By John Skibiak
John Skibiak is the Director of the Reproductive Health Supplies Coalition, the world’s largest voluntary network of reproductive health organizations, working with health systems, manufacturers, distributors, providers and educators to increase access to a range of quality-assured, affordable contraceptive methods.
Women should have access to the contraception they need, when they need it, and where they need it. To that end, partners from across the reproductive health (RH) community – health care workers, logisticians, development specialists, donors, and manufacturers — have devoted decades to establishing the supply chains and service delivery systems now in place to realize this vision.
Today, COVID-19 is threatening those systems; prompting our community to rally together to ensure their survival. We recently saw partners of the Global Family Planning Visibility and Analytics Network (Global FP VAN) call out to countries to sustain the progress in greater data sharing. The VAN is a shared platform to increase supply chain data visibility for collective decision making. In April, FP2020 – a global family planning partnership — called on national governments to maintain support for family planning programs. Also, to ensure adequate space for planned supply shipments, national health ministries are being advised by international donors to push out to the last mile what stocks they have. All these efforts to sustain the systems we have worked so hard to create are absolutely critical. However, while COVID-19 may indeed be global, each country is different. Each is confronting the virus from varying positions of strength or weakness, each striking a delicate balance between, on the one hand, the supplies they have in stock, and on the other, the services now in place to deliver those supplies. As this pandemic spreads, we must recognize that efforts to sustain systems in the long run cannot substitute for new strategies that enable women and girls to avert the pregnancies they do not want today. As a community, and as a supplies community in particular, we must come to terms with the fact that the world we have been buying for is not necessarily the world we see before us today.
We must encourage alternative supply options where contraceptive choice is limited; explore new ways to deliver supplies and services in the face of social distancing; and advance regulatory approval of new quality-assured products. Fortunately, within our community, we are seeing growing evidence of all these efforts: self-care, telemedicine, and more are coming into their own in these unprecedented times.
Through the work of professional organizations such as the Royal College of Obstetricians and Gynecologists, new clinical guidelines have been developed that will help healthcare professionals offer self-care alternatives, including emergency contraception, in contexts where face-to-face contact hinders the provision of long-acting contraception. Partners within the Global FP VAN are offering supply planners both consumption and procurement data that can help them make critical supply plan decisions, based not just on past procurements, but on how those supplies will likely be used in the coming months. Leveraging data already available within the Commodity Gap Analysis will enable countries to explore and quantify the impact of women’s decisions to maintain access to contraception. We are seeing members of our regional network in Latin America, ForoLAC, work together to shorten supply chains by sourcing quality contraceptives and other products closer to home. In East Africa and elsewhere, we are seeing improved efficiencies in applications for regulatory approval of new RH supplies. The East African Community’s (EAC) regional harmonization initiative, for example, is now accepting registration dossiers via email, file share or even regular mail. The country regulatory authorities that comprise the EAC are responding within reasonable timeframes and allowing invoices for registration and other fees to be paid electronically. We are also seeing the advent of innovative approaches to get supplies into the hands of those who need them. We are, for example, seeing expanded use of virtual care platforms such as telemedicine, clinic finders, pharmacy-led care and direct-to-consumer delivery of key RH supplies. Lastly, to help users better navigate new private sector opportunities and increasingly de-medicalize supply outlets, we are seeing calls to deliver development financing directly into the hands of those most at risk.
In some instances, these efforts may be seen as running against the tide of earlier achievements in the supplies space – a trajectory that has reflected, for example, greater investments in long-acting reversible contraception, increased globalization of supply chains, volume procurements to reduce prices of quality products; or in the development of fundamental principles underlying broad method choice. To be sure, confronting new crises as they occur may be potentially riskier than supporting systems that have benefitted from decades of fine tuning. Today, we face a new world and time is not on our side. The Guttmacher Institute estimates that just a 10% decline in the use of short- and long-term reversible contraceptives would result in 15 million unintended pregnancies―leading in turn to unsafe abortions, increased maternal morbidity and mortality and other negative health outcomes.
If we are to mitigate successfully the threat of COVID-19, we must acknowledge today’s diverse realities and work with partners at all levels to address them. We must avoid allowing our concern for the resilience of established supply chains and service delivery systems to hinder the development of new responses to social distancing, uncertain supply chains, heightened commercial risk and rapidly service delivery needs. We must share the successes of new adaptive strategies, we must support local efforts to apply them, and we must act now.
 Reproductive Health Supplies Coalition. Joint Statement on the Importance of Continued Family Planning Data Sharing and Collaboration. 2020. https://www.rhsupplies.org/fileadmin/uploads/rhsc/Uploads/Other/Joint_Statement_on_the_Importance_of_Continued_Family_Planning_Data_Sharing_and_Collaboration.pdf
 FP2020. Access to Contraception is Critical in COVID-19 Response. FP2020 Statement. 2020. http://familyplanning2020.org/sites/default/files/COVID/COVID-19%20%26%20FP%20statement%202020-04-01.pdf
 Royal College of Obstetricians & Gynecologists. FSRH CEU clinical advice to support provision of effective contraception during the COVID-19 outbreak. March 20, 2020. https://www.fsrh.org/documents/fsrh-ceu-clinical-advice-to-support-provision-of-effective/
 Royal College of Obstetricians & Gynecologists. FSRH CEU recommendation on extended use of the etonogestrel implant and 52mg levonorgestrel-releasing intrauterine system during COVID restrictions. March 20, 2020. https://www.fsrh.org/documents/fsrh-ceu-recommendation-on-extended-use-of-the-etonogestrel/
 Riely T, Sully E, Ahmed Z, Biddlecom A. Estimates of the Potential Impact of the COVID-19 Pandemic on Sexual and Reproductive Health in Low- and Middle-Income Countries. International Perspectives on Sexual and Reproductive Health. 2020 (46): 73-76. https://www.guttmacher.org/journals/ipsrh/2020/04/estimates-potential-impact-covid-19-pandemic-sexual-and-reproductive-health
Please note that blog posts are not peer-reviewed and do not necessarily reflect the views of SRHM as an organisation.