The world feels very different today than it did only a few weeks ago.
We are in the midst of a global pandemic and the world is turned on its head. The emergency facing us is becoming increasingly uncertain and more and more countries around the world face restrictions and national lockdowns.
Many of our programmes and team members around the world have been affected by the crisis and are working hard to ensure they can keep delivering for the women and girls who need them, while keeping our clients and team members safe.
The COVID-19 pandemic hit the East and Southern Africa region at the end of March when the first few cases were reported in Kenya and Ethiopia. Within a weeks’ time almost every country in the region reported confirmed cases of the virus.
A key priority from the beginning was ensuring the physical safety and security of clients and team members by providing PPE equipment. But the crisis also created unprecedented challenges due to lockdowns and restrictions of movement.
The response from all countries was fast, and all countries are continuously adapting to the restrictions outlined by individual governments. While all programmes in the region receive global guidance from global support teams, these have to be tweaked to each individual country. Each channel has to be adapted at country level to ensure maximum safety.
After only a couple of weeks of paused outreach services in Kenya and Uganda, hard work and ingenuity from the teams have meant we are able to continue to deliver services across the region.
When the Zimbabwe government announced a nationwide lockdown on 17th March, they categorised both contraception and post-abortion care as essential services. This meant that although most travel was banned, access to MSI’s services was not. However, many women were still unable to travel for services as, in some areas, the police believed that family planning was not a reason to do so. The number of women able to reach our service-delivery points has been decreasing since lockdown began.
“We were turned away at roadblocks after saying that we were on our way to look for family birth control”
- Women from Bulawayo district, after police dismissed their reasons for movement as non-essential
MSI's programme in Zimbabwe (PSZ) set up an emergency response team, alongside SIDA Zimbabwe, to deliver services to women in rural areas and in just two weeks, they served over 3,500 rural women and girls with family planning. With support from DFID and SIDA, all services across PSZ’s centres, outreach, and social franchise channels have remained open, which has enabled the programme to reach as many women as possible, despite the number of women able to travel to service-delivery points decreasing.
On the 20th March, the Government in Uganda responded to the COVID-19 pandemic by imposing a lockdown restricting travel across the country. These restrictions vary between districts, with some imposing stricter and more aggressive penalties than others. Women and girls feel the impact of the lockdown especially, with expected increases in GBV, increases in paid and unpaid caring responsibilities and decreasing access to sexual and reproductive health care services.
As of April 15th, many of our services are running as normal across the country, apart from our outreach teams who are impacted by travel restrictions and curfews. Most of the teams have been able to adapt and respond appropriately and continue to do all they can to provide essential services to women and girls in rural communities.
In Uganda, cuts caused by the US imposition of the Global Gag Rule risk making the impact of COVID-19 more dire. Marie Stopes Uganda Country Director, Dr Carole Sekimpi said:
Women and girls in Uganda have already lost access to contraception and health care due to the Global Gag Rule. They will be further stretched to prevent an unintended pregnancy or get basic reproductive healthcare when COVID hits their communities.
In the West and Central Africa region, all countries responded to Covid-19 in some way on or before the 24th March, with governments instigating lockdowns across regions, grounding flights, banning gatherings and introducing curfews.
Many of these restrictions are now being lifted, in some cases, such as in Ghana and Nigeria, much earlier than anticipated due to economic pressure. But in other areas, such as in Sierra Leone, a last-minute three-day lockdown was announced with short notice. These unexpected changes, together with rumours and fears in the communities, are making it very difficult for our teams across the region to plan and work effectively.
However, despite this instability, our teams have been incredibly pro-active. All teams have business continuity plans in place and all have bought PPE locally and placed orders internationally for use further down the line. Although some centres in Sierra Leone have closed due to the lockdown and outreach teams in Senegal have been affected, we are still able to serve clients across the region.
On 30th March, a temporary lockdown came into effect in Greater Accra and Greater Kumasi. In response, our Ghana programme quickly implemented a contingency plan to ensure they can continue to offer services to our clients.
The Contact Centre is at the heart of Marie Stopes Ghana's service delivery network, providing clients with clear information and pathways to care and after-care. To adapt to the new situation, the team of five contact centre agents set up their stations at home. The first few days of the lockdown proved that women, in these uncertain times, still require access to SRH service. In one day, the team handled a record number of 422 calls, a significant increase from the usual 140. Sporadic connectivity and electricity issues has not discouraged the team, who continue to provide clients with clear information and reassurance.
Vivian, who works as a midwife in Kumasi, Ghana, relayed that she fears a rise in unintended pregnancies due to the lockdown, with women unable to travel to her clinic. One client shared with Vivian: “I had to lie and pretend that I was seriously ill before [security personnel] would allow me to come for your services.”
Bengaly, a midwife and Marie Stopes Lady in Burkina Faso, is adapting to new challenges in order to continue to provide care to the women and girls who need her. She is able to navigate through quarantines and roadblocks by using her excellent relationships with local healthcare providers who help coordinate her visits, and even uses the quarantine checkpoints as an opportunity to educate the officers in sexual and reproductive health when travelling between villages.
To ensure the safety of herself and her clients, she has implemented the latest guidance to minimise the risk of COVID-19 infection, for example, by ensuring social distancing in the waiting areas. Her commitment has meant that she is able to continue to deliver essential contraceptive services to the women in her community. Because, as she says, “even in the most difficult situations, we have to be able to meet the needs of our clients”.Help us support our providers through the crisis
We try to adapt our strategies to serve our sisters, our daughters in their time of need. It’s a great source of motivation for us, and makes us forget about the virus a little. Together, we will overcome the challenges facing us – we’ll do whatever remains possible!
In Nepal, where the government has ordered a national lockdown, we are seeing the impact first-hand. Due to mobility restrictions, neither providers nor clients were able to reach Marie Stopes Nepal’s centres, forcing them to close. However, women’s need for sexual and reproductive healthcare has not stopped. Marie Stopes Nepal's contact centre has seen an increase in calls from women seeking abortion services since the start of the lockdown.
Sarita Ojha, a Counsellor at Marie Stopes Nepal’s Contact Centre, shared:
“This woman was crying on the phone. ‘When will your services restart? I cannot afford to have another child. Please help me!’ It really broke my heart not to have an affirmative answer for her.”
Fortunately, by working in partnership with local government, Marie Stopes Nepal has been able to re-open seven clinics, with more in the pipeline, meaning women can still access care.
In the Sindhuli district in Nepal, we find Tika. She is a qualified midwife and a Marie Stopes Lady, a collective of midwives and nurses who travel from village to village, door to door to deliver high-quality services to women in their own communities.
Working in remote areas of the country, people often need to walk far to access her services, something that for many has become impossible during the nationally imposed lockdown due to COVID-19. “I am still providing services, but they are limited. People often need to walk far to reach me and the lockdown has meant they are unable to get here.”
Despite the challenges, Tika remains determined to do whatever she can to serve the women in her community. “Today I walked four hours to deliver contraceptive services to a woman who called me asking me to come over… No pandemic should prevent women from accessing sexual and reproductive health services.”Help us support our providers through the crisis
The Vietnamese government issued strict social distancing measures as an effort to prevent and control the spread of the COVID-19 virus in 12 provinces across the country. But thanks to Sexual and Reproductive Health services being classified as essential, 10 out of 11 of Marie Stopes Vietnam’s centres are still open and providing services.
To ensure the safety of clients and team members, all centres have been equipped with enough hand sanitiser to last until the end of the outbreak. All clients and visitors are required to wash their hands and have their temperature checked upon arrival and are required to keep a distance of at least two metres from each other to prevent the spread of the virus.
In addition to the efforts to keep staff and clients safe, Marie Stopes Vietnam are offering private transport for clients in Hanoi after most taxis and other ride-hailing services in the country had to suspend their services following social distancing guidelines announced by the government.
“All the regulations of preventing the disease need to be followed very strictly, and the epidemic has become increasingly complicated, but we cannot leave our clients unserved,” says Ms. Vu Thi Mai, the manager of a Marie Stopes clinic in Hanoi. “The decision to keep our doors open for our clients is very meaningful for many women.”
In India, the COVID-19 pandemic is likely to disproportionately impact women and intensify gender inequalities. After the country went into full lockdown, vulnerable women living with violent partners, women with disabilities and poor and marginalised women face an increased risk of marginalisation.
The lockdown also means limited or completely restricted access to critical sexual and reproductive health services as it is not seen as essential. When the restrictions were put in place, our programme in India was forced to shut down service delivery. As the largest provider of family planning services outside of the public sector, our inability to offer services will result in thousands of vulnerable women in hard-to-reach locations being unable to access contraceptive services.
In response to this, our programme (FRHS India) has requested that abortion is classified as an essential service, urging the government to ensure that abortion services are available across both the public and private sector to enable women to access the care they seek.
Update: After working closely with the government, the programme was able to reopen clinics in Rajasthan and Uttar Pradeshand and are now providing safe abortion and post abortion care services to women in the regions.Why contraception and safe abortion is essential healthcare
On the 17th March, the government of Sri Lanka imposed a national lockdown in response to the COVID-19 pandemic. The restrictions on movement led to many people in the country being unable to access health services, including pharmacies.
MSI’s affiliate in Sri Lanka, PSL, reached out to government health authorities and advocated for an uninterrupted supply of contraceptives throughout the country to ensure women and girls can continue to access contraceptive services during the lockdown. Thanks to these efforts, PSL has been able to continue to operate across the country since the 13th April.
In Mexico, sexual and reproductive health services have been classified as essential during the COVID-19 pandemic. This means that Marie Stopes Mexico have been able to continue delivering services at their centres across the country.
The programme has invested in protective equipment, such as masks, gloves and security masks, to maximise the safety of clients and team members in the clinics. Team members working in contact centres have all been provided with computer equipment to enable them to continue their work safely from their own homes.
Marie Stopes Mexico has used their social media channels to reinforce the message that centres are still open and services are being provided safely to ensure clients can still find the services they need. Infographics with motivational messages and essential information have been widely shared to ensure women know where to turn for support should they need it during the crisis.