COVID-19's Sexual Health Repercussions Put Most Vulnerable At Risk

The social and economic disruption underway as the COVID-19 pandemic rages is likely to have negative consequences for sexual and reproductive health worldwide, but lessons can be learned from past epidemics to help prepare for these changes, according to two experts on outbreaks and reproductive health.

"It's important for all of us to understand this is a changing situation, and changes can have devastating effects on the most vulnerable in society who do not have the resilience to withstand them," said Dr. Benjamin Black, a consultant in reproductive health and an obstetrician and gynecologist at Whittington Hospital, in London.

"We must avoid the accident of COVID-19 tunnel vision, routine health needs will continue and for sexual and reproductive health many of these cannot be delayed without worsening outcomes," he told Reuters Health by email.

Dr. Black and his co-author, Dr. Gillian McKay of the London School of Hygiene and Tropical Medicine, were on the ground during the Ebola epidemic, and wrote a report on how the outbreak affected sexual and reproductive health services in the Democratic Republic of the Congo in 2018-2019, when the outbreak was at its peak.

"'It's like watching an explosion in slow motion' is how we described being in West Africa mid-2014 as the Ebola epidemic picked up pace, threatening to overwhelm the region's health and social services," they write in their new paper in The BMJ. "And while covid-19 is a very different disease, its potential impact on the regular functioning of health services and the most vulnerable people in society is not so distant."

The authors list several key points for sexual health and reproductive health and maternity services preparing for and responding to COVID-19:

• Consistent messaging is essential, and especially important for women in quarantined areas, those who are self-isolating, and those with limited access to transportation.
• Prioritize health protection of healthcare providers. Clearly define pathways in maternity departments. Provide workers with easy access to testing and personal protective equipment.
• Ensure that women, especially young women, have easy access to contraception and abortion services as many face changes in their homes, work, and living arrangements.
• Prepare for a rise in sexual and physical abuse and intimate partner violence. "Sexual and reproductive health providers may be the first point of contact, and hence need to be alert for signs of abuse and aware of referral pathways," the authors note.
• Health professionals and their coworkers also must plan schedules that give them enough time to rest and relax, they add. "Supporting one another will be a fundamental part of the response."

During the pandemic, Dr. Black noted, "it is paramount for professionals and the public to choose carefully where and what information they listen to. Advice on infection control measures should be taken from our experts in infection control and those with established experience of epidemic response."

He added: "This disease is new to everyone, a doctor from an affected country is not an immediate expert. Their anecdotes are of high value, but must be taken in context. Taking information from the wrong sources and without evidence (or at least an appropriate thought process) will result in the wrong decisions, increased hysteria and distract attention away from the priority areas."

—Anne Harding

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