Still Good to Go For Now: Permissible Abortion-Related Activities Under Current U.S. Law and Policy
Young people have the technical expertise and advocacy skills to be partners in decision-making and implementation to maintain essential health services, including sexual and reproductive health (SRH), during the COVID-19 pandemic. In June, the World Health Organization (WHO) released guidance on maintaining essential health services during the pandemic that addresses some of the SRH needs of young people. As governments have begun adapting the WHO guidance and developing national plans to meet their populations’ SRH needs during this crisis, they must take into account the challenges and vulnerabilities young people face through inclusive and meaningful input from young people themselves.
Some organizations, including youth-led civil society groups, are taking proactive steps to elevate the SRH needs and challenges of young people during the pandemic. They are gathering evidence, raising issues with local ministries of health and other stakeholders and advocating for young people’s participation in the development of national COVID-19 contingency plans.
PAI spoke with a youth SRH advocate in Senegal, Aminata Badiane Thioye of Alliance Nationale des Jeunes pour la Santé de la Reproduction et de la Planification Familiale (National Alliance of Youth for Reproductive Health and Family Planning, ANJSRPF). Early on in the pandemic, ANJSRPF conducted a rapid assessment with 130 respondents — primarily young people as well as community health workers and midwives — to understand the impact of the pandemic on young people’s sexual and reproductive health and rights (SRHR) and ascertain what actions would be taken to guarantee their access to SRH services. ANJSRPF found that the loss of livelihoods, particularly in the informal sector, tied to mobility restrictions has thrown young people into precarious financial situations. Along with the fear of COVID-19 and the decreased availability of SRH services during the pandemic, the cost of health services is leading young people to avoid seeking care.
The good news is that efforts are being made at the institutional level to ensure the continuity of services and health supplies. Based on the WHO guidance, the Senegalese Ministry of Health has developed a COVID-19 contingency plan for the continuity of reproductive, maternal, newborn, child and adolescent health services. The plan includes guidance on governance and coordination for the continuation of SRH public and private sector services, as well as an essential health services package, a provider guide for those services, stock management and monitoring and evaluation. The bad news is that — as is too often the case — young people have not been consulted, let alone involved, in the decision-making.
“While the risk of stockouts of contraceptive methods is being well managed, that doesn’t stop young women and adolescents from having financial difficulties obtaining products,” Aminata told PAI. While SRH services are meant to be free in Senegal, that does not apply to medications and treatments. “It’s the same problem with emergency contraception that is financially inaccessible for young women, making the situation all the more critical with increased vulnerability of girls to rape and sexual exploitation during the pandemic, which can also increase their exposure to unwanted pregnancy [and] unsafe abortion that could be avoided if they had better access.”
For adolescent and young women, the added layer of school closures means that they are left without a space that is often where they are the safest from . Additionally, the scaling back, and in many cases complete interruption, of both formal and informal education means that SRH programs for young people have stalled. In some settings, including in rural areas and for girls working as domestic workers in Dakar, the capital, menstrual hygiene management and access to clean water have become even more dire, particularly as the country has faced years of water shortages.
“These increases in vulnerability are mainly due to the fact that the government responses to COVID-19 have been security responses rather than social ones,” Aminata told PAI, referring to the imposition of curfews, bans on transport and closures of markets. “Now, we find ourselves in a state of a social and health emergency.” There are particular consequences in terms of health equity, which is imbalanced among age groups and along the urban-rural divide in Senegal. ANJSRPF heard examples of road and health center closures in rural areas with already limited health services. While inequity has always been a major factor in SRH service accessibility, the disparities are further compounded by the of the pandemic.
A number of initiatives, including at ANJSRPF, are working to elevate the voices of young people. In collaboration with other partners, the Ouagadougou Partnership, a Francophone West African initiative that seeks to increase modern contraception use across its nine member countries, developed 10 videos of youth SRH advocates. The videos address how COVID-19 impacts SRHR, including early and forced child marriage for out-of-school girls; the need for young people’s access to contraception, including flexible, mobile service delivery to reach the most vulnerable; and sexual and gender-based violence due to increased stressors; and other topics.
As Aminata told PAI, coordinated advocacy is critical for SRHR — especially to ensure that SRH service delivery models adapt to the local needs and social and economic conditions of young people in times of crisis. “The participation of young people is vital. We can accomplish more together than in isolation. It’s no secret that we are all living in difficult times and the lack of collaboration and cooperation is a major obstacle to performance and resilience.”
Read PAI’s brief, Optimizing the World Health Organization COVID-19 Interim Guidance.