The Coronavirus pandemic continues to hold countries at ransom with seemingly no end in sight. In Kenya, the continued state of lockdown and curfew, means that not only are businesses slowly crumbling but so is the medical industry. Hospitals are recording low numbers of walk in patients, let alone admissions. This could be because of the directive by the Ministry of Health for individuals to only visit hospitals when it is extremely necessary. It could also be because individuals are afraid of being diagnosed with the virus and being put in quarantine which would mean incurring costs that not many can afford in the current economic situation. As a result, some medical facilities are shutting down completely, including the provision of some reproductive health care services. While a few hospitals are embracing the use of technology and offering e-medicine, some services simply require in-person visits with the doctor. Thus, many women are having a challenge accessing reproductive health care.
Reproductive health care includes amongst other, pre and post maternal health care, contraception, and reproductive technologies. Following the difficulty of getting to hospitals and the worry about safety while there, there are reports of increased home births. Expectant mothers are worried about contacting the virus themselves or their children contracting it. Despite there being no evidence of infants contracting the virus if their mothers have it, or dire effects of the virus on pregnant people, no one is willing to take the risk and understandably so. Mothers are forced to weigh between potential risks at the hospital and the risks of a home birth. With the majority of Kenyans afraid of being caught up on the wrong side of the law by security agencies during curfew hours, mothers are choosing the latter.
With the increase in home births, there is fear of an increase in infant and maternal mortality rates. This could easily occur in cases of birth complications such as severe bleeding, and obstructed labor. Further, infections could also occur where sterile equipment are not used. With the challenge of clean water and the reality of tough economic times, using sterile tools could be a challenge. Unfortunately, those from informal settlements are disproportionately affected as they do not have access to private doctors and facilities that would ensure a smooth delivery for them as well as access to reproductive services. While we have seen some medical doctors offering to come to the aid of women in labor during the curfew period, this is not a sustainable solution. While we appreciate their efforts and thank them for the noble act, there is a worry whether they would be able to meet the demand if the government does not intervene and consider reproductive health in its management of the COVID-19.
Young women in need of reproductive care ordinarily prefer to attend the clinics in the evening after work because it is both convenient and is more private. They are unable to do so during this period as the facilities close earlier than usual to meet the curfew. If one is to choose between working to put food on their table or missing a day of work to go to the clinic, it is obvious which would supersede the other. We can not also ignore that there are several young women who have now lost their sources of income and cannot afford to pay for the reproductive health services.
Lack of an income further results into transactional sex, where women exchange sex for food and perhaps even rent. In such a situation, the women are not able to negotiate for safe sex. This could result in a surge of unplanned and unwanted pregnancies and potentially unsafe abortions during this period and even after.Statistics published by FIDA Kenya show an increase in SGBV cases in the country. With the curfew in place and limited access to reproductive health services, victims of sexual violence cannot seek appropriate and timely medical assistance.
The Constitution of Kenya 2010 provides for the protection of women’s right to reproductive health by stipulating that women should have access to the highest standard of health care including reproductive health. While we do appreciate the complexity of trying to control the spread of the virus, the government needs to ensure that it employs a ‘wholistic’ approach to ensure that no citizen is disenfranchised in the process.