Let’s talk about sexual and reproductive health and rights: Not fully implemented before COVID-19 & suspended during the pandemic
Under the current health crisis, governments have struggled introducing lockdown measures that would keep the balance between keeping us healthy and safe, without limiting our liberty and freedoms too much. National equality bodies have been monitoring these measures, to make sure they do not undermine the rights to equality and non-discrimination. It proves to be even harder, under the current circumstances, to protect and not limit those fundamental rights, which were not fully implemented before the COVID-19 pandemic broke out. One blatant example of this is sexual and reproductive health and rights (SRHR). SRHR are not only a crucial part of healthcare, but they also constitute an essential element for achieving gender equality and promoting women’s rights. They give women the possibility to make autonomous decisions about their own bodies and sexuality. They keep women healthy, dignified and safe.
This blog post outlines the pre-existing limitations in access to sexual and reproductive health and rights across Europe as well as the further violations we are now witnessing as a result of the COVID-19 pandemic. By looking at how equality bodies are responding, this article shows the unique role that equality bodies play in monitoring member states’ obligations to enforce and respect equality legislation, and to explain why their response needs to also include access to SRHR.
SRHR as part of healthcare
While sexual and reproductive health and rights cover a wide range of topics, for this post they can be generally simplified as dealing with aspects of safe sexuality and maternity. Sexual rights may include the right to sexual education, freedom from sexual violence and coercion or the right to decide whether or not to have children. Reproductive rights on the other hand, can include access to contraception (including emergency contraception), access to menstrual and sanitary products, access to safe and legal abortions and ensuring safe pregnancies and childbirth. However, SRHR also deal with violations such as eliminating female genital mutilation (FGM) and forced sterilization or preventing sexually transmitted diseases.
What all these things have in common is that they require access to health care services and medicines, health education programs and awareness-raising campaigns. As such, SRHR constitute a part of our healthcare, and equal access to healthcare is guaranteed by article 35 of the EU Charter of Fundamental Rights. Furthermore, ensuring universal access to sexual and reproductive healthcare services is also enshrined in the UN Sustainable Development Goal 3 on good health and well-being. It is thus crucial to highlight, in order to understand and fully recognize, that when we discuss access to SRHR, we are not discussing an option for member states to consider. SRHR, as part of healthcare, are essential, meaning that member states have an obligation to ensure access to them, and failing to guarantee that, is inadmissibly a breach of fundamental rights.
National equality bodies are the watchdogs for national governments’ implementation of equality legislation and the promoters of equality and non-discrimination across Europe. They are mandated to tackle gender discrimination among other grounds. Equality bodies are thus well positioned to ensure that women’s rights are not infringed, equal access to health care is guaranteed and includes SRHR.
Turning a blind eye to SRHR
Access to all sexual and reproductive health and rights was already limited before the pandemic broke out. Although abortion is now accessible under certain circumstances in 39 countries in Europe, several countries still have time limits on performing abortions ending around the first trimester, and in Malta abortions are still not allowed under any circumstances. When it comes to accessing various contraception, according to the Contraception Atlas Index by the European Parliamentary Forum for Sexual & Reproductive Rights (EPF), several European countries’ national health systems still do not provide proper reimbursement for contraceptive supplies nor provide enough supporting information on how and where to get them. Furthermore, women still face obstacles due to requirements of third-party consent. This means that they must see a doctor first, who decides whether to allow the use of contraceptive methods and then whether to write a prescription, for example, for hormonal contraception. This need to obtain a prescription from the gynecologist is another obstacle in countries where general healthcare is not always accessible. In Poland, which scores lowest on the index, even emergency contraception pills are not available without a prescription. This creates additional stress caused by the limited time available to obtain and take the emergency contraception while it is still effective. With access already limited and the complicated doctoral procedures that also imply additional financial burden in the process, it is inevitable that such restrictions further disproportionately affect women living in poverty, women with disabilities, Roma women as well as trans and gender non-binary people.
The social stigma created around the matter has further contributed to deteriorating women’s dignity and safety in attempting to access such services. Criminalising women and medical professionals who act outside of the legal framework to provide abortion, lack of proper sexual education and the use of the conscience clause even when the health risks are visible and prevailing are just a few examples of what contributes to the perceived ‘acceptableness’ of neglecting access to SRHR.
Pandemic lockdown: leading to further neglect
During the COVID-19 pandemic and the lockdown measures that followed, access to SRHR has become even more complicated than before. The Commissioner for Human Rights of the Council of Europe (CoE) has made the message clear in her statement: “While several member states are taking laudable measures in an attempt to mitigate the negative effects of the crisis on women’s rights and gender equality, they should not neglect women’s sexual and reproductive health and rights. Full respect of these is an essential component to guarantee women’s human rights and advance gender equality”. Our member, the Cypriot Office of the Commissioner for Administration and the Protection of Human Rights (Ombudswoman), additionally stressed that policies such as a blanket ban on the presence of the father or a person of the mother’s choice in maternity wards do constitute discrimination on the ground of gender.
Women living in countries with the most restrictive abortion laws usually travel abroad to neighbouring countries with more liberal laws if they need the procedure. Current travel restrictions make it impossible for these women to do that. The issue has been highlighted, for example, by activists from Malta. Another alarming issue is the disruption in supply chains caused by higher demands and cuts in personnel working in production and delivery services, leading to shortages of contraception and emergency contraception available in pharmacies. This issue is even more critical now, with the alarming rise of sexual and gender-based violence for instance, in cases of domestic abuse or rape.
Various state-imposed rules, aimed at reducing the spread of the virus, have also affected carrying out safe pregnancies and childbirth and respecting all rights and wishes of mothers. The National Centre for Human Rights in Slovakia was the first to report cases of fathers not allowed to be present during birth in certain hospitals. Experiencing similar problems, the Ombudswoman in Cyprus released an official statement establishing that “women’s rights during childbirth, must be protected during the COVID-19 pandemic, if all of the necessary precautionary and protective measures are taken to avoid the risk of spreading the virus. Otherwise it would constitute direct gender discrimination against pregnant women wishing to have the person of their choice present during childbirth.”
Fathers are not the only ones missing from treatment centres. In several regions of Poland, visiting a gynecologist has become especially tough, as many of them have closed their offices and stopped working due to the risk of catching or spreading the virus. Yet for pregnant women, prophylaxis is especially important and teleconsulting is less likely to be a sufficient alternative than for many other medical conditions. This shows that continued access to proper health care is particularly crucial when it comes to sexual and reproductive health and rights.
Certain governments’ responses to the COVID-19 pandemic have caused a deliberate deprioritisation of ensuring access to SRHR. Such was the case in Romania, where abortions are no longer deemed essential and hospitals are currently not performing them. The National Centre for Human Rights in Slovakia has also received cases of women being denied abortions under the argument that it is not urgent health care. The Centre requested a statement from the Ministry of Health. It also called to respect ethical code of medical workers and act upon their best medical knowledge, underlining that sexual and reproductive rights of women must be protected.
Other governments have also attempted to use the pandemic to intentionally introduce retrogressive restrictions on SRHR. In Poland, where a state of emergency was declared, the government in April tried to push through a bill that would further restrict abortion, whilst public gatherings were banned.
Act now, but keep the future in mind
States need to observe how the COVID-19 pandemic is affecting women’s health and draw conclusions. Now more than ever we are observing the dangerous effects that restricting access to SRHR has on women. Governments should see the health crisis as a chance for a new approach to sexual and reproductive health and rights and the protection of women. The additional obstacles, created by lockdown measures, should serve as an incentive to ensure proper access to SRHR.
Every cloud has a silver lining and there are also some countries, which have loosened laws governing SRHR in response to the conditions that COVID-19 is creating for women. In France, women are temporarily allowed to use expired scripts to renew their oral contraceptive prescriptions. In Belgium, the morning-after pill is now free, along with other forms of contraception for those aged 18 to 25. These examples show that the pandemic can also be used to give impetus to governments to ensure full and proper access to sexual and reproductive health and rights.
If we are to take the next step towards ensuring gender equality and sustain the enjoyment of our fundamental rights, now is the time to recognize the importance of sexual and reproductive health and rights. With the help of national equality bodies, SRHR needs to be promoted as part of health care and as an obligation. Awareness-raising and educational campaigns are key to ending the ostracization that girls and women still face in our society. For instance, the Spanish Institute of Women and for Equal Opportunities, has recently launched a series of online debates, #DebatesINMujer, on feminist topics. Governments also need to allocate more resources into legally ensuring safe supplies and providing services. Some countries are showcasing that this is possible. It is now time for the others to follow in their footsteps. It is now time for all governments to put in place legislative and policy measures liberalizing access to SRHR and to make sure that they stay in place long after the COVID-19 pandemic is over.
The views on this blog are always the authors’ and they do not necessarily reflect Equinet’s position.