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Wednesday, 29 April 2020

Covid-19 Impact on Sexual and Reproductive Health in Pakistan

By: Komal Qidwai 

Skyline View of Karachi after Covid-19 Lockdown 
Source: Wikimedia Commons



The Covid-19 pandemic in Pakistan is yet to peak, with over thirteen thousand recorded cases already and no indications that we are flattening the curve yet. Combined with the country’s abysmal health and gender indicators and a fragile healthcare system, this pandemic will exacerbate barriers to sexual and reproductive health and rights (SRHR) for women and girls. This blog discusses emerging areas of concern and points to some opportunities that practitioners and advocates may wish to pay attention to in the months ahead.

Even before the current crisis, access to quality and affordable reproductive healthcare in Pakistan was beyond the reach of many women. Table 1 provides data from the 2018 Pakistan Demographic and Health Survey (PDHS), proof that our key indicators of SRH are far from acceptable.

Only 51 per cent of women had at least four ANC visits for their most recent birth in the five years before the survey, even though WHO recommends a minimum of four. Despite an increase in number of women delivering in health facilities, a significant percentage still have home births in the absence of skilled healthcare providers. The percentage of married women who use contraception is also deplorably low compared to 56 per cent in Bangladesh.

Table 1.
Maternal Mortality Ratioa
276/ 100,000 live births
% of women having at least 4 antenatal visitsb
51.4
% of women who delivered in a health facilityb
66.2
% of currently married women using any contraceptionb
34.2
% of women who experience physical violence by spouseb
23.0
Source: a. PDHS 2006-7, b. PDHS 2017-18

Lockdown measures are likely to worsen these indicators for women and girls. Early reports indicate a sharp rise in domestic violence already.

As the pandemic unfolds in Pakistan, it is burdening an already over-stretched public health system. Our tracking of news and conversations with health-care providers reveal that new urgent areas of concern have emerged even before ICUs have become full of Covid-19 patients. Patients with non-communicable diseases are being denied admission in private hospitals due to a fear of infection.

Doctors and healthcare professionals treating coronavirus patients do not have access to adequate personal protective equipment, and are beaten by police when they protest. Meanwhile, outpatient services were suspended in all major hospitals in Sindh, such as Civil Hospital Karachi, Jinnah Postgraduate Medical Center (JPMC), National Institute of Child Health, as well as Sindh government hospitals and district health facilities from March 18 onwards. After April 2, outpatient services were partially reopened, with JPMC and Civil Hospital reporting a drastic reduction in number of patients.

The impact on the healthcare system is affecting the availability of sexual and reproductive health services. Gynaecologists and obstetricians with private practices in Karachi report that they are following international guidelines on Covid-19 and have limited antenatal appointments and instructed patients to visit only if absolutely necessary. “Pregnant women are very anxious because of this situation as they are unable to have their regular, scheduled appointments. Those with high-risk pregnancies are particularly anxious,” says obstetrician Dr. Sadia Pal. Patients share test results with doctors on WhatsApp, and consultations are carried out on the phone or via Zoom and Skype.

With an increased need for telemedicine, helplines have been set up, such as one by the Pakistan Medical Association for phone consultations. While emergency obstetric services are still operating, many patients may not be able to reach healthcare facilities in time due to closure of public transport. Doctors are also aware of guidelines for pregnant women infected with coronavirus, and Punjab’s health department has exclusively allocated Ganga Ram Hospital in Lahore for the treatment of infected pregnant women.

Pakistan’s National Action Plan for Covid-19 does not include any guidelines for managing SRHR during the pandemic. Sindh’s provincial government, however, has prepared guidelines on managing family planning and reproductive health services. It aims to ensure continued supply of contraceptives and functioning of its Family Welfare Centers (FWCs) situated within health facilities. Those centers located in densely populated areas will provide phone consultations. Contraceptives are to be provided to women in quarantine centers via Special Family Planning Desks.

Those providing services in communities such as Lady Health Workers (LHWs) are to give users with a two-month supply of contraceptives. However, LHWs in Karachi report that they have run out of medical and contraceptive supplies. “The government has promised to provide us with personal protective equipment, but so far we have received nothing. We even have to buy masks and sanitizers ourselves,” reveals a Lady Health Supervisor. The needs of these providers cannot be ignored as women are disproportionately represented in the healthcare workforce, and also have additional burdens of care-giving at home.

Doctors tell us that FWCs in Karachi’s government hospitals are closed due to Sindh’s province-wide lockdown. “Women are leaving hospitals without any post-partum family planning counselling,” says obstetrician Dr. Azra Ahsan. Greenstar, an organization that provides SRH services is also finding it difficult to operate. “Governments are not clear about what constitutes essential versus non-essential services and so clinics are being made to shut down,” reports Sana Durvesh about Greenstar’s family planning clinics.

Pakistan can draw lessons from the 2014-2016 Ebola outbreaks in Liberia, Guinea and Sierra Leone, an indirect impact of which was a significant increase in maternal deaths due to a failure to address SRHR in measures to control the epidemic. Even during the 2015-2016 Zika virus epidemic in Brazil, women had difficulty accessing contraceptives despite the danger it posed to pregnant women. Many advocacy groups and organizations, such as the Center for Reproductive Rights have called on governments to avoid impacts on SRHR during the current crisis. Based on these demands and emerging findings on the impact on SRH services, here are some specific recommendations for Pakistan:
  • Employ women doctors currently out of the work force to provide tele-health services from home, such as the initiative Sehat Kahani, and enable online prescriptions.
  • Provide Personal Protective Equipment to LHWs so they can continue their work within communities
  • Ensure supply, availability and accessibility of essential drugs such as misoprostol through chemists.
  • Ensure affordability by increasing availability of free or low-cost obstetric services and medicines.
  • Ensure availability of contraceptives, including contraceptive injections and long-acting reversible contraceptives.
  • Expand the testing of women in communities for Covid-19.
  • Hire and train women to serve as contact tracers.
  • Expand online counselling services for women seeking medical, psychological and legal support for domestic violence during lockdown and as economic conditions worsen.
  • Remove barriers for domestic violence survivors seeking protection services.
As we grapple with this public health emergency, it is essential that our response is inclusive of the needs of women, girls and marginalized groups and capitalizes on opportunities to remove barriers to quality sexual and reproductive health services.

16 comments:

  1. Hello everyone i am happy to say that i was cure from HIV/AIDS by Dr Padman with his herbal medications after i tested positive july 2016 and ever since then i have been on medications to extend my living on earth. One faithful day i was searching on line if i could get some tips on how to cure my illness and i saw a comment on how Dr Padman cure HIV with herbs,i was surprise and i contact him on the email they provided on the comment and i explain my problem to him and he also prepare the herbs and send to me which i use for one week as i was instructed by him and after 2weeks i went to hospital for checkup and i tested Negative and i am fully cured from the disease and i am so greatful to Dr Padman.You can also reach Dr Padman on his padmanlovespell@yahoo.com , https://twitter.com/padman_dr. https://padmanspell.com WhatsApp +19492293867

    ReplyDelete
    Replies
    1. I WILL CONTINUE TO POST THIS, I'm so happy to share this testimony thank you Dr.idowu am so happy i never believed i will be hepatitis b negative again despite all i passed through Dr.idowu you are truly God sent, am so happy that am negative again thank you Dr idowu.email him
      (Dr.idowuherbalhome@gmail.com)
      If you have any problem like
      Herpes 1/2
      HIV/Aids
      Hepatitis a,b,c
      Breast cancer/cancer
      Marriage
      Pregnancy problem
      Ex back
      Penis enlargement/ass/boos..
      Whatsapp via (+2348052789941)
      Please give him a try
      🙏🙏🙏no harm in trying

      Delete
    2. A MIRACLE TESTIMONY FOR WHAT Dr SAY0 HAS DONE FOR ME!!  
      Human PapilomaVirus (HPV) Cure Found By Dr Sayo If you're wondering why am here or why am doing this!, i just want to show appreciation to God, and i want other persons who is suffering from this deadly illness, ( Herpes, Coronary Artery Disease (Ischemic Heart Disease), Hiv/AID, Stroke, Trachea, Bronchus, and Lung Cancers, Diarrhea Diseases, Diabetes Mellitus, Dengue, Rota-virus, Other STD and others ) maybe because of ignorance. if you see this don't ignore, i was a victim of hpv, some one introduced him to me, i wrote him, told him what i was going through,  i was not too sure he could help, because i seen other persons, or post but no good outcome, he told me he could help, like others, i got the medicine or the herb whatever you may want to call it, he didn't even charge me a lot, to God i didn't want to use it, but i did, to God be the glory am the one sending this post today in good health and sound mind, ..smile.. i seek for him, i didn't mind the distance so i could show appreciation, i meet with Dr Sayo he didn't ask for anything, all he said is, 'It's God doing. I saw him treat people with different situation and problem maybe worse than yours, tell others. so am telling you today, don't ignore this, if you see this post, tell the next person who you think might need this. contact him,on email (sayoherbalhealer@gmail.com) check his FB page:  https://www.facebook.com/Sayo-Herbal-Healer-100145798345000/ OR visit his websites website; http://sayoherbalhealer.website2.me/  check blog: https://sayoherbalhealer.blogspot.com/

      Delete




    3. A MIRACLE TESTIMONY FOR WHAT Dr SAY0 HAS DONE FOR ME!!  
      Human PapilomaVirus (HPV) Cure Found By Dr Sayo If you're wondering why am here or why am doing this!, i just want to show appreciation to God, and i want other persons who is suffering from this deadly illness, ( Herpes, Coronary Artery Disease (Ischemic Heart Disease), Hiv/AID, Stroke, Trachea, Bronchus, and Lung Cancers, Diarrhea Diseases, Diabetes Mellitus, Dengue, Rota-virus, Other STD and others ) maybe because of ignorance. if you see this don't ignore, i was a victim of hpv, some one introduced him to me, i wrote him, told him what i was going through,  i was not too sure he could help, because i seen other persons, or post but no good outcome, he told me he could help, like others, i got the medicine or the herb whatever you may want to call it, he didn't even charge me a lot, to God i didn't want to use it, but i did, to God be the glory am the one sending this post today in good health and sound mind, ..smile.. i seek for him, i didn't mind the distance so i could show appreciation, i meet with Dr Sayo he didn't ask for anything, all he said is, 'It's God doing. I saw him treat people with different situation and problem maybe worse than yours, tell others. so am telling you today, don't ignore this, if you see this post, tell the next person who you think might need this. contact him,on email (sayoherbalhealer@gmail.com) check his FB page:  https://www.facebook.com/Sayo-Herbal-Healer-100145798345000/ OR visit his websites website; http://sayoherbalhealer.website2.me/  check blog: https://sayoherbalhealer.blogspot.com/








      A MIRACLE TESTIMONY FOR WHAT Dr SAY0 HAS DONE FOR ME!!  
      Human PapilomaVirus (HPV) Cure Found By Dr Sayo If you're wondering why am here or why am doing this!, i just want to show appreciation to God, and i want other persons who is suffering from this deadly illness, ( Herpes, Coronary Artery Disease (Ischemic Heart Disease), Hiv/AID, Stroke, Trachea, Bronchus, and Lung Cancers, Diarrhea Diseases, Diabetes Mellitus, Dengue, Rota-virus, Other STD and others ) maybe because of ignorance. if you see this don't ignore, i was a victim of hpv, some one introduced him to me, i wrote him, told him what i was going through,  i was not too sure he could help, because i seen other persons, or post but no good outcome, he told me he could help, like others, i got the medicine or the herb whatever you may want to call it, he didn't even charge me a lot, to God i didn't want to use it, but i did, to God be the glory am the one sending this post today in good health and sound mind, ..smile.. i seek for him, i didn't mind the distance so i could show appreciation, i meet with Dr Sayo he didn't ask for anything, all he said is, 'It's God doing. I saw him treat people with different situation and problem maybe worse than yours, tell others. so am telling you today, don't ignore this, if you see this post, tell the next person who you think might need this. contact him,on email (sayoherbalhealer@gmail.com) check his FB page:  https://www.facebook.com/Sayo-Herbal-Healer-100145798345000/ OR visit his websites website; http://sayoherbalhealer.website2.me/  check blog: https://sayoherbalhealer.blogspot.com/

      Delete
  2. I am here to testify how great man called Dr KOFI helped me out with herbs and roots which he prepared for me in use of curing my Hepatitis B I takes his product (cure) for (14) days before I am to known I was totally cure out of it, and i promised him that i will testify my healing to the whole world about how he cured me which I am very happy I am doing now , Dr KOFI also cure all kinds of diseases , HEPATITIS, A,B,C , CANCER, DIABETICS , FRIBLOD,ALL KINDS OF SPELL CAST ,and so much more , please you can get him contacted on his email at drkofiherbalcure@gmail.com He can also cure following virus (1).Herpes (2).Cancer (3).Hepatitis (4).Hiv/aids (5).Pcos (6).Fibroid...

    ReplyDelete
  3. I found out, that taking herbal treatment is the best to get rid of hpv as soon as i feel the symptoms of hpv is appearing, i took the healing process by contacting Dr OYAGU for natural treatment it works wonders, amazingly ever since I had the herbal treatment i have not feel these horrible disease anymore and my doc told me the virus is gone, i am glad i finally got cured out from this horrible disease. every hpv or herpes patients should also get in touch with this herbalist Dr to get ride of these disease forever his email.Oyaguherbalhome@gmail.com or Whatsapp him via +234810175532

    ReplyDelete
  4. Greetings to you all, am so much appreciating God almighty for using Dr Ajayi the herbal  Doctor to cure my herpes, while this may sound discouraging and people may not believe that herpes have a cure, i have been to so many places for help including hospitals wasted money and times hoping that i was going to get cured but nor was able, until God use someone to cure me from this virus, true the help of a man called Dr Ajayi, with his herbal medicine which he prepared and send to me that i took for 21 days. Well I don’t have much to say, am so much happy for his good work in my life because i never thought i will have a good health again, thank you so much Dr Ajayi. you can also contact Dr Ajayi for help via email ajayiherbalhome@gmail.com you can also call or add him on whatsapp through his mobile number +2348154724883. he also have the cure to other disease and many more...
    Hiv  cure,
    Hepatitis B cure,
    Brainstorm cure.
    Cancer cure,
    Lupus cure,
    Diabetes cure,
    Skin infection cure,
    Hsv 1/2 cure,
    penis enlargement,
    he also have powers to bring your Ex back with a spell carter,


    ReplyDelete
  5. I was suffering from herpes virus 6 years ago, i was totally depressed due to my predicament , until i meet Dr Ajayi the great Traditional healer who cured me. you can also contact him now on whatsapp +2348154724883.or via email: ajayiherbalhome@gmail.com for more information and get your healing..    

    ReplyDelete
  6. I have been suffering from (HERPES) disease for the last four years and had constant pain, especially in my knees. During the first year,I had faith in God that i would be healed someday.This disease started circulating all over my body and i have been taking treatment from my doctor, few weeks ago i came on research on the internet if i could get any information concerning the prevention of this disease, on my research, i saw a testimony of someone who has been healed from (Hepatitis B and Cancer) by this Man Dr EDES and she also gave the email address of this man and advise we should contact him for any sickness that he would be of help, so i wrote to Dr EDES, telling him about my (HERPES Virus) he told me not to worry that i was going to be cured!! hmm i never believed it,, well after all the procedures and remedy given to me by this man few weeks later i started experiencing changes all over my body as the Dr assured me that i have been cured,after some time i went to my doctor to confirmed if i have be finally healed behold it was TRUE, So friends my advise is if you have such sickness or any other at all you can email Dr EDES on : (dredeshome@gmail.com)..... THESE ARE THE THINGS DR EDES CAN ALSO CURE.. GONORRHEA, HIV/AIDS , LOW SPERM COUNT, MENOPAUSE DISEASE, PREGNANCY PROBLEM, SHORT SIGHTEDNESS PROBLEM, Stroke, Bring back ex lover or wife/husband....sir i am indeed grateful for the help i will forever recommend you to my friends!!!... you can as well add Dr EDES on WhatsApp +2348151937428
    VISIT HIS WEBSITE; https://dredesherbal.webs.com

    ReplyDelete
  7. I want to write a little testimony about the good work of dr Shaibu Abacha who cured me from Hsv 1 and 2 for just 2 week with his herbal medicine, I never believe I can be normal again and have a good life like others I always regretted the day I got diagnose with the virus, I was lost of hope when my doctor told me there is no cure for it but I keep thinking and thinking about my future, if I can have kids of my own well I am so grateful for my helper who get me cured with his herbal medicine, I go online in search of anything that can help me because I can’t deal with it forever so I found this dr Shaibu Abacha email on a blog of someone who was cured by him I quickly contact him for help and explain all my pain to him, he told me not to worry about it there is cure for real, I never believe until he send me the herbal medicine when I order for it and I have it within 4days   that is how I took the medicine for 2 week and the following week I go for test just to confirm I was 100% cured from this sickness what a miracle in my life I am so happy right now, you can also get in contact with him if you have such sickness through drshaibuabacha@gmail.com and also WhatsApp him +2349051727475.. And He also have herbs medicine to cured the following diseases; eczema,urethra wart,chronic problems.Herpes, Cancer, Als,Hepatitis, Diabetes, HPV,Infections,ulcer, kidney problem  ETC.

    ReplyDelete
  8. I have been suffering from (HERPES) disease for the last four years and had constant pain, especially in my knees. During the first year,I had faith in God that i would be healed someday.This disease started circulating all over my body and i have been taking treatment from my doctor, few weeks ago i came on research on the internet if i could get any information concerning the prevention of this disease, on my research, i saw a testimony of someone who has been healed from (Hepatitis B and Cancer) by this Man Dr EDES and she also gave the email address of this man and advise we should contact him for any sickness that he would be of help, so i wrote to Dr EDES, telling him about my (HERPES Virus) he told me not to worry that i was going to be cured!! hmm i never believed it,, well after all the procedures and remedy given to me by this man few weeks later i started experiencing changes all over my body as the Dr assured me that i have been cured,after some time i went to my doctor to confirmed if i have be finally healed behold it was TRUE, So friends my advise is if you have such sickness or any other at all you can email Dr EDES on : (dredeshome@gmail.com)..... THESE ARE THE THINGS DR EDES CAN ALSO CURE.. GONORRHEA, HIV/AIDS , LOW SPERM COUNT, MENOPAUSE DISEASE, PREGNANCY PROBLEM, SHORT SIGHTEDNESS PROBLEM, Stroke, Bring back ex lover or wife/husband....sir i am indeed grateful for the help i will forever recommend you to my friends!!!... you can as well add Dr EDES on WhatsApp +2348151937428
    VISIT HIS WEBSITE; https://dredesherbal.webs.com

    ReplyDelete
  9. I WILL CONTINUE TO POST THIS, I'm so happy to share this testimony thank you Dr.idowu am so happy i never believed i will be hepatitis b negative again despite all i passed through Dr.idowu you are truly God sent, am so happy that am negative again thank you Dr idowu.email him
    (Dr.idowuherbalhome@gmail.com)
    If you have any problem like
    Herpes 1/2
    HIV/Aids
    Hepatitis a,b,c
    Breast cancer/cancer
    Marriage
    Pregnancy problem
    Ex back
    Penis enlargement/ass/boos..
    Whatsapp via (+2348052789941)
    Please give him a try
    🙏🙏🙏no harm in trying

    ReplyDelete
  10. QUICK RELIABLE CURE, Am so glad expressing my profound gratitude to a man that is so concerned about other people's well being. I was suffering from (HERPES SIMPLEX VIRUS) over 4 years, i have spent thousands of dollars in buying expensive drugs and visiting several hospitals in different countries, i was really in severe pain "until" one glorious morning, i read about Doctor Razor on the internet on how he had helped and cured so many people suffering from HERPES 1&2, HPV, CANCER, HIV/AIDS, ALZHEIMER, FIBROID, ENLARGED PROSTATE, HEMORRHOIDS' PILE and HEART DISEASE ETC. So i contacted him through this Email: drrazorherbalhome@gmail.com and i shared my problems with him, he gave me the healing procedure and i followed them. 18 days later he told me to go for a medical test, behold the result was negative, now am (HERPES SIMPLEX VIRUS)  Negative. I just want to use this platform to thank Doctor Razor for curing me from that deadly virus and also for exposing his herbal cure to the world, please you can as well contact him at drrazorherbalhome@gmail.com (or) Whatsapp/Call him +2349065420442 for solutions to your health problems

    ReplyDelete
  11. QUICK RELIABLE CURE, Am so glad expressing my profound gratitude to a man that is so concerned about other people's well being. I was suffering from (HERPES SIMPLEX VIRUS) over 4 years, i have spent thousands of dollars in buying expensive drugs and visiting several hospitals in different countries, i was really in severe pain "until" one glorious morning, i read about Doctor Razor on the internet on how he had helped and cured so many people suffering from HERPES 1&2, HPV, CANCER, HIV/AIDS, ALZHEIMER, FIBROID, ENLARGED PROSTATE, HEMORRHOIDS' PILE and HEART DISEASE ETC. So i contacted him through this Email: drrazorherbalhome@gmail.com and i shared my problems with him, he gave me the healing procedure and i followed them. 18 days later he told me to go for a medical test, behold the result was negative, now am (HERPES SIMPLEX VIRUS)  Negative. I just want to use this platform to thank Doctor Razor for curing me from that deadly virus and also for exposing his herbal cure to the world, please you can as well contact him at drrazorherbalhome@gmail.com (or) Whatsapp/Call him +2349065420442 for solutions to your health problems

    ReplyDelete
  12. A MIRACLE TESTIMONY FOR WHAT Dr SAY0 HAS DONE FOR ME!!  
    Human PapilomaVirus (HPV) Cure Found By Dr Sayo If you're wondering why am here or why am doing this!, i just want to show appreciation to God, and i want other persons who is suffering from this deadly illness, ( Herpes, Coronary Artery Disease (Ischemic Heart Disease), Hiv/AID, Stroke, Trachea, Bronchus, and Lung Cancers, Diarrhea Diseases, Diabetes Mellitus, Dengue, Rota-virus, Other STD and others ) maybe because of ignorance. if you see this don't ignore, i was a victim of hpv, some one introduced him to me, i wrote him, told him what i was going through,  i was not too sure he could help, because i seen other persons, or post but no good outcome, he told me he could help, like others, i got the medicine or the herb whatever you may want to call it, he didn't even charge me a lot, to God i didn't want to use it, but i did, to God be the glory am the one sending this post today in good health and sound mind, ..smile.. i seek for him, i didn't mind the distance so i could show appreciation, i meet with Dr Sayo he didn't ask for anything, all he said is, 'It's God doing. I saw him treat people with different situation and problem maybe worse than yours, tell others. so am telling you today, don't ignore this, if you see this post, tell the next person who you think might need this. contact him,on email (sayoherbalhealer@gmail.com) check his FB page:  https://www.facebook.com/Sayo-Herbal-Healer-100145798345000/ OR visit his websites website; http://sayoherbalhealer.website2.me/  check blog: https://sayoherbalhealer.blogspot.com/

    ReplyDelete
  13. A MIRACLE TESTIMONY FOR WHAT Dr SAY0 HAS DONE FOR ME!!  
    Human PapilomaVirus (HPV) Cure Found By Dr Sayo If you're wondering why am here or why am doing this!, i just want to show appreciation to God, and i want other persons who is suffering from this deadly illness, ( Herpes, Coronary Artery Disease (Ischemic Heart Disease), Hiv/AID, Stroke, Trachea, Bronchus, and Lung Cancers, Diarrhea Diseases, Diabetes Mellitus, Dengue, Rota-virus, Other STD and others ) maybe because of ignorance. if you see this don't ignore, i was a victim of hpv, some one introduced him to me, i wrote him, told him what i was going through,  i was not too sure he could help, because i seen other persons, or post but no good outcome, he told me he could help, like others, i got the medicine or the herb whatever you may want to call it, he didn't even charge me a lot, to God i didn't want to use it, but i did, to God be the glory am the one sending this post today in good health and sound mind, ..smile.. i seek for him, i didn't mind the distance so i could show appreciation, i meet with Dr Sayo he didn't ask for anything, all he said is, 'It's God doing. I saw him treat people with different situation and problem maybe worse than yours, tell others. so am telling you today, don't ignore this, if you see this post, tell the next person who you think might need this. contact him,on email (sayoherbalhealer@gmail.com) check his FB page:  https://www.facebook.com/Sayo-Herbal-Healer-100145798345000/ OR visit his websites website; http://sayoherbalhealer.website2.me/  check blog: https://sayoherbalhealer.blogspot.com/

    ReplyDelete