Humans are inextricably linked with our environment, a fact that has perhaps never been clearer than during the COVID-19 pandemic. How will the lingering effects of quarantine affect not only those in need of family planning, but the natural world in which we live? Tamar Abrams examines these issue through a Population, Health, and Environment (PHE) lens.
The global COVID-19 pandemic has upended our lives and, possibly more significantly, many of the assumptions we make about the impact it is having on the world. For example, with human beings on every continent engaging in some form of quarantine for an extended time, early reports were that our lack of activity was greatly impacting the environment. And yet, current data are showing that while there was indeed a sudden plunge in global greenhouse gas emissions, the actual amount of greenhouse gases in the air is at an all-time high. The Scripps Institution of Oceanography and the National Oceanic and Atmospheric Administration (NOAA) say that carbon dioxide levels are now the highest they have seen in human history.
At the same time, experts in family planning are deeply concerned by interruptions in the supply chain of contraceptives in numerous regions. Many worry that these disruptions – coupled with the inability of women and girls to reach providers – may result in a spike in unplanned births over the next six to nine months. And, if that proves to be true, what will be the impact on the environment? And for women and girls in lockdown or struggling to survive the pandemic, they just need to know their family planning needs will be met.
Humans and the environment are intrinsically linked, with every small shudder by one having an effect on the other. At this point, data is just trickling in but it is worth looking at what we know, what we assume, and how we are planning for a time when the pandemic is no longer looming so large.
“Three months ago is when we started getting reports from partners that problems were arising,” recalls John Skibiak, Director, Reproductive Health Supplies Coalition (RHSC). “We heard from manufacturers who said they were in lockdown: ‘Our employees can’t get to work so we aren’t producing.’ Public-sector NGOs were saying their facilities are shut: ‘We are not meeting with clients, and they aren’t coming in for supplies.’”
He went on to describe a “fundamental split in the way our community is looking at this issue for the here and now. How do we do that while preserving and sustaining what we have been building for the past 20 years? Too much focus on the immediate problems (caused by COVID-19) could lead us to do something that will undermine the functionality of the system.”
Some regions are clearly hit harder than others. V.S. Chandrashekar, Chief Executive Officer of FRHS India (an affiliate of Marie Stopes International), says the worst case scenario could be that 27.18 million couples in India could not access family planning services between the last week of March through September 2020. The supply chain has been badly disrupted, he says. “Contraceptive commodities could not be moved from warehouses to distributors and from them to retail outlets since transport of non-essential goods were not allowed. We estimate the demand destruction to be 1.28 million IUCDs, 591,182 doses of injectable contraceptives, 27.69 million cycles of oral contraceptive pills, 1.08 million emergency contraceptive pills, and 500.56 million condoms.”
“Too much focus on the immediate problems (caused by COVID-19) could lead us to do something that will undermine the functionality of the system.”
A world away, in Uganda, the supply chain has been less problematic than getting women into the clinic to obtain contraceptives though, when the lockdown is lifted, there will surely be a problem. Sarah Uwimbabazi is Manager of the Uganda Sexual Health & Pastoral Education (USHAPE) program for the Margaret Pyke Trust. At Bwindi Community Hospital in the Southwest corner of Uganda, Sarah says that supplies have held steady. “They stocked up prior to the lockdown so they would be able to weather the storm so there haven’t been any stock outs. However, outreach is not taking place because of the lockdown and the number of patients seeking supplies at the hospital has dropped dramatically.”
Sarah added that when she talked to staff at the National Medical Stores – the national organization that directly receives supplies from abroad for the entire country and is responsible for distribution – she was told that they had a low supply of family planning products. They also told her that if stores were to open quickly, there would be almost immediate shortages.
It is no surprise that those hit hardest by the pandemic are those who have always had the most restricted access to reproductive health supplies. “Starting in late April, I began hearing about the economic and livelihood impacts on rural communities,” recalls Kristen P. Patterson, program director of People, Health, Planet at Population Reference Bureau (PRB). “The economic impacts of the pandemic and lockdown are going to be long term and will have a lasting impact on reproductive health and conservation. Many parts of Africa are dependent on tourism. Fortunately NGOs are helping women to diversify how they earn money – by making soaps or masks. Growing and branding coffee.”
Many donors, implementers, and partner organizations are working to determine the actual impact of the pandemic and lockdown on women and girls. Through the COVID-19 FP Impact Task Team, FP2020 is working with partners to monitor, measure and model the impact of COVID-19 on family planning. FP2020 has gathered in one place the various data, models and scenarios, and Jason Bremner, FP2020 director of data & performance management, is keen for people to look through all of them. He has never been a believer in one number representing all possible scenarios and outcomes. However, he allows, “I think the one number where Guttmacher and UNFPA/Avenir estimates are in alignment is on the estimate of a 12-month major disruption resulting in 15 million unintended pregnancies in low- and middle-income countries (minor note that Guttmacher is looking at 132 countries and UNFPA 114 countries).”
Fifteen million unintended pregnancies.
It is hard to predict what the world will look like when the threat of the pandemic has lessened and people begin to emerge from lockdowns in high numbers. But it is possible to prepare for Life After. PRB’s Kristen Patterson urges, “Let’s listen to what women are saying. We must step up funding for women- and youth-led organizations. There is recognition that the pandemic is global but the solutions are local. The more sustainable solutions will be led by local women and youth.”
FRHS’s V.S. Chandrashekar says there must be significant changes made in the wake of the pandemic. “Since a majority of services we provide are clinical in nature, we would need to put in place additional infection prevention practices and reduce the number of clients served each day,” he says. “We also would need to be prepared to serve a larger number of clients once normalcy is restored. Apart from those who could not be served during the lockdown, a large number of young migrant workforce are back in rural areas. Many may want to use contraceptives to avoid unplanned pregnancies, especially in times of uncertainties and job/income losses.”
John Skibiak at RHSC is similarly thinking through what comes next. “COVID has shone a light on many of the fundamental problems we see in the market now, regarding contraception,” he says. “The procurement system is pretty broken and fragmented. Price competition is really driving a lot of manufacturers out of the marketplace. Contracts are going to the largest manufacturers who can produce the largest volume. There may be an inclination toward shorter supply chains, with smaller manufacturers viewed in a more attractive light. There is security in having supplies come in, literally, from next door.”
As locusts attack crops in parts of Africa, as pollution clears and then returns in parts of Asia, and as pandemics continue to spring up around the world, discussions about preparing for an uncertain future increase. Few could have predicted that 2020 would take the turn it has or that so many people would talk about resilience in communities large and small. For women and girls who rely on contraceptives to give them some autonomy over their own lives, the discussions and forecasts taking place in the family planning community are critical. They are counting on manufacturers and funders and providers and advocates to figure out how to ensure they receive the products they want and need, no matter what comes next.