The Covid-19 pandemic has exacerbated barriers to sexual and reproductive health and rights (SRHR) for women and girls in Pakistan. This blog discusses emerging areas of concern and identifies some of the opportunities that practitioners and advocates would like to draw attention to. Written by AL Pakistan accountapreneur, Wajid Zahid

Before the pandemic, access to quality, affordable reproductive healthcare in Pakistan was beyond the reach of many women. As the Pakistan Demographic and Health Survey of 2018 shows us, many of the key indicators around SRHR were below international standards.

As the pandemic spread in Pakistan, it continued putting a huge strain on the public health system. Keeping track of news and conversations with healthcare providers also showed that new areas of immediate concern emerged even before ICUs were flooded with Covid-19 patients. Patients with non-communicability were being denied admission at private hospitals due to a fear of infection.

At the time, due to lockdowns and the closure of public transportation, pregnant women were experiencing high levels of anxiety, exacerbated by the fact that they were unable to visit their doctors regularly for prenatal appointments. Also, women were more likely to experience delays in reaching hospitals during emergencies. According to gynaecologist, Dr. Sadia Pal, pregnant women were very upset about the  situation created by the pandemic because they were unable to make their regular, scheduled appointments and those with high risk pregnancies were especially anxious.

Due to the increasing number of Covid-19 cases, healthcare facilities rapidly shifted their priorities and a real threat emerged that would jeopardize the availability of reproductive health services. The pandemic also threatened to increase barriers to women’s access to SRHR services as their mobility was restricted. As a result, the availability of SRHR services including contraception, safe abortion services and obstetric services in provinces declined. Instead, the federal and provincial governments, health facilities and healthcare providers shifted their resources towards the pandemic. In addition, the vulnerability of women to domestic violence increased and services to protect women became unavailable during the lockdown.

Based on these demands and the  findings on the impact on SRHR services, here are some specific recommendations for government stakeholders: 

• Provide Personal Protective Equipment to female Health Workers so they can continue their work safely within communities.
• Ensure the availability of contraceptives, including injections and long-acting reversible contraceptives.
• Issue directives that establish sexual and reproductive health services as “essential” services during the public emergencies. 
• Employ women doctors currently not of the workforce to provide tele-health services from home, such as the Sehat Kahani initiative, and enable online prescriptions.
• Expand online counselling services for women seeking medical, psychological and legal support for domestic violence during lockdowns and as economic conditions worsen.
• Remove barriers for domestic violence survivors seeking protection services.
• Ensure that services to protect women and adolescents from violence, including shelters and crisis centers, remain operational throughout the pandemic.
• Relevant government service providers i.e Social Welfare Department, Health Department and Police Department, should lead the interventions to prevent and respond to Gender-Based Violence, including referral services. 

As we are faced with a widespread public health emergency, it is important that our response is tailored to the needs of women, girls and other priority  groups and that we take advantage of opportunities to remove barriers to quality sexual and reproductive health services.

Sheena Adams