By Izzy Bohn
NOTE: I use the terms woman and women’s health, however, it is crucial to acknowledge that it is not only people who identify as women who access women’s health and reproductive services. Sexual and Reproductive Health services must be inclusive and sensitive to the needs of people whose gender identity does not align with the sex they were assigned at birth.
COVID-19 has changed the face of Sexual and Reproductive Health (SRH) services across the UK. Sexual health clinics, in particular, have had their capacity to offer life-saving services compromised due to government-enforced restrictions placed upon them
As women have been found to rely on these services more than men, what do these restrictions on SRH services say about the government’s attitude to women?
According to Marie Stopes International, a non-governmental organisation providing sexual and reproductive healthcare around the world, the disruption to SRH services in 2020 as a result of COVID-19 may have led to 3 million unintended pregnancies, 2.7 million unsafe abortions and 11,000 pregnancy-related deaths globally. These statistics reflect the risk that the pandemic has posed for women around the world.
SRH services underpin the health, rights and well-being of women and girls, and so the disruption to these services during the pandemic reflects a clear gender imbalance within healthcare which sees women-centred services side-lined. In the UK, this imbalance manifests itself through the current nationwide restrictions placed on sexual health clinics.
Although clinics function as spaces for both men and women, data gathered by the Sexual and Reproductive Health Activity Dataset (SRHAD) found that 82% of contacts with Sexual and Reproductive Health services in 2019/20 were women. Such a finding makes it possible to frame the disruption to sexual health services in the UK as a failure to prioritise women’s lives.
Clinics as life-saving services
Sexual health clinics represent an invaluable lifeline for vulnerable and underrepresented groups across the UK, with findings from the All-Party Parliamentary Group (APPG) on Sexual and Reproductive Health stating that young people and marginalised groups are most reliant on their services. Current restrictions thus represent a failure to meet the needs of those arguably most in need.
A benefit of sexual health clinics is that they provide a level of confidentiality which is necessary for vulnerable groups such as those who are victims of domestic abuse. In light of the Centre for Women’s Justice revealing that lockdown restrictions have caused cases of domestic abuse to surge, the current suspension of walk-in appointments represents an assault on vulnerable communities who rely on them.
At a time when gender violence is becoming increasingly more common, limiting access to sexual health clinics creates safeguarding issues amongst those who the government has a responsibility toward, and reflects institutional inequalities within healthcare. Furthermore, it encourages a cycle of poor health and social outcomes such as early childbearing, shorter birth intervals and unsafe abortions.
A contraceptive binary
To ensure that sexual health clinics can continue to operate at a reduced capacity, clinics have called upon the public to postpone any ‘non-urgent attendances’ and have introduced an essential and non-essential binary that determines which services warrant an appearance at a clinic.
This categorisation is dangerous and reflects a failure to understand that contraception does not conform to a one size fits all approach. Whilst emergency contraception, oral contraception and abortion services are essential, the SRH bureaucracy have deemed the fitting and removal of long-acting reversible contraception (also known as LARCs, such as the implant and coil) otherwise.
Interestingly, despite their ‘non-essential’ status, statistics from the SRHAD show that there was a 46% uptake of LARC in 2019/20, showing that more people are starting to rely on the method. Therefore, the decision to postpone these services is a cause for concern as it limits choice within contraception to user-dependent forms which may not be as appropriate to the user’s needs. In brief, the contraception binary reflects a failure to structure care around the needs of all women.
Pre-existing shortages within SRH
The pandemic has amplified lapses within sexual health and reproductive services that need urgent addressing. A key area of concern is lack of funding, with cuts to the wider public health grant affecting SRH budgets. Evidence presented to the inquiry by the APPG on Sexual and Reproductive Health suggests that SRH budgets were cut by £81.2 million between 2015 and 2017/18, a reduction of 12%. During the same period, it is estimated that contraceptive budgets were cut by £25.9 million, some 13% of the total budget.
These cuts reflect a failure to finance services that engender positive health outcomes for women and perpetuates the narrative that the government is not willing to invest in women’s lives. Without sufficient funding, SRH services may fail to make an impactful positive change in the lives of those who rely on their services and ultimately put many people at risk.
What is the post-pandemic future of SRH?
Whilst the pandemic has identified urgent problems within sexual health services, it has also opened up new opportunities for a more comprehensive approach to SRH in the UK. Limits to face-to-face appointments forced consultations online, and this integration of technology represents an opportunity to improve public services and expand access to contraception. Nevertheless, a move towards digital services must consider marginalised groups or those without private internet access, with SRH service SH:24 stressing the importance of “leaving no one behind” in the transition to digital services.
The pandemic has brought gender inequalities in government budgeting into sharp focus, with COVID-19 arriving at a time where cuts to SRH were at an all-time high and clinics were unable to create the impact that they wanted. Moving forward, we need to see greater investment into women’s futures, whether through financing SRH services or providing them with a seat at the table. Hopefully, we can look at the pandemic as an event which inspired a real commitment to doing something about gender inequality.