Community-Based Care: Combatting COVID-19’s Deadly Impact on Safe Abortion Access

During times of crisis, women’s reproductive health needs are often disregarded, and the COVID-19 pandemic is pushing many already-stretched health systems to breaking point.

At the same time, the need for sexual and reproductive health care—including safe abortion—does not just fall away. Yet, as COVID cases continue to rise globally, contraceptive and access to other safe abortion treatments are being deemed non-essential—specifically in low-income countries where women and girls need these resources the most.

Sia Sandi (right) is a midwife at Makeni Regional Hospital in Sierra Leone. (H6 Partners / Abbie Trayler-Smith)

Doctors Without Borders—also known as Médecins Sans Frontières (MSF)—an internal humanitarian organization, and Marie Stopes International (MSI), a provider of sexual and reproductive health services, hosted a briefing last week to discuss the how COVID-19 has created barriers to essential sexual and reproductive health care services around the world.

Based on their experience from previous humanitarian emergencies—such as the 2014 Ebola outbreak in West Africa—MSF and MSI fear the deadly consequences that occur when routine health care services are disrupted.

In fact, they say, these consequences can be even more deadly than the outbreak itself—since unsafe abortions themselves are a significant cause of maternal mortality and morbidity. And unsurprisingly, women and children are typically disproportionately affected by crises.

As such, MSF and MSI hope to expand self-managed and community-based care throughout the pandemic to counteract the lack of support within health care systems.

According to Dr. Manisha Kumar, head of MSF’s safe abortion care task force, MSF has performed self-managed models of care through midwives and nurses who provide aid while the women administer their own drugs and medications. Community outreach is necessary since clinics are closed.

“Self-care and community-based models have been successfully employed to increase access to a variety of life-saving health services, including treatment of malaria and HIV, especially for marginalized populations,” MSF reports.

Due to sheltering in place orders and clinic closures, many women and girls in low- and middle-income countries have limited to no access to safe care options. MSF reported that, out of desperation, women drank poison or used hangers or ink from pens in the uterus to self-inflict trauma and kill the baby.

The Guttmacher Institute also reports a COVID-related decline of services would mean an additional 15.4 million unintended pregnancies, over 3.3 million unsafe abortions and 28 000 maternal deaths.

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Yet, the briefing described how discussion on safe reproductive services has turned into a political issue, with U.S. governors “publicly categorizing abortion as non-essential and ordered or supported the cessation of services.”

In April, Ms. did a round-up of abortion restrictions by each state. However, this is becoming a global issue, with clinics around the world reporting nearly 80 percent of all services will be reduced.

While the future looks grim for access to quality and safe reproductive services, the briefing did shine a light on the many advocates calling for increased access to contraception and safe abortion care during the COVID-19 pandemic.


Ashley Lynn Priore—a social entrepreneur, writer, public servant and innovative speaker—is the founder, president and CEO of Queen's Gambit, a national nonprofit using chess as a catalyst for change. Ashley is the author of Let's Learn Chess! and is currently completing her undergraduate degree at the University of Pittsburgh.