By Avril Benoît, executive director for Doctors Without Borders/ Médecins Sans Frontières in the United States (MSF-USA)
As world leaders attempt to tackle an unprecedented number of humanitarian crises, many of them deepened beyond imagination by the coronavirus pandemic, the United States is throwing its weight around on the global stage to obstruct lifesaving aid efforts.
The Trump Administration appears intent on blocking international efforts and resolutions containing these critically important words: sexual and reproductive health.
Sexual and reproductive health care is essential health care. Yet it is often neglected, especially during emergencies. The health risks facing women and girls tend to multiply in times of crisis, and we can see the dangers clearly during COVID-19.
Doctors Without Borders/Médecins Sans Frontières (MSF) teams around the world see women struggling to obtain the health services they need. Health facilities are shutting down, transportation is restricted, supplies of medicines and contraceptives are running low, and time-sensitive services are delayed — with devastating consequences. Unless we act now, women and girls will die of preventable causes or suffer lifelong injuries simply because they cannot access care.
And yet, the US is using its tremendous power as the largest funder of global health and humanitarian assistance to slash international support for these essential services.
Most recently, the US has been working to strike references to sexual and reproductive health in an important resolution before the United Nations Economic and Social Council (ECOSOC) on strengthening emergency humanitarian assistance — at a time when it is needed most. Among the sticking points is a line urging member states “to ensure reliable and safe access to sexual and reproductive health-care services … in order to effectively meet the needs of women and adolescent girls and infants and protect them from preventable mortality and morbidity that occur in humanitarian emergencies.” Another key passage in the draft calls on states to meet the basic humanitarian needs of affected populations — “clean water, food, shelter, energy, health, including sexual and reproductive health,” among other things.
A single line in red ink stands out: “US: Cannot support references to sexual reproductive health in this text.”
It is not the first time the US has flagged these mightily significant words.
In 2018, the US State Department issued a series of internal memos instructing UN diplomats to curtail support for sexual and reproductive health programs and to oppose international resolutions that use the phrase “sexual and reproductive health.”
In 2019, the US succeeded in striking any reference to sexual and reproductive health care in a UN Security Council resolution on sexual violence and conflict.
Last month, the US explained its position in a letter addressed to the UN Secretary-General objecting to the United Nations Global Humanitarian Response Plan to Covid-19. The plan “cynically [places] the provision of ‘sexual and reproductive health services’ on the same level of importance as food-insecurity, essential health care, malnutrition, shelter, and sanitation,” reads the letter by USAID Acting Administrator John Barsa. The letter states that the UN should not use the coronavirus crisis “as an opportunity to advance access to abortion as an ‘essential service.’ ”
The US is cynically using its power in the midst of this crisis to roll back decades of progress made to improve access to health care and protect the lives of women and girls. Sexual and reproductive health care is not code for abortion. It’s a comprehensive set of services for women including prenatal check-ups, safe delivery care, neonatal care, sexual violence care, treatment for sexually transmitted infections, contraception, and safe abortion care. These are absolutely essential services.
Recent studies show that even a small reduction in sexual and reproductive health care services during this pandemic will be catastrophic.
A study by the Guttmacher Institute predicts that just a 10 percent reduction in low and middle income countries could mean an additional 15.4 million unintended pregnancies, more than 3.3 million unsafe abortions, and an additional 28,000 maternal deaths over the course of a year. At least 22,800 women already die each year due to complications from unsafe abortion, so the pandemic would more than double the death toll based on this conservative estimate of the impact. We are likely to see much more than a 10 percent loss in services, but the actual scale will be hard to measure because women and girls with no access to care often suffer at home or hidden within communities.
The awful reality is that more women and girls could die due to the pandemic’s disruption of sexual and reproductive health services than to the coronavirus itself.
We must avoid politicizing health care and focus on the medical evidence: sexual and reproductive health programs save lives.
In 2018, MSF teams treated 24,900 cases of sexual violence. We treated 28,000 women with complications from unsafe abortions — including rape survivors, women forcibly displaced from their homes, and women trapped in poverty.
Actions taken by this US Administration to limit access to abortion actually have much wider impacts on public health.
In 2017, the US reinstated and expanded the Global Gag Rule (also known as the Mexico City Policy) to prevent health providers around the world from even speaking about abortion or making referrals to other organizations that provide safe abortion care. The latest version of the Global Gag Rule applies restrictions on all US-funded global health assistance, not only aid to organizations involved in family planning. MSF does not receive US funding, but we see the harmful impacts of this policy on frontline health providers providing a range of services — including mother and child health care, nutrition programs, malaria treatment, and HIV care. A study published by The Lancet last year indicates that US policy to restrict funding for abortion services can lead to “more — and probably riskier — abortions in poor countries.”
So what can be done?
Governments and health providers must make it clear that sexual and reproductive health care is essential care, and prioritize these services accordingly. We must make every effort to mitigate the risks of movement restrictions, the shutdown of health facilities, and supply shortages. Communities urgently need clear guidance, as misinformation and fear also prevent women from getting the services they need.
This coronavirus crisis should push us to adapt and innovate to get care to the people who need it most. Right now, women and health providers are struggling with the inaccessibility of brick-and-mortar facilities. It’s time to shift our focus toward community-based activities, remote support of services, and self-care models where possible. Global health actors, including MSF, need to engage more with women and their communities to adapt our responses.
We need strong words and strong action by world leaders, including the US, to meet the extraordinary humanitarian challenges ahead. We must ensure that women and girls have access to lifesaving health care — in the midst of a pandemic and always.