Sexual and reproductive health a COVID-19 priority (Statement)

Burnet Institute, 28 May, 2020

Burnet Institute is a member of a consortium of Australian-based non-governmental organisations (NGOs) and academic institutes concerned about the detrimental effects of the COVID-19 pandemic on the sexual and reproductive health and rights of women and girls globally.

The International Sexual and Reproductive Health and Rights Consortium, which includes Save the Children, Family Planning NSW, CARE Australia, The Nossal Institute for Global Health, and Médecins Sans Frontières Australia, is calling on the Australian Government to prioritise the needs of women and girls in its response to COVID-19.

Collectively, the consortium works across 160 countries to champion universal access to sexual and reproductive health and rights.

It’s concerned that women and girls across the globe are struggling to access critical sexual and reproductive health care, citing evidence that COVID-19 lockdowns are likely to cause millions of unplanned pregnancies.

In the Pacific, travel to rural and remote areas have been curtailed, and physical distancing requirements have forced the cancellation of most group training on sexual and reproductive rights.

A recent UNFPA report determined that a six-month lockdown could mean 47 million women and girls globally cannot access contraception, and seven million will become pregnant.

The consortium has issued a joint statement setting out priorities to ensure Australia’s global response to COVID-19 meets the critical needs of all women and girls, including:

  • Recognise and respond to the gendered impacts of the pandemic, and the increased risk to women and girls from gender-based violence and other harmful practices
  • Improve the supply of contraceptives and menstrual health products which are being impacted by the strain and disruption on global supply chains
  • Increase flexibility in delivering sexual and reproductive health services during lockdown using innovative health delivery models such as task-sharing, tele-health and pharmacy distribution
  • Support sexual and reproductive health workers and clinics to continue delivering services sagely with access to personal protective equipment as well as training on how to refer, test or diagnose COVID-19.

 

There are fears coronavirus is stopping Australia’s migrant women from accessing abortions

SBS News, 26th April 2020

Vulnerable pregnant women could lose access to abortion throughout Australia because of increased financial hardship caused by the coronavirus pandemic, reproductive health providers have warned. 

A combination of widespread job losses, differing abortion laws around the country, and patchy access to Medicare, could mean more women need financial assistance to terminate unwanted pregnancies or will face carrying their pregnancies to term.

Some providers even fear a return to people attempting unsafe abortions if women cannot afford legal terminations.

Situational Report: Sexual and Reproductive Health Rights in Australia

Marie Stopes Australia, Updated 17 April 2020

Situational Report: Sexual and Reproductive Health Rights in Australia – A request for collaboration and action to maintain contraceptive and abortion care throughout the SARS-COV-2 / COVID-19 pandemic

Executive Summary

We are in a context of increased risk of unplanned pregnancy, reproductive coercion, sexually transmitted infections, lack of pregnancy options and a multitude of barriers to healthcare. Access to contraception and abortion throughout the pandemic will mitigate broader public health risks for years to come. 
.
At Marie Stopes Australia, during the pandemic we have had to:

 Cancel surgical abortion care lists- meaning women and pregnant people have had to continue with their pregnancies or are likely to seek a termination at a later gestation
 Reduce our national gestational limit for surgical abortion to 22 weeks
 Face increased costs in the provision of regional healthcare, having no other option than to charter private flights for clinical staff
 Continuously scramble for Personal Protective Equipment (PPE)
 Reduce in-clinic list capacity to enable physical distancing
 Reduce contraceptive services in order to prioritise abortion access
 Reduce financial support for clients experiencing financial hardship
 Face increased risk of staff fatigue and burn out
 Evolve models of care in an effort to maintain access to care. To address this situation, we need to review legislation and policy, evolve models of care, maintain people’s rights to access care and make healthcare more affordable.

Key recommendations at this point in the pandemic include:
 All Governments, health and hospital services, and health clinics must consider abortion an essential service with Category 1 classification
 Provide access to medical abortion via telehealth for people living in South Australia
 Increase medical abortion provision to 70 days/10 weeks gestation, supported by the  Pharmaceutical Benefits Scheme (PBS)
 All accredited sexual and reproductive healthcare providers should have access to the National Medical Stockpile for PPE
 Intrastate travel support is needed for clinical staff in order to maintain surgical abortion provision in regional and remote clinics
 Do not criminalise women and pregnant people who attempt unsafe abortion

[This report contains] further detail on these points and a longer list of recommendations that Australia will need to consider in o order to maintain sexual and reproductive health
rights throughout the pandemic.

 

 

Position Statement on LARC access during the COVID-19 pandemic

SHINE SA, April 7, 2020

SHINE SA, along with Family Planning VictoriaFamily Planning NTFamily Planning TasmaniaSexual Health and Family Planning ACTSexual Health Quarters, and True Relationships & Reproductive Health have co-signed a Position Statement on LARC access during the COVID-19 pandemic.

Extended use of and ongoing access to LARCs during the COVID-19 pandemic

Provision of contraception is essential during the COVID-19 pandemic to prevent unintended pregnancies. This is particularly important for individuals most at risk, including young people due to their high levels of fertility, people with serious health conditions, and for those who are post-abortion. Long Acting Reversible Contraceptive methods (LARCs) are more effective than shorter acting methods and increased community access and uptake is associated with lower abortion rates.

Ongoing access to LARC insertion is essential during the pandemic

Contraception is essential health care and all efforts should be made to continue the insertion of LARCs during the pandemic. To reduce the risk of infection with COVID-19, this may require different approaches to insertion such as a wearing mask during insertion of contraceptive implant or using an inserter-only approach for IUD insertion (with an assistant outside the room for emergencies).

Summary of recommendations during the pandemic

  • All efforts should be made to continue access to insertion of LARCs during the pandemic, particularly for younger people, people with serious health conditions, and post-abortion
  • The etonogestrel implant (Implanon NXT) can be extended off-label for use up to 4 years
  • The 52mg LNG IUD (Mirena) can be extended off-label for use up to 6 years
  • The 19.5mg LNG IUD (Kyleena) cannot be extended beyond 5 years
  • Standard sized T shaped banded copper IUDs can be extended off-label for use up to 12 years
  • 5-year copper IUDs (Load 375 and Copper T short) can be extended off-label for use up to 6 years
  • Additional use of condoms and/or a contraceptive pill should be discussed with users for whom the risk of an unintended pregnancy is unacceptable during extended use.

 

SHINE SA media release: CONTRACEPTION IS ESSENTIAL IN PREVENTING RISE IN UNINTENDED PREGNANCY DURING COVID-19

SHINE SA Media Release: 2 April 2020

Sexual and reproductive health must remain at the forefront of our minds during the COVID-19 pandemic. It is possible that throughout this crisis we may see a rise in unintended pregnancy as well as incidences of domestic violence, sexual violence and sexual coercion.  Unfortunately this could come at a time where our health systems are focused on the prevention and management of the pandemic itself. In addition to general sexual health services, access to pregnancy options including abortion may be impacted over the next 6 months.

Unintended pregnancy rates are already high in Australia. It is estimated that half of all pregnancies are unplanned. It is possible that self-isolation/quarantine measures could see an increase in unprotected sexual activity without reliable forms of contraception. These circumstances may contribute to unintended pregnancy and sexually transmitted infections in an environment where support systems and personal wellbeing have been affected.

SHINE SA asks that people consider all of their contraceptive choices at this time. This includes long-acting reversible contraception (LARC) options, especially if they do not wish to become pregnant in the near future. These options can be discussed with a general practitioner.

It’s also important that people are aware that they can access the emergency contraceptive pill (ECP) from community pharmacies. Oral emergency contraception is effective up to 120 hours after unprotected sex but the sooner it is taken, the greater the effectiveness.

  • South Australians looking for advice on any sexual health issue including contraception and unintended pregnancy can call SHINE SA’s Sexual Healthline.
    This is a free and confidential service provided by SHINE SA’s sexual health nurses. Call: 1300 883 793; Toll free: 1800 188 171 (country callers only).
    The Sexual Healthline is open Monday – Friday, 9:00 am – 12:30pm.
  • Australians can also call 1800 RESPECT, the national sexual assault, domestic and family violence counselling and information referral service. This service is available 24 hours a day, every day of the year. Yarrow Place Rape and Sexual Assault Service is a South Australian service for anyone who has been sexually assaulted. Call 8226 8777 or visit the Yarrow Place website for more information.
  • Visit the SHINE SA website for more information on Emergency ContraceptionChoices in Contraception and Safer Sex.
  • Download this Media Release.

COVID-19: pregnancy, childbirth and breastfeeding – statements & guidance

Various sources, March 2020