With the COVID-19 pandemic restricting access to health services, Indonesia has experienced setbacks in the progresses made in global commitments like the Nairobi Summit Statement, including the Three Zeros (Zero Maternal Deaths, Zero Unmet Need for Family Planning, and Zero Gender-based Violence and Harmful Practices). With creative and collaborative action, however, challenges in reproductive health can be overcome. 

The Impact of Pandemic on Reproductive Health

During the pandemic, essential health services, particularly reproductive health services, have been disrupted globally, including in Indonesia. A recent study that United Nations Population Fund (UNFPA) conducted with Avenir Health, Johns Hopkins University, and Victoria University estimated globally that within six months of lockdown, 47 million women in 114 countries will lose access to contraceptives, which will lead to around 7 million unintended pregnancies.

“Reduction in access to and utilization of essential maternal health services may translate to significant increases in the number of women who may suffer complications and die during pregnancy, childbirth and the postnatal period,” said Anjali Sen, the United Nations Population Fund (UNFPA) Indonesia Representative during the launch of the Knowledge Hub for Reproductive Health in November, a collaborative initiative by the Ministry of National Development Planning (BAPPENAS), UNFPA, and University of Indonesia’s Faculty of Public Health (FKMUI).

To find out how the COVID-19 pandemic and the subsequent government policy responses have affected reproductive health services, the Knowledge Hub for Reproductive Health has conducted a sentinel survey in nine locations selected based on epidemic zoning since May 2020, namely Jakarta, Surabaya, and Makassar in the Red Zone (the largest number of COVID-19 cases); Central Lombok, Lahat, and Balikpapan in the Yellow Zone; and West Aceh, Minahasa, and Manokwari in the Green Zone (the lowest number of COVID-19 cases). 

Facing Challenges with Innovations

The first phase of the survey found that key reproductive health indicators, such as antenatal care, institutional delivery, adolescent reproductive health, and contraceptives services and supplies have declined during the first phase of the pandemic in Indonesia (March-May 2020). In response, the Ministry of Health and the National Population and Family Planning Board (BKKBN) have worked on restoring the reproductive health services to normal by taking alternative approaches and mitigation measures. 

For example, to minimize the number of patients dropping out of their family planning programme, health facilities have provided sufficient personal protective equipment (PPEs) supplies for frontline health workers, particularly midwives, and improved distribution of contraceptives, pills or condoms through family planning field workers (PLKB). These approaches, along with other innovations like online consultations and health protocols to prevent COVID-19 transmission have proven to be effective in improving the coverage of reproductive health services. 

The result of the second phase of the survey (June-September 2020) showed improvements in reproductive health services indicators such as family planning services, antenatal care and post-delivery care visits. More than half (52%) of the 253 health facilities that became the respondents reported that patient visits for family planning services have resumed to normal. Although the current rate is still lower compared to the same period last year, the results are encouraging and demonstrating that it is possible to maintain the availability and accessibility of reproductive health services during this difficult time. 

The final phase of the survey, which has been conducted starting October this year to early January 2021, will summarize these findings and provide recommendations for relevant stakeholders, particularly the government of Indonesia, to ensure the accessibility of essential health services, including reproductive health services, in times of crisis.

The COVID-19 pandemic has not only taken lives, but also changed the way we deal with certain issues, including reproductive health. Amid challenges, there are always new opportunities for innovations. The survey and the progress made so far have shown that there are countless other ways for us to work and advocate for sexual and reproductive health and rights.  

Elvira Liyanto 

Maternal Health Programme Analyst

UNFPA Indonesia