How to address SRHR at a time that it is considered an unaffordable luxury?
Stories from Ghana, Kenya, Uganda and Ethiopia
During the COVID-19 pandemic, people’s main priorities are getting food on the table, a roof over their heads and not contracting the virus. Sexual and reproductive health and rights (SRHR) are considered a luxury that they cannot afford. Even though the effects of COVID-19 on SRHR are felt by everyone, some groups are more impacted than others. These include people with disabilities, people living with HIV, sex workers and the LGBTQI community. In this article I will recount some of their stories, sharing their experiences and, importantly, showcasing the innovative and resourceful approaches of local civil society staff.
How do COVID-19 restrictions affect SRHR?
To control the potential ravaging effects of the COVID-19 virus, many African governments have restricted meetings and social gatherings, banned transport, closed educational facilities and are only providing emergency health services. These measures are seriously disrupting people’s sexual and reproductive health and rights (SRHR). From my home in Nairobi, my phone is my best bet to find out how people are coping with the imposed restrictions. Most are afraid to talk, because of government warnings that anyone spreading unverified information will be prosecuted. Nevertheless, through my network and via social media I managed to reach some people willing to share their stories from Ethiopia, Ghana, Uganda, and my home country Kenya.
Worrisome side effects
I speak to Nafula, a fellow Kenyan woman. She was beaten by her husband because she asked for money to buy food. ‘Normally’ she doesn’t have to ask him, as she earns her own share as a casual domestic worker. “Lately, no one wants to hire us for fear of being infected by the Corona virus. (…) My mistake was to ask (my husband) for money for food. (…) The neighbours came to rescue me, or else my husband would have killed me on that day.” Her husband felt frustrated, after being one of the first to be laid off when the Kenyan president announced staff reductions in the industrial areas to minimise crowding.
Kenya has also reported an increase in Female Genital Mutilation (FGM) and child marriages in some parts of the country after closing all educational institutions. In one of the Girl Child Rescue centres in Kajiado County, a girl lamented: “This closure spells the end of my education. You are sending me back to the community, where I ran away from FGM and marriage. With no one to protect me now, I am finished.”
Incest and rape behind closed doors have increased due to the stay-at-home conditions. Antenatal and family planning clinics have been scaled down and, in most places, halted, after being classified as non-essential. There have been increasing reports of forced anal sex to prevent unwanted pregnancy. From all countries, we hear of women having to give birth at home without a skilled birth attendant, either due to fear of catching the virus at health facilities or being unable to reach the facility.
Civil society not “essential”
In Uganda, workers in civil society organisations can no longer move freely as they are not classified as “essential”. For instance, lawyers working at the Human Rights Awareness and Promotion Forum (HRAPF) faced frustrations in accessing their clients. “The police raided the shelter of 19 members of the LGBTQI community and took them to prison.” The legal team and their clients faced hurdle after hurdle in protecting their human rights: “When we came in to provide legal support and arrange bail, we were denied access to our clients under the pretext of social distancing rules.” On the day of the hearing, the court representatives claimed not to have transport available that met the social distancing requirements. Later, a televised court hearing was denied. And partners groups like the Human Rights Commission were poorly accessible due to movement restrictions and closed offices.
From bad to worse
Aklilu Guulay Ghiday of the Talent Youth Association (TaYA) in Ethiopia, explains that they face similar problems. They advocate for adolescent and youth SRHR, youth employment, leadership and engagement. “Our relationship with our target groups has diminished to a very low level. We try to maintain connections via social media, but this is only with those who have internet access”. For some groups, an already bad SRHR situation has become worse. Aklilu lists a few: “People with disabilities, commercial sex workers, those who make their living on the streets, people in slum areas, those with little access to information and services, migrants, health service providers (mostly women) in rural facilities with little or no supplies and commodities”. More groups could be added, and they all have one thing in common: they are bombarded by multiple vulnerabilities.
Food, roof & safety first
However essential SRHR, most people I talk to say: “Right now our priority is food on the table for our families, a roof over our heads and ensuring we do not catch the virus.” It is clear that one cannot discuss SRHR issues with a hungry and demoralized person.
Innovative practices emerging
The changed situation also stimulates innovations. Civil society staff are embracing working remotely and keeping flexible hours. They use radio and social media to reach their target groups. In Ghana, Gifty lives with a physical disability. Together with her brother, she started the Anty Gifty Disability foundation, for the inclusion of people with disabilities. Since her university was closed two weeks ago and there is no online learning, she now does desk research on COVID-19 and shares this with her members, who are very active online. And through Facebook she informs the public on the situation of people with disabilities.
In other countries creative solutions have also been found to get round the current restrictions. In northern Uganda, for instance, community health workers are visiting expectant women in their homes using bikes. In Nairobi, groups of young people are volunteering to visit informal settlements (slums) to spread SRHR messages and raise awareness about precautions to take during the pandemic. In Kibera, a blind female social worker, has continued to visit patients living with HIV. She brings them their medication and food supplies and provides health education on the virus.
Intersectional approach will strengthen SRHR
The stories above show the many challenges for safeguarding SRHR. To successfully realise SRHR for everybody, we need to use intersectional [see text box] as well as comprehensive and innovative approaches that addresses the multiple underlying aggravators – such as abject poverty and cultural and religious beliefs that underpin people’s perceptions on SRHR. Individuals and organisations working on SRHR should adjust and integrate intersectionality in their work on SRHR, doing justice to the complexity of multiple disadvantages people and groups are facing.
Support for the SRHR needs of the most vulnerable groups
What we need is intersectional SRHR advocacy that gives voice to, and creates space for, those people with little power, and that accounts for their overlapping, multiple marginalised identities and the way they shape their SRHR needs. Therefore, I call upon civil society, governments and development partners to support innovators working with the most vulnerable groups to claim their SRHR rights, especially during the pandemic. Together we can ensure cross-learning across the African continent and influence decisions for improvement in legislation, economics, social systems and institutions to fulfil SRHR needs for all.