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The lockdown has limited peoples’ access to various forms of birth control. The restrictions have also prompted a shortage of contraceptives. The government must declare sexual and reproductive healthcare an essential service or get ready to embrace a baby boom in due course

Source: The Pitt News

Lately, we’ve been joking about a lockdown baby boom. The joke may turn sour a few months on when stay-at-home rules and boredom-induced intimacy between couples start resulting in the arrival of coronababies, coronials or quaranteens.

It might sound cute and joyful, but it’s making many couples insecure — because it’s not the best time to get intimate.

“Men are spending more time at home these days. They are under no pressure from work and in no hurry to wake up early in the morning. This is making women wary of their reproductive wellbeing,” says Saima Malik, a community mid-wife, who runs Healthcare Centre and Maternity Home in Tando Haider, Sindh. “Initially, when my clinic was closed because of the lockdown, women visited me at home to acquire short-term contraceptives, like pills and condoms. They were desperate, because general stores that stock birth control items were closed. Some locals cannot even afford to purchase these items. We provide them for free.”

The government has not declared birth control an essential service in the times of coronavirus. This has critically limited people’s access to family planning services and commodities. “There is a huge risk that under the current situation chances of unintended pregnancies will rise,” says Asma Balal, the country director for Marie Stopes Society (MSS).

The United Nations has already warned of devastating consequences, including unplanned pregnancies and STDs.

At age 24, a mother of two children, Rehana (not her real name) wanted a quick fix to her seven-week unwanted pregnancy. She was stressed. She took the first dose of four misoprostol tablets; she waited for bleeding or uterine contraction, nothing happened; she took two more, no signs showed up; she took two more and then two more… a total of 10 tablets of misoprostol.

“She was bleeding excessively,” says Dr Nadeem Khalid, a gynecologist associated with the Family Health Hospital run by Rahnuma-Family Planning Association of Pakistan in Lahore’s Johar Town.

Dr Khalid fears an influx of similar cases of unsafe abortion in the near future. “The signs are worrying,” he says.

The lockdown has put thousands of women out of reach of birth control and other reproductive and sexual health needs. Family clinics are closed, and outreach services, the key to reaching women, have stopped. MSS runs a total of 450 family planning service delivery points – 50 in urban and the rest in rural areas, where inter-personal communication, door-to-door mobilization and mohalla meetings are important for creating awareness. “Easily, activities at 40 percent of these points have been suspended,” says Asma Balal.

The organisation’s 400 field health educators, who go door-to-door to mobilise people for family planning, are unable to reach out because of the contagion. “We are presently relying on walk-in clients and some mobilisation via phone,” she adds.

MSS has a setup of nine clinics in Karachi, where most of the clients are referred either by general practitioners or OPDs. “Since the OPD services are suspended in Sindh that traffic of clients has stopped,” says Asma Balal.

On the government side, too, the family planning services are restricted. “The mobile service units run by the Punjab Welfare Department are presently being used by the Health Department for Covid-19 screening, which obviously means that this service is on hold,” says Syed Kamal Shah, the CEO of Rahmuna-Family Planning Association of Pakistan (FPAP).

That’s the tragedy. Pakistan procures family planning products through international bidding. At most, the country manufactures some injectables and pills. It does not manufacture condoms.

He adds that since Rahuma-FPAP run Reproductive Health Hospital functions as an OPD, babies are delivered in emergencies these days, “strictly following Covid-19 protocols outlined by the WHO”. He points out that post-partum is the most advisable time to advocate family planning, “by not enlisting reproductive healthcare as an essential service, we are desperately missing an intervention opportunity at this critical time”.

The problem doesn’t end there. Even when clinics and reduced reproductive healthcare services are allowed to resume, they are likely to run short on their stock of vital commodities. Of the three not-for-profit partners of the governments in Pakistan – Greenstar Social Marketing (GSM), Marie Stopes Society (MSS) and Rahnuma-Family Planning Association of Pakistan (FPAP) – Rahmuna-FPAP has stocks to last for the next six months, GSM for eight months and MSS for only a few months. “There is an acute shortage of IUDs,” says Syed Kamal Shah of Rahnuma-FPAP.

“Our consumption of IUDs is high. There are delays at DRAP, Islamabad, due to the lockdown in assurance of NOCs. This is affecting our ability to import IUDs,” says Asma Balal of the MSS.

Travel restrictions and manufacturing slowdowns across the world as a result of the pandemic mean that family planning providers are waiting for the regular shipments of contraceptives and other items as stocks run short. However, the situation in Pakistan is even more complicated: “Six out of nine manufacturers of IUDs are based in India. Pakistan procures IUDs mainly from India. But, since the blocking of trade between Pakistan and India, the import of this vital commodity has been suspended,” says Dr Syed Azizur Rab, the Greenstar Social Marketing CEO.

That’s the tragedy. Pakistan procures family planning products through international bidding. At most, the country manufactures some injectables and pills. It does not manufacture condoms.

Already there is a shortfall of 100 million condoms globally after the coronavirus lockdown forced the condom manufacturing companies to shutdown. Malaysia’s Karex Bhd makes one in every five condoms globally. The Malaysian government last month closed it down to stop the spread of the virus.

Marie Stopes International estimates that with an 80 percent reduction in service delivery for three months, and minimal services for the remainder of the year, 9.5 million people will miss out. If things were to return to normal after three months of disruption, the figure would drop to 4 million.

In the current situation of pandemic, “even if Pakistan decides to procure the commodities today through international biddings, it’ll take two years for the orders to arrive. There’s a severe shortage in the international market of contraceptives,” says Syed Kamal Shah.

The government must plan for better utilisation of the available stocks, and also ponder on starting a campaign to change the peoples’ sexual behaviour by perhaps advocating the traditional methods that dominate the contraceptive prevalence rate, some unreliable ones too, like breastfeeding. It must start with the low hanging fruit.

For now, at least, the government’s pledge to increase the contraceptive prevalence rate (CPR) to 50 from 35.4 (2017-18) appears difficult.

The author is a staff member.

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