Sexual health is a critical component of general health, well-being, and life satisfaction. Experts have defined sexual health as not simply the absence of disease, malfunction, or infirmity regarding sexuality, but a condition of physical, emotional, mental, and social well-being. It necessitates a positive and respectful attitude toward sexuality and sexual relationships, as well as the ability to have joyful and safe sexual encounters devoid of compulsion, prejudice, and violence. All people’s sexual rights must be recognized, protected, and fulfilled to achieve and sustain sexual health.
We all have reproductive rights, which are protected by a myriad of fundamental human rights guarantees. These assurances can be found in some of the oldest and most widely acknowledged human rights instruments, and they relate governments’ commitments under international treaties to the protection of reproductive rights.
Some examples of these rights are; the right to reproduce, have a safe delivery, and good health development, as well as child survival. Because the right to reproductive health is related to the right to life and livelihood, there is no right to life and livelihood if there is no right to reproductive health.
Despite positive advancements in health services, sexual and reproductive health remains one of the greatest difficulties confronting young people and individuals, the majority of whom do not have access to modern contraception, and such cases increased because of COVID -19. The pandemic threatens to undermine the progress due to its unfair, cumulative, and catastrophic impact on the already marginalized populations. Because the virus is extremely hazardous and can kill a large number of people in a brief period, the government has dedicated all its resources to combating the pandemic by applying mass quarantine, shut down and social distancing. With the progress in the health system in general, there is a massive pushback against gender equality and the overall achievement of sexual reproductive health and rights.
Before COVID 19, major steps in institutionalizing Sexuality Education (SE) in schools were underway, including the historic launch of the National SE Framework in 2018; development of the SE Operational Guidelines; and development of resource materials (training guides) for teachers and a SE package for students. The SE standards for out-of-school youth, as well as the Youth Engagement Strategy on SRHR, were also validated and are now in line with the National Parenting Guidelines.
The shutdown of schools has made it difficult for students to receive comprehensive sexuality education. Aliza Singh, a program coordinator for the Beyond Beijing Committee Nepal, shared the results of a Rutgers-led study of over 2,700 young people in Ghana, Indonesia, Kenya, Nepal, Uganda, and Zimbabwe. Aliza said. “More than a third of young people felt more vulnerable to harassing, sexual, physical, emotional, or financial abuse after COVID-19 than they did before.” “Family planning services were unavailable to one-third of young people,” she explained. Not being in school has also left very many young people idle with nothing to do for long periods of time, increasing chances of them easily participating in sexual activities and yet there has been little to no service delivery of contraceptives and SRHR information to help them make informed choices.
The most common limiting issue for accessing SRHR services and information during the lockdown is a lack of transportation, followed by distance from home, cost of services, and curfew. The high percentage of no transportation, as one of the most common limiting factors to accessing SRHR services, can be explained by the lockdown status during which access to private cars and taxis has been limited to prevent the spread of the COVID-19. Moreover, industrial production, global supply chains, and service delivery were also interrupted because of the closure of international and domestic travel and enterprises. Inadvertently, condoms, contraceptive pills, and many other SRH commodities and services were suddenly judged non-essential and hence a luxury due to the shutdown of non-emergency services and transportation limitations.
Several stakeholders have pointed to a dire post lock-down situation because of government measures. The Archbishop of the Church of Uganda, Dr. Stephen Kazimba Mugalu, warned of an increase in unintended pregnancies during the lockdown during a televised Easter Sunday sermon last year. He recommended that women take control of their lives and seek out family planning services. However, this is difficult because access to sexual and reproductive health (SRH) commodities is still difficult. In some instances, facilities are closed as health workers do not have access to personal protective equipment.
As with previous pandemics, evidence points to a surge in transactional sex among young girls and women because of COVID 19. A component that has been recognized as being extreme poverty was blamed for the surge in pregnancy during the Ebola outbreak, with girls having intercourse in exchange for water, food, or other types of assistance. Reports in Uganda add the lack of sanitary pads as a leading determinant of transactional sex.
The pandemic of COVID-19 has exacerbated poverty. According to a United Nations estimate of COVID-19’s social and economic impact in Uganda, national poverty rates were expected to grow by 2 to 8 percentage points by June 2020. The UN attributed this to loss in household incomes, gaps in human development amongst sub-regions, social economic and demographic groupings in Uganda disproportionately affecting the poor, vulnerable, and marginalised groups. UN reported that the chasm would widen further by the effects on health and the health sector. A case in point is the shortage of oxygen therapy for critical patients and the exorbitant fees for intensive care support. Currently treatment for COVID 19 for critical patients averages at UGX 2 to 6 million (USD 555 to USD 1666) per day, plunging families further into abject poverty.
Additionally, vulnerable and marginalized populations, such as refugees, are disproportionately affected in several crucial areas, necessitating special assistance. Women, girls, and young people are more likely to have poor reproductive health outcomes because of this poverty and vulnerability, and key reproductive health indicators such as poor maternal health, early childbearing, unintended pregnancy, and big families are bound to be widespread. More worrying is that the vulnerability will cause many families to become warped in the sense that young girls will be married off for financial reasons, there will be a high crime rate, and vulnerable groups will be exposed to sexual and gender-based abuse.
Therefore, preventative interventions to stop the spread of coronavirus should be conducted in a way that minimizes inequality and unintended consequences for SRHR. It defeats the purpose to protect the population from COVID-19 while also exposing it to SRHR fatalities in which the government and partners have invested heavily over an extended period. The government should create steps to guarantee that reproductive, maternity, new-born, and child health services are readily available, as well as to ensure that community systems are operating to provide enough assistance for particularly vulnerable women and girls.
Uganda’s government has indicated SRHR as one of the essential areas for investment over the next five years (2020/21-2024/25), however gains to the sector require concerted efforts from all stakeholders, including in Civil society, the political class and development partners to plan, execute and monitor key SRHR interventions.