reproductive health services are also essential services, and more so during pandemics like COVID-19
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The recently
released
Asia and the Pacific SDG Progress Report 2020 shows that Asia and the Pacific
region is not on track to achieve any of the 169 targets of the 17 sustainable-development goals (SDGs), including those around ensuring universal access to
sexual- and reproductive-health services. Despite commitments made by
governments, inequality in the region is growing and the economic gains made by
it are not translating into poverty reduction and gender equity.
A pandemic like coronavirus disease (COVID-19) has added more fuel to fire to
push the region (and perhaps the rest of the world too) several steps back to
achieve 'Health for all' by 2030 by severely constraining (or threatening to
constrain) health systems. It has also impacted delivery of several significant
public health services, including sexual- and reproductive-health services.
Leading experts voiced their concerns during the recently held #APCRSHR10
Dialogues, co-hosted by the 10th Asia Pacific Conference on Reproductive and
Sexual Health and Rights (APCRSHR10) and CNS.
The COVID-19 impact
"While our day-to-day health needs, including sexual- and reproductive-health needs, do not stop because of an epidemic, but health-service
availability becomes still more difficult during such times," said Alexandra
Johns, Executive Director of Asia Pacific Alliance for Sexual and Reproductive
Health and Rights (APA).
Alexandra foresees a global shortage of medical supplies, including medicines
for people living with HIV, contraceptives and antibiotics, as a fallout of
lockdowns imposed by governments to stem the tide of COVID-19. The situation is
all the more grave for key and vulnerable populations, including sex workers.
With weak health systems groaning under the load of COVID-19, service delivery
to cater to their specific needs, like access to abortion services,
contraceptives, and life-saving treatments, along with a loss in wages, is
bound to take a hard hit.
Even in normal times, there is more focus on sexual- and reproductive-health
services for women and not for sex workers, rued Kay Thi Win, Regional
Coordinator of Asia Pacific Network of Sex Workers (APNSW).
"It is very difficult for them to access these services, leading to
unwanted pregnancies and also sexually transmitted infections like HIV.
Moreover, they do not have easy recourse to safe abortions or even PPTCT (prevention
of parent-to-child transmission of HIV) services."
In many countries, sex workers are facing a huge financial crisis, with the
bars, restaurants and other places closed. For them, loss of income is a bigger
concern than the virus, as they are sole breadwinners for their families. Then
again, most of the health providers are focusing on managing COVID-19 and not
on providing sexual- and reproductive-health services and treatment for other
health problems, said Kay Thi.
Liz Hilton of Empower Foundation, a Thailand-based sex-workers' association,
rightly says that COVID-19 is exposing the weaknesses of our society.
"While the coronavirus does not discriminate between different members of
society, the relief and the government assistance package often does," she
says.
She shared the example of Thailand, where sex workers are not looked down upon
as 'other people'. Most of them are carers, mothers and family providers. They
are not that different from other workers, but they are excluded from labour
protection and social-security benefits. They have not had any income since the
18th of March, when in response to the COVID-19 pandemic, Thailand had closed
down all bars and entertainment places.
Meena Saraswathi Sheshu, founder of Sampada
Gramen Mahila Sanstha (SANGRAM), an organisation that works for sex-workers' rights in Maharashtra and northern Karnataka, India, echoed similar
concerns: "The main problem that the sex workers face is that of
livelihood. Since the lockdown (in India) sex workers have had no clients, and
hence no income, and many of them are under severe mental stress. Just this
morning (30th March) unfortunately, one of them committed suicide by burning
herself because she could not deal with the tension of no work, no money, and
living in isolation in the brothel."
Meena is also wary of the fact that as the brothels are all thickly packed with
women, if one of them gets infected it will spread quickly to others. Then
again, while most sex workers are young, there is a critical number of those
who are old and/or who live with co-morbidities like diabetes, TB or HIV. Caste
is another big issue in India: "Most of the sex workers we work with are
from the Dalit caste which puts them in further vulnerability. Dealing with a
pandemic like COVID-19 is not easy for communities that live in packed slum
like situations and have to earn to be able to eat. There is no way this
community is going to weather this easily. We will need the government to step
in a big way to help them," she said.
Due to the existing social inequities, even the scientific advisories issued by
governments of the region to protect oneself from the coronavirus are beyond
the capacity of many to follow. People are being told to wash their hands
repeatedly assuming that they have access to clean water and sanitation
facilities, which many do not have. Then again maintaining physical distancing
is a huge problem for many, like those living in very confined spaces in
brothels and slums.
Barriers to accessing sexual- and reproductive-health services
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