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On being pregnant during a pandemic

Covid-19 Activism

WORDS: XIAN WARNER / 14.04.2020

As I write this, I am 36 years old and 33 weeks pregnant with my first child. A few weeks ago, within two days, my partner and I threw what we could into suitcases, paid four months of rent in advance, made arrangements with our employers to work remotely, picked up a ‘fit to fly’ letter from my empathetic doctor at Marie Stopes, said a rushed goodbye to our friends and Timorese family, and got on a plane from Dili to Darwin, landing just a few hours before the Australian government closed its borders to non-citizens in response to the COVID-19 pandemic. It was one of the most stressful weeks of my life.

WORDS: XIAN WARNER / 14.04.2020

A pink, cloudy sky with the silhoutte of an airplane flying in the middle and some leaves of palm trees showning in the right bottom
Illustrationt of a sitting pregnant women talking with a standing man

We are now safely in isolation at my parents’ house, with warmth, food, and a beautiful garden to take our minds off the crazy world outside. However, a swarm of unknowns still constantly buzzes around in the back of my mind.

All the birthing classes we’d booked and paid for months ago have been cancelled or moved online. The hospital we plan to give birth at has already reduced the number of allowable maternity support people down to one, meaning we can no longer have the support of the doula whom we hired to be our advocate and to help us navigate the complex Australian maternal health system. The government has recently announced that people over 70 should not go outside at all, so I have no idea when my parents will be able to meet their grandchild, or when we will be able to return to Timor-Leste to introduce this baby to the other half of its family. The evidence on whether pregnant people are at any higher risk of complications from COVID-19 is still unclear and will inevitably change as more data becomes available. Every day we are bombarded with alerts about the strain on the health system, making me wonder whether there will even be a hospital bed, doctors, or midwives for us to give birth in seven’s weeks’ time. And that’s if everything goes smoothly, and the baby and I don’t require any specialist or emergency care.

But, at the same time, my mind swings to my cousin-in-law in Timor, who is also due to give birth in the middle of the year. She couldn’t just jump on a plane to escape to Australia at the last minute, in case the pandemic decimates Timor-Leste’s already struggling healthcare system. Most pregnant people in the world couldn’t; let alone have enough of a cash buffer to pay rent in advance, have a job that was possible to do remotely, have a safe place to self-isolate…or have had the access to contraception and accurate information, and the freedom from coercive or abusive relationships, to decide to delay getting pregnant until an age or a period when their lives were stable enough to feasibly ride out the uncertainty of a crisis like COVID-19.

And this, really, is what worries me most. Prior to Coronavirus, access to sexual and reproductive health and rights was already extremely unequal around the world. Only a few months into this pandemic, the evidence is already mounting on how gendered discrimination and injustices are being exacerbated through the crisis and – as with so many tensions in the world – being played out onwomen and girl’s bodies:

The pandemic is already having a destructive effect on the global production and supply chains of contraceptives. The world’s largest condom and IUD factories have both had to shut down. Shipping and air freight routes have ground to a halt, meaning that, even where contraceptives are being produced, they are not reaching countries that need them. Even where products have been shipped, increased quarantine lengths due to concerns over the virus have delayed cargo from being released into local markets. Even when they are distributed to pharmacies and clinics, COVID-19 lockdown measures in many parts of the world make it difficult for women to access these.[1] Marie Stopes International has estimated that 9.5 million women and girls may lose access to critical sexual and reproductive health support this year, due to supply and service provision disruptions and lockdowns caused by the pandemic, resulting in around 3 million unintended pregnancies and 2.7 million unsafe abortions.

Data from China, France, the UK, and Australia is already showing increased rates – and new forms – of intimate partner violence within the context of the pandemic. Reports are emerging, for example, of abusive men restricting their partner’s access to soap and hand sanitiser or using Coronavirus as an excuse to further isolate their wives or girlfriends from contacting friends and family. Government restrictions on citizens’ mobility, to curb the spread of the virus, make it harder for women experiencing violence at home to access shelters, legal aid, or to escape to a relative’s house for the night.[2] Given we already know that forced sex and restriction of access to contraception are common features of abusive relationships, and combined with women’s current decreased access to sexual and reproductive health services due to COVID-19, the number of women and girls who get pregnant against their will is likely to rise over the coming year. Rates of incest can also be expected to increase. There are key lessons to be learned from the experiences of women with disabilities, many of whom have developed strategies for facing domestic violence within the context of isolation and confinement – but the world needs to acknowledge and listen to their expertise.[3]

As governments in...

Australia and the United States attempt to reduce the strain on their hospitals and clinics during the pandemic, whether abortions are considered ‘essential services’ is being called into question.[4] These discussions hint that we could see the excuse of the crisis being strategically used to scale back women’s hard-won sexual and reproductive health rights in many parts of the world.

In Sierra Leone, during the Ebola outbreak, there were more excess maternal and child deaths from obstetric complications than from Ebola itself.[5] In Uganda, there have already been reports of women and babies dying, as the Coronavirus-related ban on private transport has forced mothers to walk to the hospital in labour. Furthermore, as health resources get diverted to COVID-19, the pre- and post-natal support available to women, both in terms of facilities and medical staff, will be reduced. Women will also be less likely to go to clinics and hospitals for check-ups, for fear of contracting the virus – and, in places where the health system will struggle to set up effective quarantine measures, this fear will be well-founded. The less interaction that pregnant women have with healthcare professionals, however, the higher the risk of pregnancy-related complications. Current estimates suggest that there may be a additional 11,000 pregnancy-related deaths due to a reduction in services during the Coronavirus pandemic.

Access to adequate healthcare will be reduced for all women...

But will disproportionately impact female sex workers, women living with a disability [3], HIV positive,[6] and trans[7] women, who already experienced high rates of stigma and discrimination in the health sector prior to COVID-19, and who have specific healthcare needs that are unlikely to be met during this period of crisis.

As, due to all of these factors, the number of unplanned pregnancies starts to drastically rise over the coming months, this will have lasting detrimental impacts on women and girls’ educations and livelihoods around the world, long after schools have reopened, and national economies have stabilised.

I know that, as Australia and other high-income governments try to rescue their economies in the wake of this pandemic...

One of the first things to go will be the overseas development aid budget. And I don’t expect to see a significant public outcry from taxpayers when that happens, either – many of whom will, themselves, have been in financial uncertainty for months. However, additional cuts – with my tax dollars, by my government – to the already severely underfunded sexual and reproductive health rights sector of international aid will leave millions of people at risk of unwanted pregnancy, STIs, unsafe abortions, and maternal mortality. These won’t, primarily, be people who live in Australia or hold Australian passports, as I do, but their rights aren’t any different to mine. They are real people with real goals, responsibilities, and desires – just like me, just like you. Just like my cousin-in-law.

At the time of writing, Timor-Leste has had only six confirmed case of COVID-19 and no deaths...

The government has acted swiftly, particularly in comparison to many others, working with the WHO to shut borders, impose mandatory quarantine, and distribute clear public health messages. However, given the widespread lack of clean water and sanitation facilities, the large and multi-generational household structures, the high prevalence of people with pre-existing conditions, and the fact that – at last count – the country had just six respirators, it is likely that if the virus does start to spread in Timor-Leste, it will be fast and devastating. People my partner and I know personally will be affected, and some will die, not just from COVID-19, but from other health issues. Including, most likely, from pregnancy-related complications, from cervical and breast cancer that will go undetected during this time, and from domestic violence. Yes, this pandemic is a common battle every country in the world is facing, but the battleground isn’t even – it never was – and the reductions in overseas aid that will follow this crisis will further exacerbate those inequalities, particularly for women and girls.

So, as the gentle pirouettes in my belly wake me up each morning...

And I turn to scroll through the seemingly-endless notifications of new infection and death rates, alerts and restrictions on my phone, I can only hope that, for the sake of this bump in my belly and its to-be peers around the globe, the world that it emerges into in eight weeks’ time is one that has learned from this crisis to be more outward-looking and empathetic, rather than inward-looking and discriminatory.

For me, at least, the only type of navel-gazing I plan on doing in the coming months is this:

A womens' hand touching her pregnant belly with her toes showing at the back

References

[1] Purdy, Chris. ‘How will COVID-19 affect global access to contraceptives – and what can we do about it?’ presentation, Sexual and Reproductive Health Matters Webinar: “COVID-19: What implications for sexual and reproductive health and rights?” 27th March 2020; available at: http://www.srhm.org/news/covid-19-what-implications-for-sexual-and-reproductive-health-and-rights/

[2] Avni, Amin. ‘Understanding and addressing gender and violence against women in context of COVID-19’ presentation, Sexual and Reproductive Health Matters Webinar: “COVID-19: What implications for sexual and reproductive health and rights?” 27th March 2020; available at: http://www.srhm.org/news/covid-19-what-implications-for-sexual-and-reproductive-health-and-rights/

[3] Kiama, Lizzie. ‘Situating disability in the time of COVID-19’ presentation, Sexual and Reproductive Health Matters Webinar: “COVID-19: What implications for sexual and reproductive health and rights?” 27th March 2020; available at: http://www.srhm.org/news/covid-19-what-implications-for-sexual-and-reproductive-health-and-rights/

[4] Smith, Elizabeth. Remarks made during Sexual and Reproductive Health Matters Webinar: “COVID-19: What implications for sexual and reproductive health and rights?” 27th March 2020; available at: http://www.srhm.org/news/covid-19-what-implications-for-sexual-and-reproductive-health-and-rights/

[5] Church, Kathryn. Remarks made during Sexual and Reproductive Health Matters Webinar: “COVID-19: What implications for sexual and reproductive health and rights?” 27th March 2020; available at: http://www.srhm.org/news/covid-19-what-implications-for-sexual-and-reproductive-health-and-rights/

[6] Christie, Emily. ‘Rights in the time of COVID-19: Lessons from HIV for an effective, community-led response,’ presentation, Sexual and Reproductive Health Matters Webinar: “COVID-19: What implications for sexual and reproductive health and rights?” 27th March 2020; available at: http://www.srhm.org/news/covid-19-what-implications-for-sexual-and-reproductive-health-and-rights/

[7] Grinspan, Mauro Cabral. ‘Surviving while Trans. Human rights issues faced by trans people in the COVID pandemic,’ presentation, Sexual and Reproductive Health Matters Webinar: “COVID-19: What implications for sexual and reproductive health and rights?” 27th March 2020; available at: http://www.srhm.org/news/covid-19-what-implications-for-sexual-and-reproductive-health-and-rights/