Contribution from UNFPA, the United Nation’s Population Fund, to the UK International Development Committee inquiry on Humanitarian crises monitoring: Coronavirus in developing countries
Written evidence of 7 May 2020 for wave 2: longer term issues, implications and lessons to be learned. Submitted by Matt Jackson, Director UK Office, UNFPA.
UNFPA’s priorities in responding to the COVID-19 pandemic
- This contribution follows UNFPA’s initial contribution to wave 1 of this inquiry of 17 April 2020. UNFPA has set out priorities in its COVID-19 response to:
- Ensure women and girls have access to a choice of modern contraception, can give birth safely, and that survivors of gender-based violence receive support
- Strengthen health systems
- Ensure essential supplies are procured and delivered without disruption
- Help communities communicate about reducing the risks of contracting COVID-19
- UNFPA recently published a second set of situational reports from each of the six regions (Asia & Pacific, Arab States, Eastern Europe & Central Asia, East & Southern Africa, Latin America & Caribbean, and West & Central Africa). These SitReps provide information on the impact of country health systems and key population groups, measures to deliver essential services and UNFPA priorities in responding to the pandemic. In addition to the technical briefs noted in the first contribution to this inquiry, UNFPA has subsequently produced further technical briefs on: maternity services including antenatal and postnatal care, ending female genital mutilation (FGM) and child marriage, older persons and UNFPA Supplies. Details can be found here: https://www.unfpa.org/covid19
- On 28 April 2020 UNFPA launched new data on the immediate and longer-terms 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 we're already seeing around the world, domestic violence is increasing including through a rising number of calls to domestic abuse hotlines. The research indicates that 31 million extra GBV cases are likely during a 6-month lockdown
- The pandemic is disrupting programmes to end FGM and child marriage. This disruption could add 2 million FGM cases and 13 million more child marriages over the next decade, taking us way off achieving the SDG target by 2030
- Around the world there are some similarities of the impact of COVID-19. Clinical staff may not have time to provide services or lack personal protective equipment (PPE), health facilities are closing or limiting services, patients and pregnant women are missing appointments due to fears of transmission, and product shortages and supply chain disruptions are limiting availability of medicines and contraception. Social distancing has halted some of the most effective prevention programmes such as community empowerment, abandonment proclamations, addressing cultural norms or work to keep girls in school which are typically implemented in community settings to end FGM and child marriage.
Impact of COVID-19 on key populations
- The COVID-19 pandemic is having a substantial impact on women and young people, and vulnerable and marginalised groups. People with disabilities, lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) people, indigenous people, older people, refugees and migrants are among the most vulnerable and marginalised in many societies. Disaggregated data is crucial to inform targeted interventions to address vulnerable groups during the pandemic.
- In addition to disruption to health services, as noted in the ‘wave 1’ contribution women represent nearly 70% of the global health and social care workforce and therefore play a disproportionate role in responding to the pandemic. This puts women on the front lines of the response and at increased risk of infection. Stay-at-home restrictions increase the risk of domestic violence as well as other forms of gender-based violence including sexual exploitation and abuse. Women may also be harder hit by economic impacts due to their disproportionate role in insecure labour markets.
- Young people and adolescents face challenges to health services, education and training amongst other issues. UNFPA’s COVID responses includes:
- securing support from Ministries of Health/Education to create or promote online platforms that provide adolescents with SRHR information
- mobilising young people to join risk mitigation efforts through building their capacities in community efforts
- supporting youth organisations to encourage active participation in prevention and response including through supporting community workers and health professionals
- People with disabilities risk being left out of the COVID response as well as facing barriers to SRH services and increased risk of GBV. Key messages on COVID in all settings and plans for the long term recovery must recognise the needs of persons with disabilities. Existing programming on persons with disabilities must also adapt to respond to COVID, as UNFPA is doing with its ‘We Decide’ programme. In the Pacific region UNFPA has procured dignity kits adapted for women with disabilities.
- Lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) people continue to experience discrimination that negatively impacts all aspects of their lives. Because of their vulnerability and the current strain on public health systems LGBTQI people are among those at heightened risk. In countries where same-sex relations are criminalised or transgender people targeted, LGBTQI people may not seek COVID-19 testing and treatment for fear of arrest or violence. Given stay-at-home restrictions, some LGBTQI youth and adults are confined in hostile environments with unsupportive family members or co-habitants, increasing their exposure to violence, anxiety, fear and depression.
- Although global data remains uncertain at present, the heightened risks of COVID-19 for older persons are evident in all national data. Older people may face particular challenges due to a lack of institutional care for older persons, fewer community-based care programmes, living alone, or the higher risk associated with nursing homes or additional health or cognitive issues. UNFPA stresses the importance of ensuring the voices of older persons are heard in response plans to ensure accurate information, autonomy and appropriate care for older people.
Ensuring essential services continue
- In addition to the above research and data collection, UNFPA is supporting governments and partners to ensure the continuity and adaptation of sexual and reproductive health (SRH) and gender-based violence (GBV) services, while maintaining appropriate COVID-19 infection prevention and control measures. The types of services being delivered include basic and comprehensive emergency obstetric care; routine antenatal, postpartum and postnatal care to ensure safe delivery; family planning; mental health and psychosocial support; clinical management of rape; and infection control measures.
- UNFPA is also working in risk communication and community engagement, and providing commodities, medicines and supplies including modern contraceptives and PPE. Amid movement restrictions worldwide, UNFPA is employing alternative solutions to deliver services including virtual outreach, mobile clinics, hotlines for GBV survivors, and provision of dignity kits to isolation centres. UNFPA is also training health and social workers to provide mental health and psychosocial support and other services.
Commodities and family planning supplies
- UNFPA Supplies is the world’s largest provider of voluntary, modern contraceptives to developing countries covering over 40% of the global market. UNFPA focuses on 46 countries where needs are greatest. Many of UNFPA’s long term suppliers are resuming manufacturing operations at different levels. This means that, for the time being, UNFPA is experiencing minimum disruptions to most family planning products. Since the initial contribution to this inquiry IUD suppliers in India have restarted, production and supply of condoms has only minimal disruption, and suppliers of oral contraceptives are resuming operations.
- A risk-based assessment on 16 April identified stockout risks for long-acting reversible contraceptives to 46 countries over 6 months, with risks to injectables and pills affecting 20 countries, and condoms affecting 10 countries. Since then, UNFPA as part of efforts with the Coordinated Supply Planning (CSP) and Coordinated Assistance for Reproductive Health Supplies (CARhs) with USAID has taken significant mitigation actions. As a result, only 6 countries currently face projected stockouts. UNFPA continues to work with partners to ensure these stockouts do not occur so that women and adolescents are able to protect themselves from STIs, HIV and unintended pregnancies. Challenges remain in terms of transportation and freighting as well as distribution due to port closures or local travel restrictions. Access to quality-assured PPE is facing overwhelming demand, especially for gloves where the market faces continued shortages.
- As part of the initial response UNFPA Country Offices procured and supplied PPE and hand washing kits/soap to frontline health workers, clinics, mayoral offices or defence forces across many different countries. UNFPA is supporting prevention and mitigation efforts of COVID-19 transmission particularly in emergency obstetric care and neonatal facilities, and has provided training to frontline workers on use of PPE, risk management communications and telemedicine as well as access to online training in respiratory diseases.
UNFPA’s on-the-ground response
- Further examples of UNFPA’s continued on-the-ground response include:
- Afghanistan: over 41,000 Afghan travellers and returnees from Iran and Pakistan received screening through UNFPA-supported clinics. And 7,377 calls from young people were received during the initial fortnight of a UNFPA-supported youth health line
- Belarus: UNFPA developed online resources for health workers on sexual and reproductive health (SRH) and COVID-19, and over 8,000 booklets for pregnant women were distributed to antenatal care centres to minimise unnecessary visits to facilities
- Burundi: distributed 350 dignity kits (sanitary pads, soap, solar lamps etc.) to vulnerable women and girls quarantined in Makombe
- Central African Republic: donated 70 hand washing kits, 3,900 gloves, 6,900 masks and 4,489 soap tablets to 48 health centres, 10 women’s houses and 12 youth centres.
- Eswatini: supported training of 500 healthcare workers including addressing anxieties to ensure continuity of SRH services
- Haiti: adaptation of GBV referral systems, provision of oxygen for obstetric facilities, and with WHO co-led prevention, detection and referral case management at border entry points
- Indonesia: providing HIV prevention services to female sex workers through rapid assessments, shifting outreach to online services and developing guidelines in collaboration with the National Network of Sex Workers
- Jordan: ensuring continuity of essential SRH and GBV services and mobilising ‘response accelerators’ particularly within Zaatari and Azraq refugee camps. Working with Plan International and partners to conduct rapid assessment of GBV and SRHR risks on Jordanian and Syrian adolescent girls and women in refugee camps and host communities, to identify availability and obstacles to services and build on lessons learnt
- Kazakhstan: working with the government to create a multisector GBV response addressing the needs of women and girls with disabilities
- Lebanon: leading a working group to monitor service delivery at primary care level on access, availability of drugs and commodities, challenges encountered and best practices.
- Liberia: taking lessons from the Ebola outbreak, recruited over 200 UNFPA-supported contact tracers, increasing to 400 in the coming weeks to cover Margibi and Montserrado counties.
- Madagascar: following the ban on public transport, UNFPA supported transportation of pregnant women to antenatal and related healthcare appointments.
- Mongolia: developing TV programmes on comprehensive sexuality education for inclusion in national curriculum e-learning during school closures
- Nepal: creating a counselling and referral helpline for SRH services for pregnant and lactating women unable or unwilling to visit health facilities
- Tanzania: supported development of toll-free National COVID-19 Helpline for information, including access to SRH services.
- Senegal: supported installation of 247 washing points in villages through community girls’ clubs
- South Africa: provided PPE and medical equipment for mobile clinics to target populations with limited access to health services
- South Sudan: working with the Ministry of Health to safeguard maternal health services to prevent death and illness among pregnant and breastfeeding women. UNFPA has trained over half of South Sudan’s 800 midwives since independence in 2011.
- Sri Lanka: provided an additional 2,000 maternity kits to pregnant women in isolation facilities
- Sudan: trained 1,326 health care providers with a focus on midwives and emergency obstetric & neonatal care professionals in infection prevention and control
- Timor Leste: established a COVID-19 safe maternity ward for safe delivery and training of health care providers