 10-25 % of health facilities and 6 countries showed declines in more than 50% of health facilities.

Gender Based Violence

6. UNFPA’s September 2020 survey collected information from 1,356 Gender Based Violence (GBV) service delivery points in 43 GHRP countries. The survey showed that interruptions have been decreasing compared to reporting in June, but that gaps in essential GBV services remain for 293 target areas in 21 countries. The data reflects only service availability. Reported challenges in GBV response services include:

●        Operational capacity of GBV providers has decreased due to closure of safe spaces

●        Services provided through public institutions are overstretched

●        Access to clinical management of rape where women need transportation is compromised

●        Protection in camp settings without services needs prioritising during lockdowns

●        Multi-sectoral care services are impacted due to closures or repurposing of one-stop-centres

●        Access to psychosocial support and access to justice have been impacted

●        Increased need for shelters and reduced capacity of existing shelters due to social distancing measures

7. Although GBV services, including clinical management of rape, are critical life-saving services in emergency contexts, funding for GBV prevention and response remains unacceptably low. This is critical in fragile and conflict-affected countries with an ongoing humanitarian crisis where the direct and indirect impacts of the COVID-19 pandemic have been further amplified. Examples include:

• Bangladesh: UNFPA was hampered by a lack of resources in trying to roll out GBV services. It could only provide for 2 out of the 64 targeted districts
• Burkina Faso: UNFPA facilitated the integration of COVID-19, family planning and preventing sexual exploitation and abuse (PSEA) themes in the training of 40 members of women's groups
• Colombia: calls from women survivors of violence registered a120% increase between 25 March and 13 August 2020 compared to the same period in 2019. To help manage the growing number of cases during the pandemic, UNFPA has adapted GBV services to new protocols, guidelines and mechanisms including the provision of remote GBV case management, psychosocial support and safe referrals through helplines in five municipalities
• Kenya: UNFPA continues to work with partners in the informal sector to strengthen male involvement in addressing FGM and teenage pregnancy
• Somalia: a survey conducted showed a 36% increase in GBV.

Harmful practices - Child marriage and Female Genital Mutilation

8. Media outlets and development agencies have been reporting an increase in child marriages and female genital mutilation (FGM) as a result of school closures and the loss of livelihoods. Most of these reports are based on anecdotal evidence. In the absence of reliable surveillance systems, one of the few sources of reliable information are helplines or community surveys. Children and adolescents including married adolescent girls and those cohabiting (when a couple lives ‘in union’ as if married) reported being stuck at home with their abusers, unable to leave or to seek help.

9. UNFPA’s new report, published in October 2020 with UNICEF and in partnership with the Women's Refugee Commission and the Center for Humanitarian Health at the Johns Hopkins Bloomberg School of Public Health, conducted two country studies on child marriage in humanitarian settings in Bangladesh and Nepal. In South Asia, a region that has urgent and protracted conflicts and is prone to natural disasters, families may resort to child marriage during crises as it is perceived as a means of providing economic and physical security while preserving family honour in times of crises. The COVID-19 pandemic has shown that humanitarian crises can also change prevailing social and gender norms in ways that reduce, or reinforce, the persistent inequalities that underpin and perpetuate child marriage.

10. In Somalia, UNFPA’s rapid assessment on GBV and FGM found that 31% of community members think that there has been an increase in cases of FGM during the COVID-19 crisis. According to reports from ‘Nyumba Kumi’, a Government-led initiative in Kenya, 1,601 girls were cut, 45 girls received preventative interventions, and 15 arrests were made.

UK Support

11. As mentioned in a previous submission to this IDC inquiry, on 12 April 2020 the UK government announced £10 million ($12.54 million USD) support to UNFPA’s response to COVID-19 as part of the UK’s wider global assistance package. In addition, UNFPA recently received contributions from British Embassies in:

• Kazakhstan to develop a training package on GBV for health providers to be delivered online. This training is based on the first-ever GBV clinical protocol for health service providers approved by the Ministry of health (MOH) earlier this year
• Bosnia and Herzegovina to respond to a doubling in number of GBV cases since the start of the COVID-19 pandemic by supporting eight safe houses in the country and an awareness-raising TV documentary
• Turkmenistan to strengthen the capacity of an NGO partner to empower women and girls by providing them with information about COVID-19, GBV and reproductive health, accessible via hotline services.

Useful resources:

●        Resilience in Action: Lessons Learned from the joint programme during the Covid-19 crisis

●        My Body, My Life, My World, Through a COVID-19 Lens

●        September 2020 UNFPA Global COVID-19 Situation Report

●        COVID-19 GHRP Report

●        Adapting to COVID-19: Pivoting the UNFPA–UNICEF Global Programme to End Child Marriage to Respond to the Pandemic

●        Child Marriage in Humanitarian Settings in South Asia: Study Results from Bangladesh and Nepal