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Infectious Diseases

Updated 28 April 2020

Covid-19: What the lockdown means for sexual and reproductive health services

Access to reproductive healthcare services is almost always time sensitive and not something that can simply be placed on hold because of the Covid-19 lockdown,, write Thuthukile Mbatha and Tendai Mafuma.

Over the past few weeks, South Africa has taken several measures to curb the spread of Covid-19.

The first significant measure was the declaration of a national State of Disaster on 15 March. This declaration was followed by Regulations in terms of the Disaster Management Act which were amended on 25 March 2020 to implement the national lockdown. 

These changes sparked uncertainty across communities. Some people started stockpiling food and other household necessities. Some grocery stores and pharmacies ran out of basic things such as food, hygiene products and even alcohol. On social media and in mainstream media, people expressed fears of running out of basic necessities. 

It is human nature to think of fulfilling your basic needs when confronted with danger. But how many really thought about how these regulations would impact their sexual and reproductive health and rights? 

There has been relatively little discussion about access to sexual and reproductive health goods such as sanitary pads, condoms, lubricants and dental dams or access to sexual and reproductive health services such as abortions. 

Essential goods and essential services 

In terms of the amended Regulations, which will apply for the duration of the lockdown, people (except those classified as essential workers) are expected to stay within their places of residence and are only to leave for the purposes of accessing essential services or essential goods. Any services that fall outside of those that have been categorised as essential services will be shut down.

This nationwide lockdown is a first for South Africa. Generally, there has been uncertainty around the Regulations, and some aspects have since been clarified either by amendments or in ministerial press briefings. Annexures to the Regulations give more detail about what essential goods and essential services are. The annexures set out the categories (and in some instances specific details) of the goods and services that have been identified as essential goods and services during the lockdown. 

Access to sexual and reproductive health goods

In Annexure B, which deals with the categories of cleaning and hygiene goods, sanitary pads, sanitary tampons and condoms are included as essential goods. It is good that sanitary pads, tampons and condoms have been classified as essential goods, but in reality these products remain out of reach for many young girls and adolescents. They are simply too expensive.

Many young girls are dependent on school-distributed pads in some parts of the country. With schools closed during the lockdown, this may mean going back to using old pieces of cloth or cow dung as sanitary products. The same goes for people who rely on free condoms that government provides. So far, the Department of Social Development and the Department of Basic Education have put in place relief programmes in various provinces to address access to food. It is crucial that these plans also ensure that the vulnerable and marginalised can access menstrual hygiene products and condoms.  

A constitutional right

The right to have access to healthcare services, including reproductive health services, is enshrined in the Constitution. The first important thing to note is that access to healthcare services is not restricted under the national State of Disaster. The Regulations do not say people have access to essential health services (which haven’t been defined), but rather, health services have been identified as one of the services that are categorised as essential services under the Regulations. 

Annexure B of the Regulations states that medical, health (including mental health) and laboratory and medical services have been identified as essential services for the purposes of the lockdown. This means the full spectrum of healthcare services, including reproductive health care services will be available during the lockdown. However, considering the strain that the pandemic has placed on health systems in South Africa and the world over, countries have had to prioritise the provision of certain services over others.

The idea is that health systems should be able to respond to Covid-19’s unpredictability but also continue to deliver healthcare services so that the healthcare system does not collapse. In Gauteng, MEC for Health Dr Bandile Masuku earlier announced that during the lockdown public health facilities in the province were going to reduce outpatient numbers and provide emergency health and maternal health care services only.

According to the MEC only life-saving surgeries and those related to pregnancies would be provided. All elective surgeries would be placed on hold.  But what does this mean for sexual and reproductive health services? 

A time sensitive matter

Activists in the sexual and reproductive health and rights sector have warned against a number of issues that the lockdown may cause. This includes a potential increase in sexual and gender based violence against women and children during this time. The government has put measures in place to mitigate such cases including the identification of shelters for abused women and children. However, within the first week of lockdown we have already seen a huge increase in the number of reported cases of sexual and gender-based violence. 

On 5 April 2020, it was reported that the South African Police Service had received 2 320 complaints of gender-based violence during just the first week of the lockdown. This number is 37% higher than the weekly average of domestic violence cases reported to police during 2019. 

Access to reproductive health care services is almost always time sensitive and not a matter that can be placed on hold for a set period. Take for example someone who, just prior to the declaration of a national State of Disaster, had discovered that they are pregnant but did not want to continue with their pregnancy. Given the already limited access to abortion services across the country, it is important to have access to health facilities sooner rather than later. Very rarely, if at all, does someone seeking abortion services in public facilities receive those services within a month of their first visit to the clinic.

Accessing abortion services in the public health sector often involves multiple visits, often to multiple facilities, just to get an appointment date. When women eventually do get an appointment date, the date is often far into the pregnancy. The result is that pregnant women then have to seek services in the private sector if they have the means, or resort to unsafe backstreet abortions. 

Facilities refuse to provide services

There is no doubt that providing sexual and reproductive health services during the national State of Disaster must continue. However, SECTION27 has received a number of requests for assistance from the public in accessing the services – many of them reporting that some facilities are refusing to provide these services on the basis that they are not emergency services. Clear directives must be given to health facilities that abortion services must still be provided.

In addition, every effort must be made to ensure that the message that these services are available, gets to all communities. We advise anyone who has been turned away from a health facility to contact organisations such as SECTION27, the Sexual and Reproductive Justice Coalition and the Treatment Action Campaign for assistance. It is also important to note that safe private facilities such as Marie Stopes are still providing services during the lockdown period. 

Availability of sexual and reproductive medicine

The Covid-19 pandemic also impacts the availability of various goods globally. The restrictions in movement as well as the advice to maintain physical distance has meant that many factories have either had to reduce or suspend production. So, whilst the Regulations state that condoms are essential goods, their availability on the shelves will be impacted by low production. Some big condom manufacturers in China, Malaysia and India have had to reduce or suspend production and export of their products.

The pandemic will also have an impact on the production of medicines. In relation to sexual and reproductive medicines, this will come at a time when South Africa, like many other countries, is already experiencing shortages of popular contraceptives. As the pandemic persists, we are likely to see even more strain on access to contraceptives and other medicines. 

It is understandable that in times of lockdown and limited movement with not much to do at home, people may more regularly have sexual intercourse. In the absence of contraceptives, including condoms, this could potentially lead to an increase in pregnancy rates – some of which will be unplanned. Given South Africa’s high HIV prevalence, any disruption in access to HIV prevention tools such as condoms may contribute to even higher infection rates of HIV and other sexually transmitted diseases. 

The tight restrictions on public transport have definitely added an additional challenge to accessing health care services. Currently, public transportation is allowed to operate from 05h00 to 10h00 and again from 16h00 to 20h00 daily. According to the Regulations, people can make use of public transport to get essential goods, get their social grant or to get medical attention, but the limited operating hours will mean that many people in South Africa, who rely on public transport to get to public health facilities, may be unable to get to and from the facilities.

Adjustments are needed to ensure that people have access to such essential services. Ultimately, access to sexual and reproductive health services is important for the overall well-being of everyone. But, while the restrictions are affecting everyone, it is the rights of the vulnerable, including women and young girls, that are most affected. Critical services for these groups cannot be disrupted – firstly because young women and girls will suffer direct harm, but also because doing so would result in major health setbacks that the country can ill afford. 

*Mbatha is a researcher and Mafuma a legal researcher at Section27.

*This article was first published in Spotlight – health journalism in the public interest. Like what you’re reading? Sign up for our newsletter and stay informed.

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