The State of World Population (SWOP) report 2020 by United Nations Population Fund (UNFPA) has just been released. The report has once again brought to the forefront the deep-seated gender bias and discrimination which have prevailed for centuries. It has revealed that gender-biased (prenatal) sex selection accounts for about two out of every three missing girls in India. Of the 142 million women missing globally, nearly one-third, or 46 million are missing in India alone due to pre and post-natal sex selection. The data and analysis hold greater relevance today as the Covid-19 outbreak threatens to exacerbate inequalities for women and girls across every sphere. The effects of the pandemic could reverse the limited progress made on gender equality and women’s reproductive rights.
Covid-19 could exacerbate the already-alarming numbers around early marriage, violence, sex birth ratio at birth. UNFPA’s recent projections estimate 31 million additional cases of gender-based violence globally as a result of lockdowns. It further projects that Covid-19 will disrupt efforts to end child marriage, potentially resulting in an additional 13 million child marriages taking place over the next ten years that could otherwise have been averted.
Another critical aspect which needs intervention in is women’s access to sexual and reproductive health services. Evidence from past epidemics has shown that the emergency response led to the diversion of resources from routine healthcare services towards containing and responding to the outbreak. These re-allocations have constrained limited access to sexual and reproductive health services, such as clean and safe deliveries, contraceptives, and pre and post-natal healthcare.
A similar trend is currently being observed in the aftermath of Covid-19 and lockdown measures. Results from a five-state study commissioned by Population Foundation of India (PFI) to assess the impact of Covid-19 on young people — particularly young women and girls — have yielded results which should set alarm bells ringing. The findings suggest that the fear of being infected kept many from accessing services at health facilities and led to resistance in interacting with frontline health workers — the Accredited Social Health Activists and the Auxilary Nurse Midwife (ASHAs and ANMs) — on family planning during their home visits. Nearly 50 per cent or more of such workers reported that women were not accessing antenatal care services and over two-thirds (70 per cent or more) of reported beneficiaries were not accessing immunisation services. Young people in three of our largest states — Uttar Pradesh, Bihar and Rajasthan — reported an unmet need for reproductive health services, sanitary pads during the lockdown. While contraceptives were available at the district level, limited access to public transport prevented frontline workers from collecting supplies for delivery to clients.
The long term implications of limited availability of essential health services, including sexual and reproductive health services could be severe. UNICEF has estimated that India would have the highest number of forecast births (at 20 million) in the nine months span dating from when Covid-19 was declared a pandemic. According to estimates by the Guttmacher Institute, a 10 per cent decline in the use of reversible contraceptive methods in low and middle-income countries due to reduced access would result in an additional 49 million women with an unmet need for modern contraceptives and an additional 15 million unintended pregnancies over the course of a year.
Another grave concern is the compromised mental health and well-being of women and girls due to the greater caregiving role that they are expected to perform at this time. Results from PFI’s recent study to assess the knowledge and impact of Covid-19 on young people in three states — UP, Rajasthan and Bihar — show that more than half (51 per cent) female adolescents experienced an increase in workload during the nationwide lockdown, as compared to under one-fourth (23 per cent) of male adolescents. Outbreaks could also result in disruptions to mental health and psychosocial support services. Given the increase in such cases during the Covid-19 outbreak, frontline health workers, women and girls with caregiving burdens, and community members fearful of becoming infected or infecting others may all experience stress and trauma.
Going forward, we need effective solutions to ensure that women's health does not remain on the fringes in the post-Covid-19 era. Greater efforts are needed to strengthen the public health system, especially primary healthcare as well as increase budgetary investments in health. Finally, there is a need to implement targeted social and behavioural change communication interventions as a key strategy to inculcate healthy behaviours and self-care as well as transform social norms which negatively impact the lives of women and girls.
It is only after we ensure their well-being that we can make any claims of ensuring our future.