The World Health Organization declared COVID-19 a pandemic in early March as it continues to cause increased mortality, morbidity and significant widespread adverse population-wide effects on health, social, economic and political life. Kenya, like other countries, has implemented mitigation measures to slow and/or stop transmission, provide care for those infected, and minimise the impact of the epidemic on health, health care systems, social services and economic activities. The first Kenyan case was reported on March 3 and the cases have so far increased to over 1000 by May 20.
The Kenyan government has issued country-wide public health COVID-19 mitigation response measures that are updated as the situation unfolds. These include information, education and communication, as well as hand hygiene, respiratory etiquette, masks for everyone, specifically for health care workers, isolation and treatment of sick individuals, monitoring symptoms of healthy contacts, travelers health advice, environmental fumigation and cleaning, social distancing and avoidance of crowds, institutions’ closures, new regulations on the use of public transport, workplace closures and public health quarantine for asymptomatic individuals and/or isolation for ill individuals, lockdown of some areas, and national and international travel restrictions. In particular, the health care sector is supported with training, personal protective equipment and isolation and treatment centres in referral facilities. Additionally, a dusk to dawn curfew has been implemented Since March 28.
These pandemic containment measures have subsequently impacted on population health, particularly on sexual, reproductive, maternal, newborn, child and adolescent health in underserved and marginalised population groups in rural and urban areas.
In view of this foreseen expectations, Aga Khan University Centre of Excellence in Women and Child Health, in collaboration with United Nations Fund for Population Activities (UNFPA), embarked on essential, relevant and timely research to address the growing concern of the unmet health needs of resource-poor populations being left behind even further, particularly of women of reproductive age and adolescent women and girls in light of sexual and reproductive health – as defined in Sexual Reproductive Health Minimum Initial Service Package (SRH-MISP). Key assumptions and areas of the research focus include;
Population growth and fertility might be affected by COVID-19 containment measures
A combination of stay at home advisories, a dusk to dawn curfews and subsequent reduction inability to access contraceptives is likely to result in an increase of pregnancies, planned or unplanned/wanted or unwanted. The containment measures in combination with unmet needs in family planning /contraception may lead to a baby boom in the next year.
The Kenyan COVID-19 mitigation response are likely to lead to decreased access to and availability of sexual and reproductive health services which would have impact on sexual, reproductive, maternal health and newborn health of women of reproductive age (15-49 years) and adolescent girls and boys (10-19 years).
Maternal and newborn health likely to be affected
Restricted access to and highly stressed reproductive health services for instance due to health care staffing constraints, product and supply chain limitations, and reduced mobility could result in reduction of antenatal care attendance, lower rates of facility deliveries and increase of unsafe abortions for both women of reproductive age and adolescent girls age 10 to 14 years. The number of deliveries in health facilities and through skilled health workers is already declining from curfews imposed by state security where those supposed to accompany pregnant women to hospital fear harassment and arrests by law enforcement agents. In addition, health workers and facilities originally designed for maternal health may be diverted to COVID-19 treatment.
Clients/patients are also reported of being afraid of exposure to infection when visiting health facilities. Health workers might reduce in number due to illness/quarantine. Essential supply chain (e.g. Oxygen, blood banks) and equipment maintenance might be disrupted. These challenges might lead to poor pregnancy outcomes and increased maternal and perinatal morbidity and maternal and newborn deaths.
Adolescent pregnancy rates might decrease/or increase
The limitations on movement of young people, increased parental presence and control through stay-at-home, and reduced social interaction might lower risk taking behaviours and reduced adolescent pregnancies.
On the other hand, limitation of movements might expose the adolescents/youth to reduced uptake of adolescent sexual and reproductive health services including post-abortion care while at the same time, leading to increased adolescent pregnancies through insecure home settings.
Sexual and gender-based violence/ domestic violence/harmful practices likely to increase
Sexual gender based violence – is likely to rise as isolation and lockdown situations increase exposure to its risk factors such as male controlling behaviour, intimate partner violence, reduced women’s access to resources and increased stress levels. Adolescent girls and boys in insecure homes settings could suffer increased exposure to sexual abuse. There are already media reports as well as reports from human rights bodies, both globally and locally of an increase in sexual and gender-based violence associated with Covid-19 related public health mitigation measures
Clinical management of rape, mental health and psycho-social support for survivors may be cut of in the health care response when health care providers and personnel are pre-occupied responding to the pandemic.
The usual level of scrutiny by government and other stakeholders of female genital mutilation (FGM) will decrease and be overshadowed by COVID-19 response. This could increase instances of FGM.
In conclusion, while the measures targeting the spread of the COVID-19 pandemic are both necessary and relevant, attention is needed for the unintended impact of such measures on the access to and provision of sexual and reproductive services including maternal and newborn health services, contraception, management of unintended pregnancies, as well as gender based violence and FGM for the population, in particular any inequalities related to socio-economic status, younger age or other vulnerabilities.
Professor Marleen Temmerman Chairs the Department of Obstetrics and Gynaecology at Aga Khan University Hospital Nairobi and is the Director, Aga Khan University’s Centre of Excellence in Women and Child Health