This guidance was current as of early April 2020, but is subject to change as we gain more knowledge and experience in addressing COVID-19 and ensuring continuity of essential health services during this pandemic. Please check for updates and continue to share relevant experience.

GOAL

Maintenance of essential preventive, promotive, and curative sexual and reproductive health services in fragile and humanitarian settings during the COVID-19 epidemic threat and outbreak period

OBJECTIVE

Provide programmatic guidance for decision making on sexual and reproductive health, including maternal and newborn health services, in fragile and humanitarian settings in the face of threat or reality of COVID-19

FOCUS

Fragile and humanitarian settings

1. GENERAL GUIDANCE

Experience in past epidemics has shown that lack of access to essential health services and shut down of services unrelated to the epidemic response resulted in more deaths than those caused by the epidemic itself.

As the world tackles the COVID-19 pandemic, it is important to ensure that essential health services and operations continue to address the sexual and reproductive health (SRH) needs and rights of people living in humanitarian and fragile settings.

• First and foremost, with the understanding that the risks of adverse outcomes from medical complications outweigh the potential risks of COVID-19 transmission at health facilities, the availability of all critical services and supplies as defined by the Minimum Initial Services Package (MISP) for SRH must continue. This includes intrapartum care for all births, emergency obstetric and newborn care, post-abortion care, safe abortion care to the full extent of the law, contraception, clinical care for rape survivors, and prevention and treatment for HIV and other sexually-transmitted infections. A lead SRH organization should be identified to coordinate implementation of the MISP for SRH and to plan for comprehensive sexual and reproductive health services if not already in place. It is essential that SRH coordination is integrated with the broader pandemic response coordination.
• Comprehensive sexual and reproductive health services should be maintained as long as the system is not overstretched with COVID-19 case management. This includes all antenatal care, postnatal care, newborn care, breastfeeding support, family planning and contraception services, cervical cancer screening, and care for those experiencing intimate partner violence. These services should stay available to all who need them, including adolescents and other often marginalized populations such as people with disabilities, for as long as possible.

Reductions or modification in routine services should only be considered to (1) ensure support to the epidemic response and COVID-19 case management and/or (2) to avert undue exposure to risk of contracting the virus in a health facility during an epidemic outbreak and/or when community transmission has been confirmed. A lead SRH agency should be identified to coordinate all actors and plan to reestablish comprehensive services as soon as possible.

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