Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1694818574717.pdf (Australia)
30 June, 2020 Committee Secretary Joint Standing Committee on Foreign Affairs, Defence and Trade PO Box 6021, Parliament House Canberra, ACT 2600 RE: INQUIRY INTO THE IMPLICATIONS OF THE COVID-19 PANDEMIC FOR AUSTRALIA’S FOREIGN AFFAIRS, DEFENCE AND TRADE.
To the Committee Membership, The International Consortium for Sexual and Reproductive Health and Rights (hereafter the Consortium) welcomes the opportunity to engage in the consultation for the Inquiry into the implications of the COVID-19 pandemic for Australia’s foreign affairs, defence and trade.

The Consortium is a partnership of 11 non-governmental organisations (NGOs) and academic institutes based in Australia.
Together, we draw on our collective experience and complementary expertise to champion universal access to sexual and reproductive health and rights (SRHR) as a key contributor to gender equality.

Our members work in over 160 countries, bringing together diverse technical, policy, programmatic and research expertise.
The Consortium has provided technical and advisory support to the Department of Foreign Affairs and Trade (DFAT) and the Australian Parliamentary Group for Population and Development since 2012 on a range of SRHR matters in foreign policy and development The Consortium commend the Australian Government’s inclusion of sexual and reproductive health and rights in its COVID-19 Development Response “Partnerships for Recovery”.
Sexual and reproductive health care has been recognised internationally as an essential health service that needs to remain available and accessible during crises to protect health and respect human rights.

The Consortium, therefore, urges the Australian Government to maintain and increase financial and technical support to neighbouring countries to ensure sexual and reproductive health and rights are upheld and strengthened at this crucial time.
Supporting our neighbours in responding to and recovering from the COVID-19 pandemic is not only a matter of health security but has social and economic implications that go beyond the immediate situation and directly impact Australia’s national interest.

The impact of COVID-19 on Sexual and Reproductive Health and Rights in the Pacific: 1.
Supporting a sustainable and recovering health system and SRHR workforce The COVID-19 pandemic has led to a rapid redirection of health services as countries prepare and respond.

In healthcare we have seen resource reallocation and re-prioritisation, decision-making based on fear with minimal evidence available to inform practice, transitions to telehealth and other remote contact and wide variations in country and regional guidance.
Sexual and reproductive health services have been particularly affected with some countries choosing to cease antenatal care or family planning programs due to staff or resource limitations and in efforts to reduce COVID-19 transmission.
Unfortunately, this focus on COVID-19 and associated task shifting has been at the detriment of sexual and reproductive health services and resulted in reduced access to contraception, STI and HIV testing and treatment, and psycho-social support and care for people living in the Indo-Pacific region.

Some of the largest providers of contraception globally have observed declining client numbers through the pandemic due to inaccessibility, reduced community engagement, or fears of infection.
In some instances, the latter has increased stigma towards health care providers and against clients1.
1 Church, K., Gassner,J., & Elliott, M. (2020) Reproductive health under COVID-19 – challenges of responding in a global crisis, Sexual and Reproductive Health Matters, 28:1, 1-3, DOI: 10.1080/26410397.2020.1773163 Inquiry into the implications of the COVID-19 pandemic for Australia’s foreign affairs, defence and tradeSubmission 31 Travel bans and border closures have contributed to supply chain issues and stock outs, with SRH commodities having been severely disrupted2.
The result is a lack or limited availability of essential sexual and reproductive health commodities and medicines.

Furthermore, the social and economic impact of physical distancing and lockdowns have prevented people from accessing sexual and reproductive services when they are available.

This is particularly the case where there is a cost for sexual and reproductive services or where people are required to travel to reach these services.
COVID-19 has exposed constraints and limitations in the wider health system, particularly in relation to sexual and reproductive health care.

For example, some health services have been unable to transition to remote contact or lack the infrastructure to adequately support physical distancing in outpatient clinics in the Indo-Pacific region.
The ISRHR Consortium calls upon the Australian Government to ensure that sexual and reproductive health services are prioritised and recognised as essential health care as countries begin to rebuild from the response as well as prepare for potential second waves.

2.

Those most vulnerable including women, girls, people living with disabilities experiencing the brunt of the impact of COVID-19 Vulnerable populations, particularly women and girls are disproportionately affected by the COVID-19 pandemic.
In the Pacific, women are often the primary care givers and represent the majority of front- line health workers.

Over 70% of the global health workforce are women3.

Not only have women been central to the COVID-19 response, the nature of public health emergencies often renders women and girls at increased risk of unmet contraceptive needs, unintended pregnancies and gender-based violence4.
Globally, it is anticipated that for every 3 months countries impose lock down measures, there will be an additional 15 million cases of intimate partner violence5.

Movement and travel restrictions as a result of the pandemic also disproportionately affect the most vulnerable.

With mobile outreach suspended or heavily restricted, women and girls in rural, marginalised communities are left with no alternatives.
They are also the least likely to access or be able to pay for pharmacy-supplied products, to access any form of telemedicine or to be able to travel further to towns to find care6.

Other marginalised or vulnerable populations are also at greater risk of poor physical and mental health due to reduced health services, such as, people living with disabilities and people living with HIV.
Health system strengthening is crucial to ensure all including the most vulnerable and marginalised populations have access to SRH services.
The ISRHR Consortium calls upon the Australian Government to prioritise meaningful engagement with community organisations, support social protection and promote universal health coverage to ensure essential SRHR services reach all who needs them so that health services genuinely engage with women, community members and healthcare providers so that care is responsive to the needs and preferences in all contexts and settings during COVID-19 and beyond.

2 UNFPA .
2 UNFPA .

UNFPA supplies COVID-19 update – 16 April 2020.

New York : United Nations Population Fund; 2020; [cited 2020 May 11].

Available from: https://www.unfpa.org/resources/unfpa-supplies-covid-19-update-16- april-2020 .

3 World Health Organisation.

Gender equity in the health workforce: Analysis of 104 countries, https://www.who.int/hrh/resources/gender_equity-health_workforce_analysis/en/.

2020, WHO, Geneva: Switzerland.


4 ASHM Blood Borne Virus, Sexual Health and COVID-19 Regional Advisory Group, The Covid-19 Pandemic and Sexual and reproductive health and Rights in the Pacific.

https://ashm.org.au/covid-19/regional/the-covid-19- pandemic-and-sexual-rep-rights-in-the-pacific/.

2020.

ASHM.

Sydney.


5 UNFPA, Impact of the COVID-19 Pandemic on Family Planning and Ending Gender-based Violence, Female Genital Mutilation and Child Marriage https://www.unfpa.org/sites/default/files/resource-pdf/COVID- 19_impact_brief_for_UNFPA_24_April_2020_1.pdf.

2020, UNFPA, Avenir Health, Johns Hopkins University, Victoria University Australia: New York.

6 Church et.al., 2020 Inquiry into the implications of the COVID-19 pandemic for Australia’s foreign affairs, defence and tradeSubmission 31 3.
An opportunity to ‘do things better’ Despite the upheaval, COVID-19 provides an extraordinary opportunity to reform health care services.

Adaptation of health services due to the COVID-19 pandemic has led to innovative methods of health service delivering including tele-health, multi-month drug dispensing and greater community-led responses7.
Community-led approaches and partnerships with local civil society actors are the most effective and far reaching, particularly among under-served populations such as people living with disabilities, men who have sex with men, sex workers and those living in remote communities.
Learning from and engaging in innovative approaches to health service delivery is likely to have positive economic and environmental impacts through reduced travel, easier access to sexual and reproductive services and greater community engagement, as well as promoting universal access to healthcare.

The ‘new normal’ for the healthcare system is yet to be determined, but it is clear that short-, medium- and long-term change is here to stay.
We need to examine these changes to ensure that future health services, particularly sexual and reproductive health services, are agile and resilient with the necessary organisational infrastructure, capacity and networks.
The ISRHR Consortium calls upon the Australian Government to support Indo-Pacific countries in supporting effective delivery of essential sexual and reproductive health services in the COVID-19 recovery and beyond through establishing partnerships with local organisations and technical partners to ensure efforts are responsive to local context and to build sustainable and resilient health systems and programs.
Yours sincerely, ASHM, Burnet Institute, CARE Australia, Family Planning NSW, International Planned Parenthood Federation, International Women’s Development Agency, Marie Stopes International Australia, Médecins Sans Frontières, Nossal Institute for Global Health, Plan Australia, Save the Children 7 Family Planning NSW.

The Value of NGOs in responding to Covid-19 in the Pacific Islands.

2020.

FPNSW.

Sydney.


(Unpublished) Inquiry into the implications of the COVID-19 pandemic for Australia’s foreign affairs, defence and tradeSubmission 31