This report is a review of major epidemics since 2003, including SARS-CoV, HIV/AIDS, Ebola, Zika and MERS-CoV. Often, responses to such outbreaks have had a negative impact on maternal, reproductive and child health services. Recognising how, and how much, epidemics affect women, children and other vulnerable populations is crucial if nations are to create effective and fair responses.
We have set out lessons learned from past epidemics, with an emphasis on how to ensure reproductive, maternal, child and adolescent health services continue effectively during the current COVID-19 pandemic.
Maternal and Newborn Health
The extent and severity of the Ebola outbreak (2013-2016) meant countries and health systems were in uncharted territories. The same is true with COVID-19. A few lessons learned from the response to the Ebola outbreak and other similar crises include the following:
→ Consistent messaging is essential. It will help women and their families seek early advice and make timely decisions.
→ It is also critical to ensure maternity wards are always perceived as safe places.
→ Healthcare workers (HCWs) should have proper training in infection control and prevention practices, as well as in the proper use of personal protective equipment (PPE).
→ Establishing a clear 'hazard incentive payment' can help boost the number of HCWs.
→ In order to offer proper follow-up and protection, all pregnant women should be regularly tested as part of their antenatal care.
→ Women who test positive for COVID-19, including those who are breastfeeding, should not be separated from their infants. Instead, they should heed precautions such as wearing masks when feeding their babies.
→ Interventions should be developed supporting facilities, midwives and health personnel working privately in communities, so they become safe alternatives for women during crises.
Sexual and Reproductive Health
The diversion of both financial resources and healthcare providers to help address the pandemic may cause a shortage of doctors and other medical professionals providing sexual and reproductive health services. It is paramount that we implement measures NOW to lessen this disruption. Therefore:
→ A Sexual and Reproductive Health (SRH) representative should have a seat at the table in COVID-19 response co-ordination teams.
→ Access to contraception should extend beyond routine health facilities.
→ The presence of skilled service providers may increase the uptake of services by adolescents and help prevent unwanted pregnancies.
→ Health promotion campaigns can inform communities about contraception and how to access it.
Gender-Based and Domestic Violence
There is a high risk of GBV increasing during the current pandemic as movement restrictions trap women and children in their homes. Disease control measures that do not consider the gender-specific needs and vulnerabilities of women and children may also increase their protection risks and lead to negative coping mechanisms. Therefore:
→ It is important to bolster violence-related first-response systems. First responders should anticipate a surge of GBV at the start of a pandemic outbreak and prepare accordingly, including through increasing staff and resources.
→ We should explore how technology can support those in quarantine who need access to GBV services.
→ We should ensure GBV is integrated into the responses of health systems. Healthcare providers should all be trained to identify women and children at risk of violence and be present in all testing and screening locations.
→ We should collaborate with existing formal and informal social networks such as women's groups, community groups, civil society organisations and women's rights organisations.
Another important measure in the response to this pandemic, and to ensure we are adequately prepared for more of them in the future, is the development of reliable and rapid data collection methods followed by expert analysis and timely reporting. All these at the start of a pandemic are crucial in order to rapidly implement measures to tackle it. Furthermore, the development of an 'App' that can be used within the West and Central African region to collect all data related to COVID-19, as well as data specific to RMNAH, would be a welcome contribution in this epic battle.