Written by Pilar Montalvo, Senior Program Officer, Latin American Planned Parenthood Global Program
When Elena* first realized she was pregnant, her first reaction was fear. Not the jitters that many first-time parents experience — but real dread. Her domestic partner, who had forbidden her to use contraception, used drugs and was prone to violence and controlling behaviour. Furthermore, the pandemic raging outside their home on the outskirts of Lima, Peru had effectively trapped Elena, 24, with the person she fears most. Feeling anxious and isolated, she had no one to talk to and nowhere to go.
Elena’s situation is far from unique, as the pandemic has taken an alarming toll on Latin America, which in July surpassed the United States in confirmed deaths from COVID-19. Peru, which was early praised for its strict containment measures, as of Aug. 17 had 536,000 cases and more than 26,000 deaths and rising — a third after Brazil and Mexico in the region and among the highest in the world.
We know that women and girls are feeling the disproportionate burden of this crisis. The same travel restrictions aimed at limiting the spread of the virus are having a devastating impact on access to critical health services, including essential sexual and reproductive health services. The United Nations Population Fund (UNFPA) estimates that some 18 million women Across Latin America and the Caribbean, access to modern contraceptives will be lost due to strain on health systems and massive disruptions to family planning and supply chains.
In Peru, this translates into a projected increase of between 50,000 and 100,000 unplanned pregnancies between 2020 and 2021, according to UNFPA. Many of these women will choose abortion, which is legal in Peru only when a pregnancy threatens a woman’s health or life. Such limitations make secure access a challenge.
Intimate partner violence and violence against children and adolescents are also increasing as a result of the lockdown measures. About 1,200 women and girls have been reported missing in Peru since March and the government’s emergency hotline has received almost 68,000 calls reporting domestic or sexual violence against women, children and adolescents during the lockdown. The pandemic is also deepening existing social and economic inequalities between women, young people and vulnerable populations, such as indigenous communities, refugees, people with disabilities or those living in extreme poverty.
The cumulative impact of this erosion on health and human rights will take years, if not decades, to reverse unless we act now.
In my role as senior program manager for Planned Parenthood Global in Peru, I work every day alongside colleagues and community partners to protect women’s health and rights at all costs. While our work is not new, the pandemic has highlighted that we need to look beyond traditional health care models. Now is the time to embrace self-care in SRHR by empowering women and girls and building capacity outside of clinics and hospitals.
We cannot do this in a vacuum. We need to strengthen the enabling environment for self-care—by creating more supportive policies and regulations, training providers and pharmacists on how to facilitate self-care, and increasing access to the tools and resources people need to make the best decisions for themselves and their families.
While what counts as self-care varies from country to country, interventions that are increasingly being adopted around the world include, but are not limited to, self-testing for HIV, emergency oral contraception, self-injectable contraceptives, and self-administered abortion.
The World Health Organization (WHO) recognizes the power and potential of self-care in SRHR, as demonstrated by guidelines issued last year, and the inclusion of self-care interventions in them guidelines for basic health services during COVID-19. Among other key elements, the WHO highlights the potential of self-care to “create innovations in health, including by catalyzing digital and health approaches”. This emphasis on digital solutions and health (referring to the delivery of healthcare through mobile or wireless technology) is absolutely timely as we understand that healthcare as we know it is transforming.
With already weak health systems in Latin America now fully overwhelmed, Planned Parenthood Global is supporting the expansion of digital innovations in Latin America by working with long-standing partners such as OBVIOUSLYa Peruvian organization that uses technology and digital innovations to connect women to SRHR services and information.
Among other services, APROPO provides accurate information and referrals for women, especially those under 24 who have nowhere else to turn, connecting them to a multidisciplinary team of obstetricians, midwives, psychologists, social workers and reproductive health specialists. APROPO fields approximately 13,000 inquiries per month through digital platforms such as Facebook Messenger, WhatsApp, APROPO Chat Site Safe sexand a hotline that includes a “ChatBot” to provide information and referrals.
In today’s climate, APROPO’s emphasis on technology is needed more than ever. It empowers women to make their own health decisions at a time when face-to-face communication is difficult, telehealth is more accepted and professionals are rethinking who needs to see in person.
It is especially important that young women and teenagers understand what options are available to them, as they are often the ones who face the most stigma and discrimination from traditional providers. To that end, another Peruvian Planned Parenthood Global partner advocates, Red Interquorum (Red IQ), specifically focuses on ensuring that young women, adolescent girls and girls know their rights. Red IQ is run by young people who lead digital activism to draw attention to the numerous cases of young women and girls who have been forced to become pregnant—putting their health at risk—and to hold governments accountable for failing to protect their rights. Through activities such as the recent social media campaign #EsHoradeOtraHistoria (“it’s time for another history”), Red IQ is helping to change the national conversation around the rights of teenagers and girls by amplifying their own voices and experiences.
At their core, these initiatives are about harnessing the power of technology—whether it’s telehealth, health, or social media—to reach more people with essential health messages and services, and to promote their own bodily autonomy.
For Elena, this meant being able to message APROPO via WhatsApp after watching a short video they posted online. Elena received advice and guidance via telehealth as to what options were available to her and what legal rights she had. Eventually, given the impact of the pregnancy on her mental and physical health, Elena was able to access a therapeutic abortion. In addition to the information and referral she needed to make an informed decision about her pregnancy, Elena also contacted APROPO to discuss her options for escaping domestic violence. APROPO was able to refer her to a government-run women’s emergency center and she later called to say she was safe.
Planned Parenthood Global is proud to stand with these organizations that ensure women and girls like Elena always have a lifeline. While COVID-19 has brought countless challenges, it has also illuminated what is possible when old devices no longer serve our needs. We have seen how adaptability and acceptance of technology and innovation can provide a road map for navigating this crisis.
So are we ready for the digital revolution in sexual and reproductive health? COVID-19 has shown us that we may not have a choice.
*The name has been changed.
Pilar Montalvo, MS, is senior program officer for Planned Parenthood Global’s Latin America Program in Peru. Obstetrician, Pilar has labored with indigenous organizations and civil society on sexual and reproductive health programs in rural areas in Peru, Bolivia and Brazil. Part of the Wanka Nation of Peru, Pilar is also a member of the International Indigenous Peoples Secretariat on Sexuality and Human Rights and a leader in the International Indigenous Working Group on HIV and AIDS.
Please note that blog posts are not peer-reviewed and do not necessarily reflect the views of SRHM as an organization.
