Challenges Deep for Improving Sexual and Reproductive Health, Study Says

The coronavirus pandemic has no doubt worsened existing vulnerabilities within global health care systems, and sexual and reproductive health are no exception.

But even before the virus made its way around the world, U.S. efforts to “reinterpret and subvert long-accepted global agreements on sexual and reproductive health” made those services increasingly vulnerable, according to a recent report released by the Guttmacher Institute, calling the U.S. “perhaps the single greatest obstacle to progress on sexual and reproductive health over the last four years.”

The United States, with a long-standing history of leadership in global health, gradually moved away from its role during the Donald Trump administration, culminating in the U.S. withdrawal from the World Health Organization in July of 2020. Recently inaugurated President Joe Biden has reversed course, having America rejoin the WHO, but the preceding Trump-Pence administration “repeatedly took aim at issues related to global sexual and reproductive health and rights,” according to the report’s authors, with policies such as the “global gag rule,” and other attempts to remove federal funding for global reproductive services.

Paired with the COVID-19 pandemic, the global health landscape is “fundamentally altered,” according to the report from Guttmacher, a Washington, D.C.-based research and policy organization.

Although the exact toll of the pandemic on sexual and reproductive health is difficult to measure, due in part to data-gathering challenges worldwide, an overwhelming sense exists that like the entire health care industry, sexual and reproductive health has seen significant losses. According to the Guttmacher report, “it is now clear that the pandemic has potentially set back global health efforts by decades, including when it comes to sexual and reproductive health and rights.”

As early as last May, just two months after the WHO declared the COVID-19 pandemic, the spread of the coronavirus was damaging four areas of reproductive and sexual health care, according to Dr. Jennifer Balkus at the University of Washington’s School of Public Health.

Even a 10% decline in sexual and reproductive health care as a result of the COVID-19 pandemic would cause significant effects globally, according to a separate Guttmacher Institute analysis earlier this year, resulting in 49 million more women in low-to-middle-income countries with unmet needs for modern contraception, and 15 million more unintended pregnancies. Additionally, 28,000 maternal deaths and 168,000 newborn deaths would result from major complications during birth without adequate health care, according to the report.

Those estimates build on the already existing troubling health outcomes. In 2019, even before the pandemic began, 218 million women in low-to-middle-income countries wanted to avoid pregnancy, but were not using modern contraception, the report says, leading to 111 million unintended pregnancies and 35 million unsafe abortion annually. In addition, 16 million women and 13 million newborns did not receive care for major complications in pregnancy and childbirth, the report says, with nearly 300,000 pregnancy-related deaths and 2.5 million newborn deaths.

The report posits that in order to recover from the Trump-Pence administration’s policies, and the challenges of the coronavirus pandemic, new commitments must be made, especially by the Biden-Harris administration. Although Biden in his first week as president took steps like rejoining the WHO and repealing the global gag rule, the report notes that “true progress in this new global landscape requires not simply reverting to previous structures, but instead developing new, coordinated strategies to deliver equitable gains.”

“The question now before the global community and the Biden-Harris administration is how to move forward on sexual and reproductive health and rights under these changed circumstances,” the report says. “The answer cannot simply be a reversion to how things were in the ‘before’ times. Rather, the answer must be a new vision that builds on past progress, addresses inequities and disparities, and adopts new technologies and approaches.”

But the report notes that “the needs are too urgent, the problems too complex and the scale too massive for a single actor to tackle them alone.” Instead, it argues that “it is time for a new era of global partnership, innovation and change, with U.S. leadership once more at the forefront.”

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