Every year, nearly 700 million women access modern contraceptive methods, over 90 million give birth in a health facility, and tens of millions access safe abortion services in low- and middle-income countries (LMICs) all around the world. However, in the midst of this pandemic, bad policies and structural barriers may contribute to many people losing access to these essential services.

A Grim Picture

In order to get a clearer sense of the potential effects of the COVID-19 pandemic, a Guttmacher research team used data on sexual and reproductive health service provision from 132 LMICs, covering 1.6 billion women of reproductive age (aged 15–49), to estimate the impact of pandemic-related challenges on the provision of core services and subsequent health outcomes. These challenges include supplies, equipment and staff being diverted to other types of care; supply chain disruptions; women avoiding preventive care or choosing to deliver outside of facilities; and clinic closures.

The team estimated how sexual and reproductive health outcomes could change following only a modest decline of 10% in access to care. The implications are staggering in terms of needs left unserved, unintended pregnancies, unsafe abortions, and maternal and newborn deaths.

​These estimates are shocking, but the reality could be much worse if more than 10% of services are compromised or disrupted. Moreover, the scale of the impact could be many times greater in specific countries or regions, as the virus and the lack of effective response has and will hit harder in certain areas.

Disproportionately Devastating Fallout

When assessing the potential fallout laid out in these scenarios, we must pay special consideration to people who already faced structural and systemic barriers to care before the pandemic, because these inequities are exacerbated under the weight of a global crisis. It is well documented that denial or lack of access to sexual and reproductive health services, including safe abortion, is especially devastating for marginalized populations who are already dealing with legal, economic, social, cultural and logistical barriers to care.

Policies and relief efforts must address the specific needs of marginalized people and populations, including migrants, people living with HIV/AIDS, people in humanitarian settings, people with disabilities, people experiencing intimate partner violence, LGBTQ+ individuals, incarcerated people, people with low incomes, adolescents, racial, religious and ethnic minorities, and others.

The Moment to Act

Policymakers in LMICs and their partners can avert or mitigate this catastrophe if they take swift, decisive action. Here are some steps they should take: 

These actions would not only mitigate the impact of COVID-19 in the short-term but also provide benefits over the longer term, as innovations are adopted and institutionalized.

As the largest donor for sexual and reproductive health programs globally, the United States has a significant role to play in preventing this looming disaster.

Outbreaks are inevitable, but catastrophic losses for sexual and reproductive health are not. By learning from prior epidemics, putting in place critical resources and systems, and promoting sexual and reproductive health and rights, we can prevent health system disruptions that would have devastating, lasting impacts on individuals, families and the global community.