By Siddharth Chatterjee
Sexual and reproductive health and pandemics might seem to be unrelated topics, but large and dense populations are drivers of the high velocity transmission of COVID-19, and there are lessons to be learned for the future.
Gains made in women’s sexual reproductive health and rights just took several steps backward in the midst of the COVID-19 pandemic. Access to contraceptives has been interrupted, resulting in an increase in unintended pregnancies. With schools closed, Female Genital Mutilation (FGM) and child marriages are rising. Globally gender-based violence has risen exponentially, as people are advised or required to stay home, and women and girls may not be able to leave an unsafe or violent situation.
The United Nations Population Fund(UNFPA) Executive Director, Natalia Kanem has said, “the world needs to do much more to ensure that the most intimate, yet essential, needs of the world’s women and girls are met while we battle COVID-19.”
Among the chief immediate concerns is severely reduced access to sexual and reproductive healthcare while the pandemic rages on. But diminished women’s rights and services have even greater long-term implications for the outbreak and spread of future epidemics.
Africa has yet to see the devastation from COVID-19 that most developed countries are facing in terms of infections and deaths, but the virus is already wreaking havoc on the livelihoods of millions on the continent. With travel bans, curfews and lockdowns, for countless who depend on daily wages and small informal businesses, are facing hunger and destitution. Unlike richer nations, most African countries have little wriggle room in their budgets to afford meaningful stimulus packages and have social safety nets.
Some forecasts suggest that in the absence of a considerable fiscal stimulus, COVID-19 could see Africa’s GDP decline by over 5% in 2020.
A good place to start is with the root of recent pandemics. Zoonosis is the transmission of a disease from animals to human. COVID-19, Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) are all coronaviruses, and all originated in bats, which are a natural reservoir for viruses.
Such jumps from animals to humans are on the rise for reasons that include unhygienic and close proximity to animals, bush meat consumption, wet markets and–crucially–human encroachment into wilderness and wildlife habitats.
One of the main drivers of such encroachment is the exponential population growth.
We are exploiting forests at a calamitous rate, eating away into the traditional buffer zones that once separated humans from animals, and from the pathogens that they carry. Forest destruction also drives climate change and soil erosion. In turn, growing urbanization means higher population densities, providing a ready route for the rapid and extensive spread of disease.
Long-term preparation must begin with the acknowledgment that runaway population growth is a driver of modern pandemics.
UN Secretary-General Antonio Guterres observed on the 2019 World Population Day, “for many of the least developed countries, the challenges to sustainable development are compounded by rapid population growth as well as vulnerability to climate change.”
Most African health systems operate in a constant state of struggle and crisis. There is only one doctor for every 1,000 people in Africa, and each must serve overwhelmingly young, poor and unemployed patient populations.
Family planning and sexual health services are only patchily available, and cultural pressures mean girls and women may find it difficult to access them even where they exist. Too often the result is large families living in poverty and ill-health, and a worrying predominance of early pregnancy.
Africa is the most rapidly urbanizing region in the world, with 50-70% of urban dwellers living in slums. Uncontrolled population growth, crowded and unhygienic conditions, and destruction of natural ecosystems combine to create a perfect storm for the next pandemic, whose speed, scale and virulence may well surpass COVID 19.
In such circumstances there is a central need for bold global leadership. That is why policymakers, led by the US, must reconsider the Mexico City policy, often known as the global gag rule. The recently expanded global gag rule now applies not only to comprehensive sexual and reproductive healthcare and safe abortion, but also to programmes that include HIV, water, sanitation and hygiene.
In Kenya we are already seeing the domino effect of the global gag rule with increased teenage pregnancies and a spike in unsafe abortions. Almost one in five girls aged 15-19 is either pregnant or already has a baby. Adolescent girls in the worst affected parts of Kenya have lost their ability to make informed choices. It is a crisis of health, education and opportunity, made far worse by COVID 19.
It should concern all leaders that reduced resources for such programmes have led to more poor women suffering the effects of unplanned pregnancies, contributed to higher rates of maternal mortality and to an increase in unsafe abortions. Goals for programmes such as the Family Planning 2020(FP 2020) launched by Melinda Gates, which includes giving 120 million more women and girls access to contraceptives by 2020, will remain unfulfilled as the deadline approaches. FP2020 is based on the principle that all women, no matter where they live, should have access to lifesaving contraceptives.
Today, Africa has the world’s highest fertility rates. On average, women in sub-Saharan Africa have about five childrenover their reproductive lifetime, compared to a global average of 2.5 children. Africa’s population is expected to grow from the current 1.1 billion to 2.3 billion people by 2050 while the global population is expected to reach 10 billion at that time.
If Africa accelerates structural reforms, some believe the continent can emulate China’s rapid rise of the last 50 years. McKinsey predicts $5.6 trillion in African business opportunities by 2025. If Africa succeeds, it could be a poster child for Sustainable Development Goal 1-ending poverty by 2030, as well as become a stable and prosperous economic partner for the rest of the world.
At the top of the reforms must be safeguarding the primacy of reproductive health and rights. With a median age of 19 years, for Africa to benefit from the demographic dividend its youthful population could offer, family sizes must fall drastically. Smaller households link directly to improved health, education and living standards, which in turn translate into investment, employment, and economic growth. This can only happen if programmes that increase access to family planning are widely available.
We must look at strategies to stabilize the global population with renewed urgency. Political and religious, globally must show courage, responsibility and vision through a robust commitment to ensuring that every person, everywhere, has access to affordable contraception and is able to exercise their sexual and reproductive rights.
To help stave off the havoc of the next pandemic, the world must unite behind UNFPA’s mission “to ensure that every pregnancy is wanted, every childbirth is safe and every young person’s potential is fulfilled.”
Siddharth Chatterjee is the United Nations Resident Coordinator to Kenya. He has served in various parts of the world with UNFPA, UNICEF, UNDP, UNOPS, UN Peacekeeping and the Red Cross Movement. A decorated Special Forces veteran, he is an alumnus of Princeton University. Follow him on twitter-@sidchat1