Written by Pilar Montalvo, Senior Program Officer, Planned Parenthood Global Latin America Program
When Elena* first realized she was pregnant, her first reaction was fear. Not the nervous jitters experienced by many first-time parents—but true terror. Her domestic partner, who had forbidden her to use contraception, was using drugs and was prone to violence and controlling behavior. On top of that, the pandemic raging outside their home on the outskirts of Lima, Peru had essentially trapped Elena, 24, with the person she fears most. Feeling anxious and isolated, she had no one to talk to and nowhere to go.
Elena’s situation is far from unique, as the pandemic has taken an alarming toll in Latin America, which in July surpassed the United States in confirmed fatalities from COVID-19. Peru, which early on was lauded for its strict containment measures, as of August 17 had 536,000 cases and more than 26,000 deaths and growing—a ranking third to only Brazil and Mexico in the region, and among the highest in the world.
We know that women and girls feel the disproportionate weight of this crisis. The same restrictions on movement that aim to curb the virus’s spread are having devastating effects on access to critical health services, including essential sexual and reproductive health services. The United Nations Population Fund (UNFPA) estimates that some 18 million women across Latin America and the Caribbean will lose access to modern contraceptives due to the strain on health systems and massive disruptions in family planning programming and supply chains.
In Peru, this translates into a projected increase of between 50,000 and 100,000 unplanned pregnancies between 2020 and 2021, according to UNFPA. Many of these women will opt for abortion, which is legal in Peru only when a pregnancy will threaten a woman’s health or life. Such limitations make safe access a challenge.
Intimate partner violence and violence against children and adolescents are also surging as a result of quarantine measures. Some 1,200 women and girls have been reported missing in Peru since March, and the government’s emergency hotline has received almost 68,000 calls reporting domestic or sexual violence against women, children and adolescents during lockdown. The pandemic is also deepening existing social and economic inequalities among women, young people and vulnerable populations, such as indigenous communities, refugees, people with disabilities, or those living in extreme poverty.
The cumulative impact of this erosion to health and human rights will take years, if not decades, to reverse if we don’t act now.
In my role as senior program officer for Planned Parenthood Global in Peru, I am working every day alongside colleagues and community partners to safeguard women’s health and rights at all costs. While our work is not new, the pandemic has underscored that we need to look beyond traditional health care models. Now is the time to embrace self-care in SRHR by shifting more autonomy to women and girls and building capacity outside of clinics and hospitals.
We cannot do this in a vacuum. We must strengthen the enabling environment for self-care—by shaping more conducive policies and regulations, training providers and pharmacists in how to facilitate self-care, and increasing access to the tools and resources individuals need to make the best decisions for themselves and their families.
While what is considered self-care varies from country to country, interventions being increasingly adopted around the world include HIV self-testing, emergency oral contraception, self-injectable contraceptives, and self-managed abortion, among others.
The World Health Organization (WHO) recognizes the power and potential for self-care in SRHR, as evidenced by the guidelines issued last year, and the inclusion of self-care interventions in their guidance on essential health services during COVID-19. Among other key elements, the WHO highlights the potential of self-care to “create health sector innovations, including by catalyzing digital and mhealth approaches.” This emphasis on digital solutions and mhealth (referring to health care delivery through mobile or wireless technology) is entirely timely, as we come to grips with the realization that health care as we know it is morphing.
With already weak health systems in Latin America now completely overwhelmed, Planned Parenthood Global is supporting the expansion of digital innovations in Latin America by working with longstanding partners such as APROPO, a Peruvian organization that uses technology and digital innovations to connect women with SRHR services and information.
Among other services, APROPO provides accurate information and referrals for women, especially those under 24 who don’t have anywhere else to turn, connecting them to a multidisciplinary team of obstetricians, midwives, psychologists, social workers, and reproductive health experts. APROPO fields around 13,000 inquiries a month through digital platforms including Facebook Messenger, WhatsApp, APROPO’s chat site Sexo Seguro, and a phone line that includes a “ChatBot” to provide information and referrals.
In today’s climate, APROPO’s emphasis on technology is needed more than ever. It enables women to take charge of their health decisions at a time when “face-to-face” communication is challenging, telehealth is more accepted, and practitioners are rethinking who needs to be seen in person.
It is particularly important that young women and adolescents understand what options are available to them, as they are often the ones who encounter the most stigma and discrimination from traditional providers. To this end, another Peruvian partner Planned Parenthood Global supports, Red Interquorum (Red IQ), is specifically focused on ensuring young women, teens, and girls know their rights. Red IQ is run by young people leading digital activism to call attention to the numerous cases of young women and girls who have been forced into pregnancy—putting their health at risk— and to hold the government accountable for failing to protect their rights. Through activities such as their recent #EsHoradeOtraHistoria (“it’s time for another story”) social media campaign, Red IQ is helping to change the national conversation around teens’ and girls’ rights by amplifying their own voices and experiences.
At the core, these initiatives are about harnessing the power of technology—whether it be telehealth, mhealth, or social media—to reach more people with essential health messages and services and to promote their own bodily autonomy.
For Elena, this meant the ability to message APROPO via WhatsApp after having seen a brief video they put out online. Elena received counseling and guidance through telehealth as to what options were available to her and what legal rights she had. Ultimately, given the impact of the pregnancy on her mental and physical health, Elena was able to access a therapeutic abortion. As well as receiving the information and referral she needed to make an informed decision about her pregnancy, Elena also reached out to APROPO to discuss her options for escaping from the violence at home. APROPO was able to refer her to a government-run emergency women’s center, and she later called back to say she was safe.
Planned Parenthood Global is proud to stand with these organizations that are ensuring women and girls like Elena always have a lifeline. While COVID-19 has brought innumerable challenges, it has also illuminated what is possible when old modalites no longer serve our needs. We have seen how being adaptive and embracing technology and innovation can offer a roadmap for navigating this crisis.
So are we ready for the digital revolution in sexual and reproductive health? COVID-19 has shown us we may not have a choice.
*Name has been changed.
Pilar Montalvo, MS, is senior program officer for Planned Parenthood Global’s Latin America Program in Perú. An obstetrician, Pilar has worked with indigenous organizations and civil society on sexual and reproductive health programs in rural areas in Peru, Bolivia, and Brazil. Part of the Wanka Nation of Peru, Pilar is also a member of the International Secretariat of Indigenous Peoples on Sexuality and Human Rights, and a leader in the International Indigenous Working Group on HIV and AIDS.
Please note that blog posts are not peer-reviewed and do not necessarily reflect the views of SRHM as an organisation.