Effects of COVID-19 on sexual and reproductive health services access in the Asia-Pacific region: a qualitative study of expert and policymaker perspectives

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Abstract

The COVID-19 pandemic has strained health systems globally, with governments imposing strict distancing and movement restrictions. Little is known about the effects of the COVID-19 pandemic on sexual and reproductive health (SRH). This study examined perceived effects of COVID-19 on SRH service provision and use in the Asia-Pacific region. We conducted a qualitative study using semi-structured interviews with 28 purposively sampled SRH experts in 12 Asia-Pacific countries (e.g. United Nations, international and national non-governmental organisations, ministries of health, academia) between November 2020 and January 2021. We analysed data using the six-stage thematic analysis approach proposed by Braun and Clarke (2019). Interviewees reported that COVID-19 mitigation measures, such as transport restrictions and those that decreased the availability of personal protective equipment (PPE), reduced SRH service provision and use in most countries. SRH needs related to service barriers and gender-based violence increased. Systemic challenges included fragmented COVID-19 response plans and insufficient communication and collaboration, particularly between public and private sectors. SRH service-delivery challenges included COVID-19 response prioritisation, e.g. SRH staff task-shifting to COVID-19 screening and contact tracing, and lack of necessary supplies and equipment. Innovative SRH delivery responses included door-to-door antenatal care and family planning provision in the Philippines, online platforms for SRH education and outreach in Viet Nam, and increasing SRH service engagement through social media in Myanmar and Indonesia. To ensure continuation of SRH services during health emergencies, governments should earmark human and financial resources and prioritise frontline health-worker safety; work with communities and the private sector; and develop effective risk communications.

Résumé

La pandémie de COVID-19 a mis à rude épreuve les systèmes de santé dans le monde, les gouvernements imposant des mesures strictes de distanciation et de limitation des déplacements. On sait encore peu de choses sur les conséquences de la pandémie de COVID-19 sur la santé sexuelle et reproductive (SSR). Cette étude a examiné les effets perçus de la COVID-19 sur la prestation et l’utilisation de services de SSR dans la région Asie-Pacifique. Nous avons mené une étude qualitative entre novembre 2020 et janvier 2021 à l’aide d’entretiens semi-structurés avec 28 experts en SSR sélectionnés par choix raisonné dans 12 pays d’Asie et du Pacifique (par exemple des institutions des Nations Unies, des organisations non gouvernementales nationales et internationales, des ministères de la santé, des établissements universitaires). Nous avons analysé les données en utilisant l’approche d’analyse thématique en six étapes proposée par Braun and Clarke (2019). Les personnes interrogées ont indiqué que les mesures d’atténuation de la COVID-19, comme les restrictions de transport et celles qui ont diminué la disponibilité des équipements de protection individuelle (EPI), ont réduit l’offre et l’utilisation de services de SSR dans la plupart des pays. Les besoins de SSR liés aux obstacles aux services et à la violence sexiste ont augmenté. Les difficultés systémiques comprenaient des plans de riposte fragmentaire à la COVID-19, de même qu’une communication et une collaboration insuffisantes, en particulier entre les secteurs public et privé. Les obstacles se rapportant à la prestation des services de SSR incluaient la priorité accordée à la réponse à la COVID-19, par exemple l’affectation du personnel de SSR à des tâches de dépistage de la COVID-19 et de recherche des contacts, et le manque de fournitures et d’équipements nécessaires. Les réponses innovantes en matière de prestation de SSR comprenaient des services de soins prénatals et de planification familiale à domicile aux Philippines, des plateformes en ligne pour l’éducation et la sensibilisation à la SSR au Viet Nam, et l’accroissement de la participation des services de SSR par le biais des médias sociaux au Myanmar et en Indonésie. Pour garantir la continuité des services de SSR pendant les urgences sanitaires, les gouvernements devraient réserver des ressources humaines et financières, et donner la priorité à la sécurité des agents de santé de première ligne; travailler avec les communautés et le secteur privé; et mettre au point une communication efficace des risques encourus.

Resumen

La pandemia de COVID-19 ha causado una sobrecarga de los sistemas de salud del mundo, y los gobiernos han tenido que imponer estrictas restricciones de distanciamiento y movimiento. Aún no se sabe mucho sobre los efectos de la pandemia de COVID-19 en la salud sexual y reproductiva (SSR). Este estudio examinó los efectos percibidos de COVID-19 en la prestación y el uso de servicios de SSR en la región de Asia-Pacífico. Realizamos un estudio cualitativo utilizando entrevistas semiestructuradas con 28 expertos en SSR muestreados intencionalmente, en doce países de Asia-Pacífico (ej. Naciones Unidas, organizaciones no gubernamentales internacionales y nacionales, ministerios de salud, académicos) entre noviembre de 2020 y febrero de 2021. Analizamos los datos utilizando el enfoque de análisis temático de seis etapas propuesto por Braun y Clarke (2019). Las personas entrevistadas informaron que las medidas de mitigación de COVID-19, tales como restricciones al transporte y aquellas que disminuyeron la disponibilidad de equipo de protección personal (EPP), disminuyeron la prestación y el uso de servicios de SSR en la mayoría de los países. Aumentaron las necesidades de SSR relacionadas con las barreras a los servicios y la violencia de género. Algunos de los retos sistémicos eran planes fragmentados de respuesta al COVID-19 y comunicación y colaboración insuficientes, en particular entre los sectores público y privado. Ejemplos de retos relacionados con la prestación de servicios de SSR eran la priorización de respuesta a COVID-19, ej. redirigir las tareas del personal de SSR al tamizaje de COVID-19 y al rastreo de contactos, y la falta de insumos y equipos necesarios. Entre las respuestas innovadoras para la entrega de servicios de SSR se encontraban la atención prenatal y provisión de planificación familiar de puerta en puerta en Filipinas, plataformas en línea para la educación y actividades de extensión comunitaria sobre SSR en Vietnam, y mayor participación en los servicios de SSR por medio de las redes sociales en Myanmar e Indonesia. Para garantizar la continuación de los servicios de SSR durante emergencias de salud, los gobiernos deben asignar los recursos humanos y financieros y priorizar la seguridad de los trabajadores de salud de primera línea; trabajar con las comunidades y el sector privado; y formular comunicaciones eficaces de riesgos.

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Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis

John Allotey, Elena Stallings, Mercedes Bonet … (2020)

Abstract Objective To determine the clinical manifestations, risk factors, and maternal and perinatal outcomes in pregnant and recently pregnant women with suspected or confirmed coronavirus disease 2019 (covid-19). Design Living systematic review and meta-analysis. Data sources Medline, Embase, Cochrane database, WHO COVID-19 database, China National Knowledge Infrastructure (CNKI), and Wanfang databases from 1 December 2019 to 26 June 2020, along with preprint servers, social media, and reference lists. Study selection Cohort studies reporting the rates, clinical manifestations (symptoms, laboratory and radiological findings), risk factors, and maternal and perinatal outcomes in pregnant and recently pregnant women with suspected or confirmed covid-19. Data extraction At least two researchers independently extracted the data and assessed study quality. Random effects meta-analysis was performed, with estimates pooled as odds ratios and proportions with 95% confidence intervals. All analyses will be updated regularly. Results 77 studies were included. Overall, 10% (95% confidence interval 7% to14%; 28 studies, 11 432 women) of pregnant and recently pregnant women attending or admitted to hospital for any reason were diagnosed as having suspected or confirmed covid-19. The most common clinical manifestations of covid-19 in pregnancy were fever (40%) and cough (39%). Compared with non-pregnant women of reproductive age, pregnant and recently pregnant women with covid-19 were less likely to report symptoms of fever (odds ratio 0.43, 95% confidence interval 0.22 to 0.85; I2=74%; 5 studies; 80 521 women) and myalgia (0.48, 0.45 to 0.51; I2=0%; 3 studies; 80 409 women) and were more likely to need admission to an intensive care unit (1.62, 1.33 to 1.96; I2=0%) and invasive ventilation (1.88, 1.36 to 2.60; I2=0%; 4 studies, 91 606 women). 73 pregnant women (0.1%, 26 studies, 11 580 women) with confirmed covid-19 died from any cause. Increased maternal age (1.78, 1.25 to 2.55; I2=9%; 4 studies; 1058 women), high body mass index (2.38, 1.67 to 3.39; I2=0%; 3 studies; 877 women), chronic hypertension (2.0, 1.14 to 3.48; I2=0%; 2 studies; 858 women), and pre-existing diabetes (2.51, 1.31 to 4.80; I2=12%; 2 studies; 858 women) were associated with severe covid-19 in pregnancy. Pre-existing maternal comorbidity was a risk factor for admission to an intensive care unit (4.21, 1.06 to 16.72; I2=0%; 2 studies; 320 women) and invasive ventilation (4.48, 1.40 to 14.37; I2=0%; 2 studies; 313 women). Spontaneous preterm birth rate was 6% (95% confidence interval 3% to 9%; I2=55%; 10 studies; 870 women) in women with covid-19. The odds of any preterm birth (3.01, 95% confidence interval 1.16 to 7.85; I2=1%; 2 studies; 339 women) was high in pregnant women with covid-19 compared with those without the disease. A quarter of all neonates born to mothers with covid-19 were admitted to the neonatal unit (25%) and were at increased risk of admission (odds ratio 3.13, 95% confidence interval 2.05 to 4.78, I2=not estimable; 1 study, 1121 neonates) than those born to mothers without covid-19. Conclusion Pregnant and recently pregnant women are less likely to manifest covid-19 related symptoms of fever and myalgia than non-pregnant women of reproductive age and are potentially more likely to need intensive care treatment for covid-19. Pre-existing comorbidities, high maternal age, and high body mass index seem to be risk factors for severe covid-19. Preterm birth rates are high in pregnant women with covid-19 than in pregnant women without the disease. Systematic review registration PROSPERO CRD42020178076. Readers’ note This article is a living systematic review that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication.

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Supporting the Health Care Workforce During the COVID-19 Global Epidemic

James G Adams, Ron Walls (2020)

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Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study

Timothy Roberton, Emily Carter, Victoria Chou … (2020)

Summary Background While the COVID-19 pandemic will increase mortality due to the virus, it is also likely to increase mortality indirectly. In this study, we estimate the additional maternal and under-5 child deaths resulting from the potential disruption of health systems and decreased access to food. Methods We modelled three scenarios in which the coverage of essential maternal and child health interventions is reduced by 9·8–51·9% and the prevalence of wasting is increased by 10–50%. Although our scenarios are hypothetical, we sought to reflect real-world possibilities, given emerging reports of the supply-side and demand-side effects of the pandemic. We used the Lives Saved Tool to estimate the additional maternal and under-5 child deaths under each scenario, in 118 low-income and middle-income countries. We estimated additional deaths for a single month and extrapolated for 3 months, 6 months, and 12 months. Findings Our least severe scenario (coverage reductions of 9·8–18·5% and wasting increase of 10%) over 6 months would result in 253 500 additional child deaths and 12 200 additional maternal deaths. Our most severe scenario (coverage reductions of 39·3–51·9% and wasting increase of 50%) over 6 months would result in 1 157 000 additional child deaths and 56 700 additional maternal deaths. These additional deaths would represent an increase of 9·8–44·7% in under-5 child deaths per month, and an 8·3–38·6% increase in maternal deaths per month, across the 118 countries. Across our three scenarios, the reduced coverage of four childbirth interventions (parenteral administration of uterotonics, antibiotics, and anticonvulsants, and clean birth environments) would account for approximately 60% of additional maternal deaths. The increase in wasting prevalence would account for 18–23% of additional child deaths and reduced coverage of antibiotics for pneumonia and neonatal sepsis and of oral rehydration solution for diarrhoea would together account for around 41% of additional child deaths. Interpretation Our estimates are based on tentative assumptions and represent a wide range of outcomes. Nonetheless, they show that, if routine health care is disrupted and access to food is decreased (as a result of unavoidable shocks, health system collapse, or intentional choices made in responding to the pandemic), the increase in child and maternal deaths will be devastating. We hope these numbers add context as policy makers establish guidelines and allocate resources in the days and months to come. Funding Bill & Melinda Gates Foundation, Global Affairs Canada.

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Author and article information

Journal

Journal ID (nlm-ta): Sex Reprod Health Matters

Journal ID (iso-abbrev): Sex Reprod Health Matters

Title: Sexual and Reproductive Health Matters

Publisher: Taylor & Francis

ISSN (Electronic): 2641-0397

Publication date (Electronic, pub): 8 September 2023

Publication date (Electronic, collection): 2023

Publication date PMC-release: 8 September 2023

Volume: 31

Issue: 1

Electronic Location Identifier: 2247237

Affiliations

[a ]Research Fellow, London School of Hygiene & Tropical Medicine, Department of Global Health & Development, London, UK; Overseas Research Associate], Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore

[b ]Visiting Scholar Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Alumnus, London School of Hygiene & Tropical Medicine, Department of Global Health & Development, London, UK.

[c ]Research Fellow, London School of Hygiene & Tropical Medicine, Department of Global Health & Development, London, UK

[d ]Research Associate, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore

[e ]Research Associate, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore

[f ]Research Fellow, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore

[g ]Intern, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore

[h ]Senior Resident, Preventive Medicine, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore

[i ]Partner, Stanford University, Stanford Distinguished Careers Institute, Stanford, USA

[j ]Associate Professor, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Associate Professor, London School of Hygiene & Tropical Medicine, Department of Global Health & Development, London, UK

Author notes

Correspondence: st.lam@ 123456u.nus.edu

Supplemental data for this article can be accessed online at https://doi.org/10.1080/26410397.2023.2247237

[†]

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Manar Marzouk https://orcid.org/0000-0002-9801-1263

Sze Tung Lam https://orcid.org/0000-0001-6033-262X

Anna Durrance-Bagale https://orcid.org/0000-0001-6674-1862

Michiko Nagashima-Hayashi https://orcid.org/0000-0002-3666-7814

Pearlyn Neo https://orcid.org/0000-0002-7797-8942

Mengieng Ung https://orcid.org/0000-0003-1411-5442

Ayshath Zaseela https://orcid.org/0000-0002-9727-2664

Zeenathnisa Mougammadou Aribou https://orcid.org/0000-0002-7127-7299

Sunanda Agarwal https://orcid.org/0000-0003-0109-2368

Natasha Howard https://orcid.org/0000-0003-4174-7349

Article

Publisher ID: 2247237

DOI: 10.1080/26410397.2023.2247237

PMC ID: 10494729

PubMed ID: 37682084

SO-VID: 4f5b22a5-e452-48ca-a285-182b45498a08

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This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent.

Effects of COVID-19 on sexual and reproductive health services access in the Asia-Pacific region: a qualitative study of expert and policymaker perspectives

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Most cited references 36

Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis

Supporting the Health Care Workforce During the COVID-19 Global Epidemic

Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study

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