World Population Day 2021: Bangladesh’s concerns over sexual and reproductive health during Covid-19

World Population Day 2021 focuses on the impact of Covid-19 on reproductive healthcare services including family planning, maternal health, and health of children. These issues are prioritised in the Millennium Development Goals (MDGs, 2000-2015) and the Sustainable Development Goals (SDGs, 2015-2030) as well. And there is a good reason behind that.

Before the pandemic, approximately 214 million women reported their desire to plan their pregnancy but could not avail appropriate care, i.e, information and supplies. This situation only deteriorated during the pandemic. According to a WHO survey from April 2021, more than 40% of countries reported disruptions in family planning and contraception services during Covid-19.

The global spread of the coronavirus has resulted in unprecedented containment measures including hospital services that are reduced only to emergency services and movement of people are restricted. While these are appropriate responses to the coronavirus, it poses a serious risk to reproductive healthcare services.

The UNFPA warns such restrictions could lead up to 9.5 million women and girls to miss out on vital family planning services, potentially resulting in millions of unwanted pregnancies, unsafe abortions, and thousands of deaths.

Given such circumstances, the theme for this year's world population day is 'Rights and Choices are the answer: Whether baby boom or bust, the solution lies in prioritising the reproductive health and rights of all people'.

Bangladesh is one of the worst infected countries with coronavirus and the country is now facing its third wave. To tackle the spread of Covid-19, several containment measures have been undertaken by the government during each wave, such as Lockdown.

All available resources in the health care sector, i.e, hospital beds and healthcare personnel have been now reallocated to treat Corona-infected patients. The Covid-19 pandemic exposed the lack of preparedness in the healthcare infrastructure that has a ripple effect on other sectors as well.

For some reason, reproductive healthcare is always undermined in Bangladesh in comparison to treating people with specific diseases. People even felt discomfort visiting the hospital to access family planning services.

These problems only worsened during this pandemic because of the potential risks of infection. Ongoing approach to provide family planning services by visiting eligible women's homes every 14 days mostly failed because of the lockdown.

This, therefore, increased the number of people with an unmet need for contraception, in addition to the 12% unmet need for contraception in Bangladesh reported at the normal time. These multidimensional challenges over the family planning issues in Bangladesh could have several negative impacts including an increase in the number of unintended births and induced abortions.

At the beginning of the pandemic in March 2019, it was expected that Bangladesh, as well as other countries in the world will face a baby boom because of the challenges to ensure family planning services as well as prolonged periods of lockdown.

Evidence suggests a significant increase in the number of births and lower maternal healthcare services access during the pandemic. As per the recent BDHS, over 20% of the total births ⎯- translating to around 1 million live births in a year ⎯- in Bangladesh are unintended, mostly because of a lack of effective contraceptives.

Studies also found that the occurrence of unintended pregnancy is associated with a 35-40% reduction in the use of antenatal, delivery, and postnatal healthcare services. Continuity of receiving these services occurred in only 12% of total pregnancies, which is reduced to 5.6% if the pregnancy is unintended.

Thus, a higher number of pregnancies, especially unintended pregnancies and a lower supply of maternal healthcare services during the pandemic, can be a significant burden for Bangladesh in the coming days. To tackle these issues, the government should come up with a comprehensive set of plans that prioritise reproductive health care.

Broadly speaking, three areas need to be addressed in this plan.

First, the government and pertinent authorities must form a robust distribution system that ensures every couple can avail of necessary contraceptives. Currently, 52% of all users collect their contraceptives from private sources. Harsh lockdowns hinder the supply of these products and consequently, consumers, particularly in rural pockets of the country cannot access them.

Second, women having an unintended pregnancy are usually not interested in accessing services because of anxiety and depression over their pregnancies.

The Covid-19 poses additional barriers as people are reluctant to go out and the health care sectors remain overwhelmed with emergency patients. Hence, it is essential that the government employs community health workers who bring the service to the doors of these women.

Third, any policy must focus on strengthening over 13,442 Upazila to Union level healthcare facilities and community clinics and supplying them with essential supplies regarding reproductive health care.

It must also be ensured that healthcare personnel are present at their stations. Family planning workers working at the community level should also be monitored and they should be trained to provide more effective contraceptives such as implants which at present, is only available in the governmental healthier facility.

These initiatives can help the country to overcome the negative effects of Covid-19 on maternal health as well as keep the country on track to achieve the SDG targets of reproductive, maternal and child health.

The author is a public health expert and lecturer of population science at Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh.

Disclaimer: The views and opinions expressed in this article are those of the authors and do not necessarily reflect the opinions and views of The Business Standard.