COVID-19 and Family Planning and Reproductive Health
COVID-19 is now present throughout the four regions of the world where The Challenge Initiative (TCI) implements its evidence-based family planning and adolescent and youth sexual and reproductive health (AYSRH) solutions. TCI expects COVID-19 to have some negative impact on its implementation efforts and perhaps even outcomes related to contraceptive uptake during this period. However, every crisis also offers opportunities to demonstrate leadership. Below are some ways in which TCI can support local governments to ensure that family planning service delivery is assured as an essential serve at this time and post-COVID-19.
Family Planning Service Delivery in the Time of COVID-19
Infection control is a core competence in providing quality family planning services as noted in this approach. Given the spread of COVID-19, infection control practices are more important than ever before. In addition, to the Chapter on Infection Protection in Family Planning: A Global Handbook for Providers, please see specific guidance on COVID-19 from WHO and the UK government:
- Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected
- COVID-19: infection prevention and control (IPC)
Given that health facilities may be overburdened with cases of COVID-19, it is critical to make sure that pharmacies and patent and proprietary medicine vendors (PPMVs) are well-equipped to not only provide counseling but also have contraceptive stock and equipment available. As a result, it is extremely important that facilities continue to closely monitor their supplies and inform authors about their surplus and expiring supplies so that they can be redistributed accordingly.
In addition, it is critical that local governments continue to integrate family planning in the provision of other health services, in particular strengthening the provision of post-partum family planning services, and ensure access to multiple packs of short-term methods and widening knowledge and availability of Plan B – Emergency Contraception during times of lockdown. Finally, local governments should explore options for wider use of DMPA SC, an injectable contraceptive method that women can administer themselves.
For more details on contraception/family planning and COVID-19, see WHO’s Q&A from 6 April 2020.
Strengthening Linkages Between the Facility and Community
Adaptations made to TCI’s proven Community Health Worker (CHWs) approach
- Training CHW (also referred to as village health teams or ASHAs, depending on the TCI location), to counsel potential clients and provide contraceptive methods and effectively deliver correct messages on COVID-19, such as the importance of hand washing and social distancing
- Linking CHWs/VHTs/ASHAs to health facilities and other private sector outlets, such as pharmacies and drug shops, for commodities
- Refer potential clients for COVID-19 testing, if show or complain of symptoms
- Supervise CHWs/VHTs to ensure they have correct information on COVID-19 according to WHO and country policies and family planning promotion in communities and ensuring their motivation
Social and Behavior Change for Family Planning in the Time of COVID-19
- Continue to work with national and sub-national coordination mechanisms, such as SBCC Committees in the case of Nigeria, to harmonize and integrate family planning into COVID-19 messages.
- Ensure an open and ongoing dialogue with local service delivery partners to understand continued changes in contraceptive commodity and availability of public and private facilities. This should be reflected in SBC messaging to ensure clients have up-to-date information on the availability of family planning services.
- Link family planning programs to existing work on gender-based violence (GBV), such as by raising awareness of potential increases in violence among communities and health providers, training family planning providers to probe for and respond to reports of violence, and providing information on available GBV support services as part of family planning SBC programs.
- Continue mass media activities and explore other channels, such as community-based public address systems and community radio stations to share messaging on family planning and GBV, especially to reach audiences without mobile access.
- Consider offering digital-based training to pharmacists/PPMVs to improve their ability to counsel women, men, and couples on available methods and share other family planning-related information, including up-to-date information on access to services for longer-term methods.
- Promote self-care for family planning, including fertility awareness among women and men, girls and boys, through engaging and interactive online approaches; for example, digital guidance on how to make cycle beads, based on the Standard Days Method, at home or instructions on how to use the existing digital app available for Android and Apple devices.
- Pretest new messages, materials, and interventions using virtual channels such as WhatsApp or Facebook.
- Modify content and increase the promotion of existing health hotlines and other digital and mobile services (SMS/IVR) for family planning and GBV information and counseling, such as “3-2-1,”3 WhatsApp, and Facebook, to advise callers about where to find modern contraceptives, how to manage side effects, and how to access GBV resources in the community. Use virtual training to strengthen hotline counselor/staff capacity to make referrals to GBV resources.
- Identify new opportunities to reach existing clients and those with unmet need to share information and referrals for family planning during this time, such as providing family planning information and services at quarantine centers.
- Consider the special needs of sub-populations, such as youth and women with disabilities, by including targeted messaging that takes into account their family planning needs during this time.
For an illustrative list of family planning messages for SBC program, see the Breakthrough ACTION fact sheet.
For more general COVID-19 related resources, see Health Compass’ Trending Topics on Coronavirus as well as its comprehensive collection COVID-19 Videos, Songs, and PSAs for raising awareness, wearing a mask, social distancing and hand washing.
In addition, WHO offers helpful myth busters for the public.
Advocacy Efforts During COVID-19
It’s critical that we continue to monitor TCI’s strides in getting local governments’ to commit family planning financial resources and make note of any funding reallocations from family planning to COVID-19. It is imperative that we continue to advocate for the reproductive health needs of women, men and adolescents and help to ensure that they have access to contraceptive services through a variety of outlets. Reminding government stakeholders of the negative effects of unintended pregnancies and the fact that “provision of modern short- and long-acting contraceptives, information, counseling, and services (including emergency contraception) is lifesaving and should be available and accessible” is especially critical at this time. By preventing the negative health consequences associated with unintended pregnancies, unsafe abortion and sexually transmitted infections (including HIV), contraception can help alleviate unnecessary additional pressure on already-stretched health systems which are working hard to address COVID-19.
Policymakers may consider taking the following actions to help make sure their communities have access to contraception and family planning information and services:
- Plan and develop innovative strategies to ensure as many eligible people as possible can access information and contraception during this period.
- Increase use of mobile phones and digital technologies to help people make decisions about which contraceptive methods to use, and how they can be accessed.
- Enable health care workers to provide contraceptive information and services as per national guidelines to the full extent possible. This is particularly important where pregnancy poses a high risk to health.
- Expand availability of contraceptive services (including both information and methods) through places other than healthcare facilities, such as pharmacies, drug shops, online platforms and other outlets. This can be with or without prescription depending on national guidelines and contraceptive method.
- Relax restrictions on the number of repeat issues of prescription-only hormonal contraceptives that can be issued.
- Ensure access to emergency post-coital contraception, including consideration of over the counter provision.
- Enable access to contraception for women and girls in the immediate postpartum and post-abortion periods when they may access health services.
Adapted from WHO’s contraception/family planning and COVID-19 Q&A
Family Planning Service Delivery
- COVID-19 and Implications for FP Services, webinar by WHO, UNFPA, IPPF and Jhpiego
- Contraception/Family planning and COVID-19, WHO
- COVID-19 Contraception and Family Planning (English | French), FIGO
- Sexual and Reproductive Health and Rights: Modern Contraceptives and Other Medical Supply Needs, UNFPA COVID-19 Preparedness and Response
- Estimates of the Potential Impact of the COVID-19 Pandemic on Sexual and Reproductive Health in Low- and Middle-Income Countries, International Perspectives on Sexual and Reproductive Health
- Kenya COVID-19 RMNH guidelines, Government of Kenya
- Tanzania COVID-19 guidelines (in Swahili), Government of Tanzania
- Uganda COVID-19 guidelines, Government of Uganda
- Programmatic Guidance for Sexual and Reproductive Health in Humanitarian and Fragile Settings During COVID-19 Pandemic | (French version), Inter-Agency Working Group on Reproductive Health in Crises
- How COVID-19 is affecting the way that women receive care and the response of our members, IPPF
- Contraception in the Era of COVID-19, Global Health Science and Practice
- WHO Consolidated Guideline on Self-Care Interventions for Health: Sexual and Reproductive Health and Rights, WHO
- Acceleration of Self-Care in the Time of COVID-19, Knowledge SUCCESS
- DMPA-SC digital training resources for health workers and clients, PATH and JSI
- Self-Care Trailblazer Group (SCTG): Self-injection resources, PSI
- The COVID-RHR Hub, Bill & Melinda Gates Institute for Population and Reproductive Health
- COVID-19 & Family Planning, FP2020
- Chapter on Infection Protection, Family Planning: A Global Handbook for Providers
- COVID-19: infection prevention and control (IPC), UK Government
- Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected, WHO
SBC for Family Planning
- Guidance on Social and Behavior Change for Family Planning During COVID-19 | (French version), Breakthrough ACTION
- ASHA & ANM COVID-19 and Family Planning Messages, Government of India with support from TCIHC
Engaging Communities & Community Influencers
- Tips for Engaging Communities during COVID-19 in Low-Resource Settings, Remotely and In-Person, WHO
- Community Engagement During COVID-19: A Guide for Community-Facing Staff, Oxfam
- Practical considerations and recommendations for religious leaders and faith-based communities in the context of COVID-19, WHO
Gender Equality Considerations
- A Pandemic Within a Pandemic: Technical Resources to Address GBV in the Age of COVID-19, IGWG
- COVID-19: Gender Equality Matters, Save the Children
- COVID-19: A Gender Lens, UNFPA
- The COVID-19 Impact on Sexual- and Reproductive Health Rights and Gender-Based Violence, Human Sciences Research Council
- Resources on Gender-Based Violence and the COVID-19 Pandemic, Western University
- COVID-19 Gender Equality Global Adaptation and Response Framework, Plan International
- Beyond Sex and Gender Analysis: An Intersectional View of the COVID-19 Pandemic Outbreak and Response, Centre for Global Health, Queen Mary University