The ripple effects of improving women’s reproductive and mental health
The impacts of the COVID-19 pandemic are still being felt by women who couldn’t access sexual health services or lost their livelihoods. Three organizations share how they've adapted in order to keep supporting women despite new challenges.
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The negative ripple effects of the COVID-19 pandemic — including lockdowns, supply chain disruptions, and job losses — have hit women and girls particularly hard.
Women’s access to health services, including sexual and reproductive health services and access to contraceptives, were severely affected. The United Nations Population Fund estimates that nearly 12 million women lost access to contraception due to disruptions caused by the pandemic, leading to 1.4 million unintended pregnancies.
Job losses hit women hard too. While an estimated 1 in 4 people worldwide lost their jobs during the pandemic, women aged 24-44 were more likely than men to lose their employment or to see reduced paid working hours.
Meanwhile, lockdowns aimed at containing the virus meant that many women were suddenly confined inside with their abusers in dangerous situations, in what’s been dubbed “the shadow pandemic.” In a 2021 study conducted by UN Women, 45% of women said that they had directly or indirectly experienced violence since the onset of the pandemic, and 56% said they feel less safe at home — and numbers are even worse for unemployed women.
Supporting women’s health in Uganda
Health care providers have had to innovate in order to continue serving patients against the backdrop of tightening budgets as both personnel and economic resources were diverted away from routine health services toward the COVID-19 response.
“In Uganda, there was actually a ban on the use of public transport [because of lockdowns], so clients sometimes had to walk very long distances, sometimes an hour, sometimes three hours, to access their routine medical services, attend a medical appointment, or to collect their medication,” said Dr. Agnes Barbara Kobusingye, country director for Uganda at mothers2mothers, an international nonprofit that trains and employs so-called Mentor Mothers — local women living with HIV — as community health workers.
A mothers2mothers’ client with her baby, during a visit to the Ikhwezi Clinic in Cape Town. © mothers2mothers
A mothers2mothers’ client with her baby, during a visit to the Ikhwezi Clinic in Cape Town. © mothers2mothers
The Namulenga Health Centre, in Mulanje District, Malawi. A Mentor Mother provides a woman visiting the health center with access to critical health information that will ensure she stays in care. © mothers2mothers
The Namulenga Health Centre, in Mulanje District, Malawi. A Mentor Mother provides a woman visiting the health center with access to critical health information that will ensure she stays in care. © mothers2mothers
Banda Health Center, Namayingo District, Uganda. mothers2mothers provides services that protect and improve the health and development of infants and children. © mothers2mothers
Banda Health Center, Namayingo District, Uganda. mothers2mothers provides services that protect and improve the health and development of infants and children. © mothers2mothers
These Mentor Mothers work at health centers and in their communities to support women, children, adolescents, and entire families to access necessary health care, with a special focus on preventing HIV infection and related diseases. Their services span pregnancy and breastfeeding as well as early childhood development to ensure babies are born and stay HIV-free.
During the height of the pandemic, these health workers were recognized as an essential workforce, allowing them to reach families that needed urgent medication such as antiretrovirals. Some used bikes or motorbikes for door-to-door delivery in hard-to-reach areas.
mothers2mothers also created a virtual help desk on WhatsApp to help health care workers track clients, gather information, and receive guidance on how to best advise a patient. They’ve continued to use the platform, which can also be accessed directly by patients in need of health information, support, or medicines.
Since launching in 2001, m2m has created nearly 12,000 jobs for women living with HIV.
It has reached more than 15 million people with critical health services in sub-Saharan Africa and virtually eliminated pediatric HIV-AIDS in the areas where it works.
The health effects of the pandemic are still being felt, including an increase in HIV cases, especially among adolescent girls and young women, explained Kobusingye, adding that it’s hard for some clients to afford and adhere to treatment.
The Mentor Mothers are a vital link between health centers and their communities, and help to connect – and keep – people in care. A key part of their model is “the availability of [the] community health care worker, who is within your vicinity, who comes from your community, and is available for you to talk to at any one time. For me, that is a very important aspect of the work that mothers2mothers does,” said Dessalegm.
A Mentor Mother visits a mother and young baby at her home. Photo: © mothers2mothers/Karin Schermbrucker
The community Mentor Mothers go door to door in the catchment areas served by the nearest health centre to directly deliver services, but also to educate, engage, and follow up with clients who have not received medical care or who have stopped treatment.
During the pandemic, that link to the Mentor Mothers were one of the things they worked hard to sustain. “You don't want to take that away from a woman living with HIV/AIDS, or a family dealing with a chronic illness,” she said.
A Mentor Mother visits a mother and young baby at her home. Photo: © mothers2mothers/Karin Schermbrucker
A Mentor Mother visits a mother and young baby at her home. Photo: © mothers2mothers/Karin Schermbrucker
More choices, more money
Staying in school is one of the biggest determinants of women’s economic empowerment as more educated women tend to earn higher salaries — just one more year of school can increase a girl’s earnings by up to 20% once she reaches adulthood.
However, school closures caused by the pandemic have caused huge setbacks to girls’ education, and some 11 million girls may not return to school as a result of child marriage, child labor, and other factors — including having children themselves.
A woman queues at the health post of Keur Momar Sarr in the remote Louga region of Senegal, where an MSI outreach team is providing access to free, high-quality sexual and reproductive health services for girls and women, such as family planning and cervical cancer screening and treatment. Photo: © Cyril Le Tourneur/Cartier Philanthropy
A woman queues at the health post of Keur Momar Sarr in the remote Louga region of Senegal, where an MSI outreach team is providing access to free, high-quality sexual and reproductive health services for girls and women, such as family planning and cervical cancer screening and treatment. Photo: © Cyril Le Tourneur/Cartier Philanthropy
Women of reproductive age represent one third of Senegal’s population, but only 23% use modern contraceptive methods. MSI mobile outreach teams work in the most remote communities, where public health services are limited. © Cartier Philanthropy/Cyril Le Tourneur
Women of reproductive age represent one third of Senegal’s population, but only 23% use modern contraceptive methods. MSI mobile outreach teams work in the most remote communities, where public health services are limited. © Cartier Philanthropy/Cyril Le Tourneur
Keur Momar Sarr rural commune, in the Louga region of Senegal. MSI Reproductive Choices has been working in Senegal since 2011 to improve access to contraception and family planning services across the country. Photo: © Cyril Le Tourneur/Cartier Philanthropy
Keur Momar Sarr rural commune, in the Louga region of Senegal. MSI Reproductive Choices has been working in Senegal since 2011 to improve access to contraception and family planning services across the country. Photo: © Cyril Le Tourneur/Cartier Philanthropy
A 2021 report by the British Medical Journal found that adolescent secondary school girls who were out of school for six months due to the COVID-19 lockdown in Kenya were twice as likely to become pregnant and three times as likely to drop out of school compared with those graduating prior to the pandemic.
“There really is a very obvious linkage between access to sexual reproductive health and educational attainment, economic empowerment, social development, political participation — it really is a crosscutting issue,” said Banchiamlack Dessalegn, Africa director at MSI Reproductive Choices, an international NGO providing reproductive health care services in 37 countries.
MSI Reproductive Choices provides reproductive health care including contraception, safe abortion when legal, and post-abortion care in 37 countries around the world.
In 2022, MSI’s services averted an estimated 14.1 million unintended pregnancies and 6.6 million unsafe abortions.
When a woman or a couple is able to determine if, when, and how many children they want, they have more control over the circumstances in which their children are raised, whether they are able to attend school or whether the older children will have to leave school early to financially support the cost of the younger ones. “A couple having control over their own fertility really has potential to transform and break that generational entrapment of poverty,” said Dessalegn.
Access to contraception and reproductive health services is at the heart of MSI Reproductive Choices’ work. Photo: © Cyril Le Tourneur/Cartier Philanthropy
In order to continue serving women during the pandemic the NGO had to quickly adapt by providing clients with new ways of accessing information. In response, they’ve expanded their contact center network to 33 centers around the world where 300 agents fielded some 2.7 million calls in the past year alone, according to Dessalegn.
Banchiamlack Dessalegn, Africa director for MSI Reproductive Choices, explains the benefits of investing in safe reproductive health.
With many women lacking a private space to discuss their sexual health during lockdowns, MSI Reproductive Choices also found that more women were seeking information and getting in touch through social media platforms, including WhatsApp and Facebook. Some 40% of the NGO’s inbound inquiries are now via social media messages versus 26% the previous year, explained Dessalegn.
The use of contraception is a deeply entrenched taboo in Senegal. In rural areas like the Louga region, less than 1 in 5 women use birth control. Photo: © Cyril Le Tourneur/Cartier Philanthropy
The organization’s programs also had to rapidly adapt, sometimes with only 24 hours’ notice of an impending lockdown, in order to ensure continued access to contraceptives, for example, by moving reproductive health supplies as close as possible to the last mile, before transport was restricted.
Access to contraception and reproductive health services is at the heart of MSI Reproductive Choices’ work. Photo: © Cyril Le Tourneur/Cartier Philanthropy
Access to contraception and reproductive health services is at the heart of MSI Reproductive Choices’ work. Photo: © Cyril Le Tourneur/Cartier Philanthropy
Access to contraception and reproductive health services is at the heart of MSI Reproductive Choices’ work. Photo: © Cyril Le Tourneur/Cartier Philanthropy
The use of contraception is a deeply entrenched taboo in Senegal. In rural areas like the Louga region, less than 1 in 5 women use birth control. Photo: © Cyril Le Tourneur/Cartier Philanthropy
The use of contraception is a deeply entrenched taboo in Senegal. In rural areas like the Louga region, less than 1 in 5 women use birth control. Photo: © Cyril Le Tourneur/Cartier Philanthropy
Strong minds, strong economies
The COVID-19 pandemic has also taken a toll on women’s mental health, as domestic violence increased and many found themselves losing jobs and income.
StrongMinds, a nonprofit treating depression in women and adolescents in low-income communities in sub-Saharan Africa, saw a big increase in anxiety and suicide cases as fear spread in communities. “People were asking themselves things like ‘Where are we going to get food?’ or ‘What is going to happen?’” explained Sharon Birungi, head of programs at StrongMinds Zambia.
Chilufya Chimbala, peer therapy program lead at StrongMinds, shares how talking therapy can help women to manage and overcome depression.
During the pandemic, the nonprofit wasn’t able to host its usual peer-to-peer therapy groups — normally consisting of 12 women — so instead, it quickly shifted to smaller teletherapy groups of up to five people as well as individual phone calls. “Teletherapy was a blessing in disguise because initially we were [only] in a few communities in Lusaka [the capital of Zambia], but with teletherapy we could reach anyone, anywhere,” she said.
StrongMinds has treated 160,000 individuals for depression in Zambia and Uganda since 2013.
80% of individuals are depression-free six months post-treatment.
StrongMinds’ core model is based on interpersonal psychotherapy for groups and in-person meetings, which continue to be the most important part of its programs. What makes the model scalable and effective is that the women who have gone through therapy often go on to become peer facilitators themselves. Chilufya Chimbala, a peer therapy program lead at StrongMinds, has seen firsthand how women who have passed through the eight sessions of group therapy have “graduated” to become volunteers and sometimes even run their own therapy groups. Even after the therapy programs have concluded, many groups continue to meet for mutual support.
She particularly remembers a woman named Taweelah whose husband had fallen sick, making the family lose its income and unable to keep their children in school. “From the first time she joined, she never missed a session,” said Chimbala. After receiving treatment, Taweelah started looking for medical help for her husband and has become a peer facilitator herself, leading therapy and supporting other women in her community.
Despite some 280 million people living with depression globally, treatment isn’t accessible in most low- and middle-income countries, where 75% of cases go untreated. And there’s an economic cost to depression too.
StrongMinds has seen a 16% increase in work attendance among the women it serves. “When women are severely depressed … they're actually very weak, sometimes they lose energy. Who wants to find a job when they're feeling like that?” said Chimbala.
The challenge with mental health is that some people don’t understand it very well, explained Birungi. The COVID-19 pandemic helped bring awareness to the issue, as people started to talk more openly about what they were going through.
“We are focusing on women and the most vulnerable communities because we believe that when we treat one woman, you're indirectly treating the community,” said Birungi.
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