The covid-19 pandemic has impacted our lives in many aspects. The pandemic has various negative sociosexual impacts on humankind. How the pandemic has impacted our reproductive health and hygiene?
The pandemic has changed our lives a lot. A lot of research has been going on as to the short and long-lasting impact of the pandemic on people’s reproductive health. Findings from experts around the world showed widespread losses in access to sexual and reproductive health information and services and increased concerns over gender-based violence.
From the social perspective, Covid-19 has various negative sociosexual impacts compared with previously emerging humanitarian crises. Restriction on human movement and activity has generally reduced access to clinical reproductive healthcare support and reproductive products, which has many negative social and reproductive/mental health-related repercussions. For example, restricted access to contraception especially in countries like India can increase the rate of unplanned pregnancy. Reports have shown that in South Asian countries, this has actually happened. As a result, the rate of pregnancy complications, unsafe abortions, postpartum depression and suicide has increased.
Moreover, there has been a lack of reproductive hygiene products during Covid times, such as male and female condoms. Hence, the rate of sexually transmitted infections such as Chlamydia and HIV has increased in the last year. More and more women with Sexually Transmitted infections have remained untreated as there has been a lack of sexual health clinics for treating these women during the Covid times. And these infections if left untreated can lead to disastrous effects such as severe pelvic infections, chronic pelvic pain, intractable vaginal discharge and Infertility.
There have been varied human experiences with viruses such as the Zika virus and the HIV virus. These viruses have had a lot of adverse effects on pregnant mothers and there is a high chance of vertical transmission of these viruses to the fetus in the womb. The behaviour of the SARS Cov 2 virus is much more unpredictable. The virus has not been seen to be definitively transferred in utero to the newborn.
Transplacental transmission of this virus is rare. However, there have been reports of transmission of the virus through infected body fluids at delivery. And transmission to the newborn deteriorates the health of the newborn and can pose a grave burden on the health care system. The limited extent of data regarding the maternal and fetal effects of Covid-19 infection especially for the first trimester provide little reassurance.
The pandemic posed an immediate dilemma for centres actively treating infertile couples with medically assisted reproduction (MAR) and Assisted Reproductive Technology (ART), including in vitro fertilization. Out of caution, several professional societies around the world recommended suspending therapy for infertility services initially in March 2020, 1 week after the World Health Organisation declared Covid-19 infection to be a pandemic.
All guidelines published by reproductive medicine societies at this time endorsed cessation of infertility services although some granted exemptions for exceptional circumstances, such as oocyte or sperm freezing procedures in patients about to undergo chemotherapy or radiation, that would likely deplete their gamete number. Reasons cited for these extraordinary measures included preventing possible complications of ART, possible virus-induced complications of pregnancy and concerns regarding potential vertical transmission to the fetus in the womb of Covid infected mothers.
Additional priorities included optimizing the allocation of critical health care resources and supportive policy for recommendations for social distancing. Subsequent advisories have refined the original recommendations. There is a reason why. Many infertile couples who were in the cycle of ART were denied these services. Most of the infertility clinics shut down during the start of the pandemic due to the instructions by the WHO, leading to these infertile couples losing their chance of having a baby. Now, the clinics have opened, and they are overburdened with couples on the waitlist for In vitro fertilization. Many clinics have reopened with staff shortages, which is affecting the quality of work done at these clinics.
Millions have been rendered jobless during the Covid-19 pandemic. Couples who were willing to spend a few lakhs of rupees at the infertility clinics to bring a baby home are now struggling to meet their household expenses. They do not have the finances to afford to bring a child into the world. More and more couples are remaining infertile and childless during the pandemic due to financial constraints.
The short term adverse effects have been a profound depression in these couples. More and more of these couples have visited mental health professionals during the pandemic for counselling and treatment. The long term effects of this problem are yet to be studied. However, this problem will pose a great challenge to reproductive health care in the near future. In future, the family life and family dynamics of these couples will be greatly affected.
On the one hand, we will have the lower socioeconomic populace exploding in numbers. On the other hand, people belonging to the higher socioeconomic strata will be burdened by the problem of infertility. Their population will keep falling in the future. This will create a gross societal and moral imbalance in the world in future.
The pandemic has affected the sexual life of couples greatly. Restriction in movement and loss of jobs has created a sense of insecurity in our lives. This insecurity has gnawed into the minds of couples. The fear of being affected by Covid and the financial burden has greatly affected the frequency and quality of sexual intercourse between partners.
An increasing number of couples are walking into the chambers of gynaecologists with the complaint of damaged sex life. This has affected their physical and mental well being as well. Studies have shown that lack of sex and a poor quality of sexual life has led to depression, lack of sleep, increased partner violence and marriage breakups. Infertility is another potential problem of a damaged sex life between partners.
Women’s reproductive health rights have also been greatly violated during the pandemic. Since the outbreak of Covid-19, emerging data and reports from those on the front lines, have shown that all types of violence against women and girls, particularly domestic violence, has intensified. This is the Shadow Pandemic growing amidst the Covid-19 crisis and we need a global collective effort to stop it.
As Covid-19 cases continue to strain health services, essential services such as domestic violence shelters and lifelines have reached their capacity. More and more male members are sitting at home without a job. Consequently, domestic violence has increased. However, NGOs all over the world are continuously fighting to protect women.
The pandemic is truly the worst of times. It has drained the healthcare system and has also greatly affected our sexual and reproductive health. We have to wait with patience to free ourselves from the clutch of the pandemic. Hope is the key to our health. And I am sure good times will prevail again.
(Poushali Sanyal is an obstetrician and gynecologist.)
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