The COVID-19 pandemic has affected people, communities and economies everywhere and the global response to the COVID-19 pandemic has largely been a ‘one size fits all,’ centred around extensive lockdowns to ensure physical distancing whilst trying to maintain essential healthcare as much as possible. Such an approach has resulted in a shift of focus from essential healthcare services to providing mainly emergency services alongside COVID-19 care.
As the world struggles to adjust to life during a pandemic, maternal health needs don’t go away—they grow. Now more than ever, the health needs of women must be safeguarded. Sri Lanka has come a long way to achieve exemplary results in maternal health. 99% of mothers receive antenatal care from a skilled health care provider, and nearly 100% of births are delivered in a health facility assisted by a skilled attendant (Demographic And Health Survey Report, 2016). However, critical gaps remain to ensure universal health coverage and to tackle the last mile challenges to leave no one behind. The pandemic has made things worse, and has possibly stalled progress and gains made over the past few decades.
Women today are worrying about how to care for themselves and their families when COVID-19 is impacting their community.
*Sandamali is 26 weeks pregnant, but she doesn’t yet know the sex of her unborn child. She lives in Bodagama, Sri Lanka with her husband and her two children, where healthcare facilities are at a bare minimum. With the nearest hospital over an hour's distance away in Hambantota down-south, it has been extremely challenging to make the trip to the hospital to even get the scan done. The one hour commute is tiring enough but coupled with the fear of the ongoing COVID-19 pandemic and the travel restrictions in place, Sandamali and many other women have had almost no access to essential family planning services or life-saving obstetric and gynecological care.
“This virus has made me scared, not just for my two children but for my unborn baby because if anything happens I don’t have any access to a hospital.”
She is not alone. Around the world, the pandemic has affected women’s access to family planning information and services, particularly in low-income countries and marginalized communities.
The impact of COVID-19 on vulnerable communities
The COVID-19 virus is the greatest public health crisis the world has seen in the recent past. Two years into the pandemic, despite the Governments’ best attempts to respond to the pandemic, there is much more that needs to be done to the ever evolving situation. One thing however remains common; the socio-economic impact of the pandemic can be seen far and wide, increasing global poverty and compounding existing inequities - shocks that are likely to be long lasting. Millions have lost jobs and as a result, access to education, healthcare and social security systems as well. Individuals from all walks of life have been afflicted with economic uncertainty causing increased burden and psychological stress within families.
Women and girls have especially been hit hard by the pandemic. These days, Sandamali has a lot on her mind. The pandemic forced her husband to close their family business. They invested years of effort into a restaurant which accounted for all their income. But today the kitchen is shut and there are no customers. “We have no savings now,” says Sandamali, adding that her family has fallen through the cracks and been overlooked by government programmes designed to support the poor. “We were also not selected as Samurdhi beneficiaries and we did not even get the Rs. 5000 that some families received.”
Sandamali already has two children at home. With barely any money to hold body and soul together, Sandamali doesn’t know what kind of life they can offer their new baby. “I haven’t even been able to sew any baby clothes yet,” she says. She knows the threat posed by COVID-19 will end, but for now she cannot imagine what the future holds in store for her little family. “I still can’t think of any ways of starting our life after the pandemic,” says Sandamali. “The only thing I know is we will have to start from scratch.”
For K.V. Thilini Nilushika Lakmali, the pandemic has put an end to her livelihood and created a descent into debt. “The pandemic has badly hit our families,” she says, explaining that their farm was already reeling from a season of poor rainfall and now social distancing measures means farmers cannot work the fields together. In better times, Lakmali could count on her extended family, including her parents, to help keep food on the table but with the lockdown, no one has much to spare. “I am four months pregnant,” she says, uncertain about what kind of future she can offer her child.
The 30-year-old housewife lives in Bodagama and is making ends meet by borrowing money at a high interest. They are not eligible for social security payments through Samurdhi nor were they able to qualify for the Rs.5000 handout the Government was offering some families.
Unlike in the bigger cities, there is no door-to-door deliveries of food or medicines in Bodagama. The curfew in this area has been lifted a few times. Since she is pregnant, Lakmali’s family decided she should stay safe at home. Her husband goes out, but she worries about him as he must brave long queues. The only comfort is that as an expectant mother, Lakmali receives a nutrition pack worth Rs.2000 every month from the state – it’s the only thing standing between her and malnourishment.
She first saw news of COVID-19 on the television, and by now Lakmali knows what she needs to do to protect her family. “We wear masks and use soap for washing hands and try to keep our distance from other people,” she says. “Usually we also have a bath before entering the house whenever we go outside.” Without any clear end in sight, life is now about managing day-to-day. “We have no plans, I do not know how long we can cope,” she says quietly.
The way forward
Sandamali and Lakmali are two of the many pregnant women facing similar challenges. Babies don’t stop for pandemics, so as governments prepare systems to deal with the influx of COVID-19 patients, they must also act urgently to ensure mothers and newborns are still able to get the routine and emergency care they need.
This includes ensuring funds for the COVID-19 response go toward efforts to ensure continuity of care with adequate funding for infection prevention and control supplies and equipment for healthcare workers. Health services must remain financially and physically accessible for women whose households may lose income or whose normal service delivery provider may no longer be available.
Working for the survival of mothers is a human rights imperative, and it is a development priority. Health workers serving on the frontlines to deliver health services to mothers and babies in their communities should be involved in policy response discussions and need to have access to up-to-date, evidence-based information that can be delivered through peer-to-peer networks and messaging applications. Referral pathways and transportation must remain intact to deal with obstetric emergencies and hospitals need to be able to properly screen, isolate, and care for infected pregnant women. Guidance specific to reproductive age and pregnant women needs to be developed and effectively communicated to women in their own languages. Ensuring services are delivered with dignity and respect must be prioritized during these uncertain and stressful times. The lives of Sandamali, Lakmali and countless other mothers and their babies depend on it.
Role of UNFPA in ensuring no mother is left behind
Making motherhood safer is a top priority for UNFPA. Worldover, UNFPA works at all levels to promote universal access to sexual and reproductive health care and rights, including by promoting international maternal health standards and providing guidance and support to health systems. In Sri Lanka too, UNFPA works very closely with the Government and other entities to ensure every child birth is safe and no mother is left behind.
