UN Sustainable Development Goals for Asia at Risk

Reproductive health services are essential services, including during pandemics

By: Shobha Shukla, CNS

Asia and the Pacific region are not on target to achieve any of the United Nations’ 17 sustainable-development goals adopted in 2015 that seek to end poverty, protect the planet and ensure peace and prosperity by 2030, according to the newly released  Asia and the Pacific SDG Progress Report 2020 by the United Nations Economic and Social Commission for Asia and the Pacific

Among those goals that are not on target are those ensuring universal access to sexual and reproductive health services. Despite commitments made by governments, inequality in the region is growing and the economic gains made by it are not translating into poverty reduction and gender equity.

The Covid-19 coronavirus pandemic could, in fact, push the region and perhaps the rest of the world several steps back in the campaign to achieve health for all by 2030 by severely constraining health systems. It has also impacted the delivery of several significant public health services, including sexual and reproductive health services.

The COVID-19 impact

"While our day-to-day health needs, including sexual and reproductive health needs, do not stop because of an epidemic, health service availability becomes still more difficult during such times,” said Alexandra Johns, Executive Director of Asia Pacific Alliance for Sexual and Reproductive Health and Rights. Johns said she foresees a global shortage of medical supplies, including medicines for people living with HIV, contraceptives and antibiotics, as a fallout of lockdowns imposed by governments to stem the tide of the virus.

The situation is all the more grave for vulnerable populations including sex workers. With weak health systems groaning under the load of Covid-19, service delivery to cater to specific needs like access to abortion services, contraceptives, and lifesaving treatment and loss in wages is bound to be hard hit.

Even in normal times, there is more focus on sexual and reproductive health services for women and not for sex workers, said Kay Thi Win, regional coordinator of Asia Pacific Network of Sex Workers.

"It is very difficult for them to access these services, leading to unwanted pregnancies and also sexually transmitted infections like HIV,” Win said. “Moreover, they do not have easy recourse to safe abortions or even prevention of parent to child transmission of HIV services."

In many countries, sex workers face a huge financial crisis, with bars, restaurants and other places closed. For them, loss of income is a bigger concern than the virus, as they are sole breadwinners. Most health providers are focusing on managing Covid-19 and not on providing sexual and reproductive health services and treatment for other health problems, she said.

"While the coronavirus does not discriminate between different members of society, the relief and the government assistance package often does," according to Liz Hilton of Empower Foundation, a Thailand-based sex workers' association. She shared the example of Thailand, where sex workers are not looked down upon. Most of them are care-givers, mothers and family providers. They are, however, excluded from labor protection and social security benefits. They have not had any income since March 18 when authorities closed all bars and entertainment places.

Meena Saraswathi Sheshu, founder of Sampada Gramen Mahila Sanstha (SANGRAM), an organization that works for sex workers' rights in Maharashtra and northern Karnataka, India, said the main problem sex workers face is loss of livelihood.

“Since the lockdown (in India) sex workers have had no clients, and hence no income, and many of them are under severe mental stress,” Seshu said. “Just this morning, one of them committed suicide by burning herself because she could not deal with the tension of no work, no money, and living in isolation in the brothel."

Seshu said she is also wary that if one woman gets infected in the thickly-packed brothels, the infection will spread quickly. While most sex workers are young, a critical number are old and/or living with co-morbidities like diabetes, TB or HIV. Caste is another big issue.

"Most sex workers we work with are from the Dalit caste which puts them in further vulnerability,” she said. “Dealing with a pandemic is not easy for communities that live in packed slum-like situations and have to earn to be able to eat. There is no way this community is going to weather this easily. We will need the government to step in a big way."

Due to existing social inequities, even the scientific protection advisories issued by governments of the region are beyond the capacity of many. People are told to wash their hands repeatedly assuming that they have access to clean water and sanitation facilities, which many do not. Maintaining physical distancing is a huge problem for many living in very confined spaces in brothels and slums.

Sexual and reproductive health barriers

Hopefully, Covid-19 will pass. But systemic barriers to make sexual and reproductive health services available to all will remain unless governments act proactively. Some of these barriers listed by Alexandra Johns include neoliberal corporate systems favoring the few over the many; militarism that diverts funds away from health services; workforce gender discrimination; patriarchy and the rise of authoritarian governments that prevent women from accessing rights-based sexual and reproductive health services, information and education; discriminatory/ regressive laws and policies still in place in many countries; criminalizing LGBTIQ communities and same sex activities and sex work, restricting access to abortion, early/ forced child marriages and female genital mutation.

For sex workers, lack of information and lack of access to sexual and reproductive health services is a big barrier. In some countries these services are not available and even where they are, they are either not affordable or information is lacking on what services are available and who provides them.

The way forward

Both women emphasized that not only should governments address these issues urgently, but also generate more data around sexual and reproductive health and rights. Even the UNESCAP progress report mentions that data is available for only 42 percent of the 169 targets of Agenda 2030. Evidence-based data from community members is necessary to monitor progress and advocate with policymakers. Engaging civil society in decision-making is imperative.

Kay Thi Win insisted that governments must acknowledge the experience and expertise of the communities like sex workers and gain their trust. Meaningful community engagement is very effective, especially in times of crises like Covid-19, when sex worker-led organizations are working to spread awareness and providing them with condoms, lubricants, masks and hand sanitizers.

Shobha Shukla is the founding Managing Editor at Citizen News Service. Follow her on Twitter @shobha1shukla or visit www.citizen-news.org