As this very unusual semester comes to an end, the world around us is filled with uncertainty. The Covid-19 crisis has changed our learning, working, and social environments in profound ways that would have seemed unimaginable just a few months ago. The challenges of transitioning to online learning are capped by the disappointment of missing out on the rituals that come with spring at Duke, especially LDOC and graduation activities. We are faced with uncertainty about when we’ll see friends and classmates again, stress associated with working at home while ostensibly caring for and schooling our children, and navigating the continuously changing work demands and structures. On top of this, most of us are worried about the health and safety of loved ones and are wondering when we will get back to normal—and what normal will look like. It may seem that now is not the time to focus on sexual and reproductive health and to prioritize issues directly related to the pandemic. That would be a mistake.

The impact of Coronavirus in many countries, including our own, reminds us how central sexual and reproductive health services are, and how vulnerable the rights and access to these services can be, especially in times of social and political upheaval. The Coronavirus has not only caused both types of upheaval, while also directly impacting the ability of health care systems to meet the needs of their populations. Although data suggests that men infected with coronavirus may have a greater mortality risk, we are seeing increasing evidence from around that world that Coronavirus has had a disproportionate impact on women’s health and lives.

Most health systems have delayed non-urgent health services for the next few months. This step, while necessary to meet the needs of COVID patients has highlighted and exacerbated the inequities in reproductive health care. Women around the world have had challenges receiving new prescriptions or refills for birth control. Several states have taken advantage of this situation to define abortion as non-urgent and therefore able to be deferred, essentially removing access to an intrinsically time-sensitive procedure. In countries with curfews, women have had difficulty accessing hospitals for maternity services, leading to an increase in unattended and home deliveries. In the US, restrictions on visitors in hospitals have dramatically changed the labor experience for women, in some places leaving women to labor, deliver and recover without a support person. Globally, women are at increased risk when sheltering in place with a violent partner.

Economic disparities between genders have been amplified by the pandemic, with one-third of women, and even more nonwhite women, being among those whose jobs are considered essential, while representing a much larger proportion of low-wage workers. According to a recent New York Times article, women are on the front lines of health care, making up the vast majority of nurses, respiratory technicians, social workers, and pharmacists. Women also make up over two-thirds of fast food and grocery store workers. While many women are working on the front lines of health care or the infrastructure necessary to meet society’s needs, they may be even more vulnerable to unemployment and the dire economic impact of the infection. Many people who lose

their jobs may no longer have health insurance to cover their chronic or reproductive health care needs.

So while the Covid-19 response has focused on the health care infrastructure and public health planning during and after the epidemic, there is also a crucial need for work to mitigate the potentially profound impact on sexual and reproductive health around the world. In the setting of social distancing and stay-at-home orders, many providers are turning to telehealth visits to provide basic reproductive health care, including here at Duke. As our colleagues at FHI360 point out, telehealth strategies to ensure contraceptive provision should be prioritized in low-resource settings as well, where the consequences of unintended pregnancies can be more severe. Our teams in Kenya and Peru are working to ensure that access to preventive care and cervical cancer screening services will be available and tailored to the needs of the post-Covid society. While the changes we are experiencing right now may seem overwhelming and at times paralyzing, there are many leaders and organizations working to understand the Covid impact and shore up sexual and reproductive health and rights. You can find more information in these links:

Guttmacher Institute

United Nations Populations Fund

American College of Obstetricians and Gynecologists

Global Health 50/50

Stay safe, stay well, and stay involved!

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