This factsheet was developed for the 2021 Asia Pacific Forum on Sustainable Development (APFSD), by the Regional Civil Society Engagement Mechanism Asia Pacific (RCEM) Thematic Working Group on Gender. Sexuality and SRHR, which APA co-leads.
Overview Gender inequality, patriarchy, religious fundamentalism and increasing militarism limit the opportunities, available services and capabilities of nearly half of the population in Asia and the Pacific where women, girls and lesbian, gay, bisexual, transgender, intersex, queer, asexual, plus (LGBTIQA+) people face multiple levels of marginalization and constant threat of discrimination and/or violence. 53.8 million unintended pregnancies occur each year in Asia, of which nearly 65% end in abortion[1]
The COVID19 pandemic has greatly exacerbated underlying structural inequalities. Lockdowns have massively disrupted routine health services, including SRHR, leading to a rise in unintended pregnancies, increase in unsafe abortion, and increase in preventable maternal mortality across the region. In the Philippines, for example, a country with one of the most restriction abortion laws in the region, it is predicted that an extra 214,000 unplanned babies will be born in 2021[2] as a result of COVID lockdowns. Countries with severe restrictions on abortion are less likely to have implemented changes to SRHR delivery to mitigate the impact.
Many countries in the region have seen decreased access to and increased violations of SRHR during the pandemic. There has been widespread increases in domestic and gender based violence against LGBTIQ people and women as a result of lockdowns. According to UNFPA projections, COVID-19 could potentially result in an additional 13 million child marriages between 2020 and 2030 due to programmatic interruptions[3]. As the financial resources of families dwindle, adolescent girls are forced to marry at younger ages, contributing directly to school drop-out, early pregnancies, maternal morbidity and mortality, and a life of domestic servitude.
Women represent 80% of the nurse force in Southeast Asia and the Western Pacific. As women are disproportionately represented in the health and social services sectors, increasing their risk of exposure, as well as exposing them to workplace discrimination and having a detrimental impact on their SRH and psychological needs.
As the UN Secretary-General’s Call to Action on the response to the socio-economic impacts of COVID-19 points out “Governments must ensure the continued delivery of sexual reproductive health services, such as access to contraceptives without prescription during the crisis.”[4] Inequality in access to SRHR services, education and information frequently translates in inequalities of income, education, employment opportunities and overall health and well-being[5].
COVID-19 impacts on achieving the SDGs under review
Goal 1: No Poverty COVID-19 will dramatically increase the poverty rate for women and widen the gap between men and women who live in poverty - projections now point to an increase of 9.1 percent due to the pandemic and its fallout[6]. And women who are poor and marginalized face an even higher risk of COVID-19 transmission and fatalities, loss of livelihood, and increased violence.
Too many women, migrants, minority groups, LGBTIQA+ and non-binary folks, people with disabilities and other marginalized communities continue to face inadequate access to health services, water and sanitation, housing and shelter, forced evictions, unsafe transportation, lack of electricity, high levels of pollution, and discriminatory land tenure and ownership.
Goal 2: Zero Hunger In Asia Pacific, pervasive gender bias is a critical factor behind malnutrition and the undernourishment amongst women and girls, which directly impacts their sexual and reproductive health and rights (SRHR)[7]. Pregnant and lactating women, women of reproductive age, adolescent girls, and infants and young children who have specific nutritional and dietary needs are especially worse off during natural disasters, failed crops, climatic events and resulting food shortages, and often suffer increased levels of violence.
COVID-19 exacerbates discriminatory gender and social inequalities around food with adverse impacts on the nutritional status of women. Disruptions in food systems can limit the availability of and access to nutritious foods, increase food prices and/or reliance on cheap staples and nutrient-poor ultra-processed foods, affecting the quality of diets and nutritional status of women, girls and newborns.
Goal 3: Good Health and Wellbeing Lockdown measures in 2020 led to major disruptions in the contraceptive supply chain as big manufacturers in Asia had to halt production/operate at a limited capacity. The pace of progress on the percentage of girls and women with access to family planning in the Asia region was already slow, 64.5% in 2000 to 72.4% in 2018. It was estimated that at this pace of change only 76% of women and girls would have access to contraceptive services.[8] This is likely to be further impacted due to supply chain disruptions.
At least 32 women died due to related birth complications in the first two months of lockdown in Nepal. This is an almost 200% increase in the maternal mortality ratio since the lockdown began, compared to 80 cases in the previous fiscal year. The antenatal and postnatal visits by pregnant women have been halted due to no public transportation.[9]
Goal 8: Decent Work Care work and other essential work are crucial to the survival and well-being of human society during the pandemic, but they are often devalued. In the majority of Asian countries (56%), the percentage of women workers in the informal economy exceeds men[10]. Their overrepresentation in the informal sector has meant almost no access to social protection systems and benefits, and remedy for vocational hazards
Women in Asia and the Pacific work the longest hours in the world. On average, women in the region work 7.7 hours daily, of which only 3.3 hours are paid, and the rest are dedicated to unpaid care work. In Asia and the Pacific, around 426 million people belonging to the working age population cite unpaid care responsibilities as one of the main reasons for staying out of the labour market, and 80% of the unpaid care work in the region is done by women.The disproportionate burden of unpaid care work acts as a barriers to women's participation in the labor force and continues to be the unremunerated contributions to the economy[11].
Women are disproportionately represented in the health and social services sectors. This increase their risk of exposure to COVID-19, as well as the workplace discrimination and have a detrimental impact on their SRH and psychological needs.
Goal 10: Inequality Women, transgender people, sex workers and other groups that are over-represented in the informal sector have been hit especially hard by the impact of the pandemic on livelihoods, lacking access to social protection mechanisms. Government imposed mobility control orders have a devastating effect on migrants in particular Beyond economic impacts, migrants face discrmination and blame for spreading the virus across borders, have been prevented from accessing SRHR services, and in some cases unable to access ARVs. In informal settlements in Myanmar, for example, establishing effective community services including SRHR services to assist victims of domestic violence has been especially difficult due to xenophobia and a lack of support networks.
Goal 12 Responsible Consumption Unsustainable biomass and fossil fuel consumption disproportionately affects women and girls. The burning of wood, animal waste and coal for heating, cooking, and lighting is responsible for about 2.8 million deaths worldwide, affecting mostly women and children[12].Physiological changes during pregnancy, such as a 40% increase in the amount of air pregnant women breathe per minute as well as a 50% increase in how hard their hearts work, can make pregnant women particularly vulnerable to pollutants and may cause preterm birth and low birthweight[13]
Exposure to potentially harmful chemicals is also a health concern and evidence shows that endocrine-disrupting chemicals (EDCs)[14] in the environment affects both male and female fertility, and can be passed from mothers to children through the placenta and breast milk.[15].
Goal 13: Climate Action Climate change disproportionately affects the health of women and girls. According to WHO, pregnant women face poorer maternal health due to risks brought about by climate change[16]. Furthermore, the absence of clean water makes menstrual hygiene management a great burden for women and girls and can lead to health complications and other unintended consequences like school dropouts.
In the Pacific, access to investment funds for green technology, and the adverse impacts of climate change directly impact women’s SRHR and contribute to unwanted pregnancies, maternal mortality, and reduced access to education and health services[17].
COVID19 has exacerbated these health and social impacts of climate change. A more forward looking, robust and inclusive response to climate change can have positive effects on public health, including the health of the women and girls.
Goal 16 Peace and Justice Without reduced inequality, violence, injustice and corruption, it will be impossible to make the necessary progress on global agendas such as education, health, gender equality, and climate change. In Myanmar, a direct nexus has been found between the lack of gender equality within the country and within ethnic communities, and the prevalence of sexual and gender-based violence (SGBV)[18]. Ethnic women and girls such as the Rohingya are doubly victimised: as women and girls and as members of ethnic minority communities.
During COVID19 lockdowns, evidence from 8 Asian countries shows that internet searches related to VAW and help-seeking rose significantly, underscoring evidence of the particular dangers faced by women confined to homes or restricted in their movements[19]. All women and marginalized groups need to be able to turn to fair, effective institutions to access justice and essential services.
Goal 17 Partnerships COVID19 shows just how imperative strong equitable global partnerships are, as the pandemic has further exposed the world’s inequalities and the injustices caused by neoliberal globalization and flawed macroeconomic governance. Even now countries are taking nationalistic approaches to vaccination and leverage their privilege and economic domination to secure vaccine doses. It is a deep injustice that nine out of 10 people in 70 low-income countries are unlikely to be vaccinated against COVID-19 next year because the majority of the most promising vaccines have been bought up by countries of the global North. This will have a disproportionate impact women and girls, LGBTIQ and marginalized groups in developing countries, as gender discrmination manifests on every level as a barrier to accessing vaccinations[20].
Stories of resilience and recovery
● Experience from the Asia Pacific region shows the well-funded robust public health system is critical to combatting the pandemic, this meand addressing the needs of marginalized groups such as female migrants, sex workers, LGBTIQ, Women living with HIV and young people, amongst others.
● The pandemic has strengthened the agenda and the call for intersectional and disaggregated data. Even before COVID-19, advocates demanded for expansion of the current framework of data collection to generate disaggregated data. Disaggregated data where available can be used for devising appropriate response policies and programmes that address diverse needs.
● Countries with strong feminist leadership and women represented in positions of leadership have seen a more gender equitable recovery.
● Leveraging technology to support the dissemination of information and services on SRH. Digital and telehealth interventions have emerged as an effective approach to providing a range of SRH services including access to medical abortion, to women, gender diverse groups and marginalised populations.
● Increased support for grassroots movements as they are best placed to be first responders in crisis situations
● Adapting existing and/or developing national SRH policies to include abortion-related and contraceptive-related self-care interventions.
● Digital health interventions such as e-learning courses on a range of topics covering cervical screening, contraception, STIs and general sexual and reproductive health for teachers, nurses, midwives and doctors; sexuality education courses suitable for teachers and support staff, guidance counsellors, school nurses, carers, social workers and others working with young people;
● Use of messaging technology to reach key affected populations to provide information including, regular updates; frequently asked questions; link to online educational resources and location of clinics
Our Demands
● Revitalise partnership for gender equality in the region and facilitate country to country and regional cooperation to achieve gender equality. Ensure allocation of adequate budget to gender equality laws, policies and programme design within the nation SDG implementation plans.
● All political responses, whether aimed at domestic or international action, must be people-centred and gender transformative, guarantee the right to health including SRHR, and uphold the commitments contained in the 2019 Political Declaration on Universal Health Coverage (UHC). Health systems must include fully resourced SRHR, to ensure resiliency,and mitigate the impact of future epidemiological outbreaks.
● To end the pandemic requires swift and justice distribution of vaccines and to fill the gap between wealthy Northern nations and developing countries in the Global South. The pharmaceutical companies should share their data, technology and knowledge for vaccine manufacturing via the WHO COVID 19 Technology Access Pool (C-TAP). The governments should support the TRIPS Waiver currently being debated at the WTO which, if successfully passed, would temporarily suspend IP restrictions on COVID 19 related technologies and treatments. In turn, this would allow manufacturing of vaccines on a larger scale, expanding availability and accessibility.
● Governments must include SRHR as an essential service. Emergency preparedness plans must guarantee access to essential SRHR services, including CSE provision and SGBV services and prevention.
● Support and invest in an assessment on the impact of COVID-19 on gender equality laws, policy and programme implementation, and develop plans to bounce back. For gender responsive sustainable development, additional resources on gender equality and sustainable financing should be mobilised.
● Ensure the inclusion of civil society and community groups in the international and national response committees to emergencies and pandemics
● Ensure that the most marginalised groups have access to health services, including SRHR. Governments should work with CS and recognize innovative approaches that empower marginalized communities to take informed decisions over their own health, This includes self-care protocols and the use of telemedicine for the SRHR, including access to medical abortion and post abortion care; online resources, and mobile applications for the provision of CSE
● Social safety nets should be gender-responsive and facilitate women’s access to health, healthy diets, nutrition and positive nutrition practices. Prioritize women with increased nutritional and health vulnerabilities including adolescent girls, and those who are underweight, overweight, anemic, hypertensive, live with HIV or noncommunicable disease (including gestational diabetes), and those in the third trimester of pregnancy
● Ensure gender-equitable participation, access to information, and influence in planning and decision-making processes around climate change, in particular inclusion of indigenous and rural women. Ensure that SRHR is incorporated into National Adaptation Plans (NAPs)
● Government and private service providers should boost their online reach and engagement with survivors of gender based and sexual violence,.
● Governments should use an intersectional and gender-responsive approach to address the impact of the COVID-19 crisis on women, adolescents and girls, as well as addressing the needs of women health workers.
● Ensure strong evidence bases that fill research gaps on SRHR and gender are used to inform decisions, policies and programmes at all levels. Recognize the contribution of CS generated evidence, including qualitative research. Invest in intersectional and gender-disaggregated data to guide response and recovery efforts, keeping privacy and security in mind for person-level data.
● Stigmatisation curbs people’s sexual and reproductive health accessibility rights - elimination of stigma and discrimination should be made a priority. Even in countries with a strong legal framework, it is not fully implemented, and as a consequence not reaching the grassroots levels
[1] Guttmacher Institute (2018). Abortion in Asia: Fact sheet.
[2] According to projections by the University of the Philippines Population Institute and the United Nations Population Fund. In BBC. 23 December 2020. Covid-19: The Philippines and its lockdown baby boom. Available at: https://www.bbc.com/news/world-asia-55299912
[3] UNFPA (2020) Impact of the COVID-19 Pandemic on Family Planning and Ending Gender-based Violence, Female Genital Mutilation and Child Marriage see: https://www.unfpa.org/press/new-unfpa-projections-predict-calamitous-impact-womens-health-covid-19-pandemic-continues
[4] United Nations Secretary-General report entitled ‘Shared responsibility, global solidarity: Responding to the socio-economic impacts of COVID-19’, March 2020.
[5] APA/RCEM (2020) Human Well-being and Capabilities and Linkages with Gender and SRHR. see: https://www.asiapacificalliance.org/our-publications/human-well-being-and-capabilities-and-linkages-gender-and-srhr
[6] UN Women (2020) From Insights to Action: Gender Equality in the wake of COVID-19, available at: https://www.unwomen.org/-/media/headquarters/attachments/sections/library/publications/2020/gender-equality-in-the-wake-of-covid-19-en.pdf?la=en&vs=5142
[7] Asia Development Bank (2013). Food security in Asia and the Pacific.
[8]https://arrow.org.my/publication/affirming-rights-accelerating-progress-and-amplifying-action-monitoring-sdg5-in-asia-pacific/
[9] The Kathmandu Post, Kathmandu. May 27, 2020
https://kathmandupost.com/national/2020/05/27/a-200-percent-increase-in-maternal-mortality-since-the-lockdown-began
[10] ILO/WEIGO (2019). Women and Men in the Informal Economy: A Statistical Brief.
[11]See: https://arrow.org.my/publication/affirming-rights-accelerating-progress-and-amplifying-action-monitoring-sdg5-in-asia-pacific/
[12] UNDESA (2018). Accelerating SDG7: Achievement Policy Briefs in Support of the First SDG 7 Review at the UN High-Level Political Forum, 2018.
[13] See: https://www.figo.org/covid-19-pollution-and-health.
[14] EDCs are typically man-made and are found in materials such as pesticides, metals, food additives and personal care products
[15] https://www.figo.org/news/environmental-factors-facing-womens-health
[16] WHO (2014). Gender, climate change and health. Available at: https://bit.ly/35FRgXn
[17] APA and RCEM factsheet. (2020) Energy Decarbonization and Linkages with Gender and SRHR, see: https://www.asiapacificalliance.org/our-publications/energy-decarbonization-and-linkages-gender-and-srhr
[18] Sexual and gender-based violence in Myanmar and the gendered impact of its ethnic conflicts* Human Rights Council forty second session. A/HRC/42/CRP.4
[19] UNFPA (2021) COVID-19 and Violence against Women: The evidence behind the talk. See : UNFPA Asiapacific | COVID-19 and Violence against Women: The evidence behind the talk
[20] See for example: https://www.researchgate.net/publication/281553089_Gender_Determinants_of_Vaccination_Status_in_Children_Evidence_from_a_Meta-Ethnographic_Systematic_Review
|
|
