The collapse of medical supply chains has been a catastrophe for women in developing countries. Lockdowns have made matters worse. When a mother of three, aged 27, missed her period in March, she felt her stomach sink with dread. She is a farmer in western Kenya; her husband is a motorcycle taxi driver. Together, they barely make enough to feed their family. Unable to care for another child, she visited a local health clinic, walking more than 3 miles to save the taxi fare. But the doctor told her that the abortion pills she needed were unavailable because of shortages caused by the pandemic.
Covid-19 has created delays and disruptions at every step of the supply chain that brings critical safe abortion medication and contraceptives from Asia to East Africa – halting factory production, delaying air and sea shipments, complicating customs approvals, and restricting in-country transport from seaports and airports to hospitals, pharmacies, and health care clinics. Lockdowns and curfews have added to the crisis, preventing women from travelling to clinics to get critical family planning and reproductive health care, and blocking service providers from conducting outreach in hard-to-access rural areas. Experts expect to see a rise in unintended pregnancies and unsafe abortions in a region where thousands of women already die each year due to restrictive abortion laws and lack of access to reproductive health care and contraception….
As manufacturing in Asian countries hit hard by Covid-19 stalled in the early months of this year, factories temporarily stopped producing critical raw materials for products such as .condoms and intrauterine devices, and medications including emergency contraceptive pills and medical abortion pills. The manufacturing shutdowns created temporary delays in filling orders and resulted in backlogs in supplying key reproductive health medications and commodities to countries around the world.
Severe lockdowns and restrictions on pharmaceutical exports in countries like India compounded the manufacturing delays. Even as some nations have recommenced production of critical commodities and medications, many of these goods still cannot leave their countries of origin.
India has gradually lifted its restrictions on shipping certain medications and medical devices, but there has been a three-fold increase in freight charges due to limited airline staff and flights for medications permitted to leave the country.
In Kenya, the port of Mombasa has been overwhelmed by staff shortages that are hindering the customs and regulatory approval of products… Once the products are cleared, they are loaded onto trucks, which bring them to distribution centers in Kenya and Uganda. But trucks also experience delays en route to their final destinations because, during the early weeks of Kenya’s nighttime curfew and a total lockdown in Uganda, the company needed to carry additional authorisation letters to pass through checkpoints. “Within the city and within the counties, they’re a little unclear about what essential services are,” Khalfan explained. “They say pharmacies are an essential service, so people can travel if you’re working with a pharmacy. But what about the product that’s in a truck?”…
The delays and price hikes mean that medical distributors, hospitals, and health care clinics across Kenya and Uganda are running out of essential medications… Lockdowns and restrictions on movement have added to the crisis, preventing women from travelling to clinics to get critical care and commodities and prohibiting outreach in hard-to-access rural areas. In Kenya, women and girls are facing rising prices due to restrictions on movement. Kenya’s matatus, small buses that are the primary mode of public transportation in the country, have been prohibited from carrying more than a few passengers at a time, so they’ve raises fares. Passengers must also wear masks.
Nelly Munyasia, head of the Reproductive Health Network Kenya, said that to spare the travel expenses, women and girls will choose to visit local unqualified providers passing themselves off as pharmacists and doctors, who often use coat hangers, bleach, or even crushed glass to try to terminate women’s pregnancies. Health care workers say they have already begun to see a rise in unwanted pregnancies and are predicting a correlated increase in unsafe abortions by as early as June.
SOURCE: Foreign Policy, by Neha Wadekar with Type Investigations, 4 May 2020 ; PHOTO: Matutu driver, Nairobi, 27 March 2020