Access to Sexual Reproductive Health & Rights (SRHR) During the COVID-19 era

ACCESS TO SEXUAL REPRODUCTIVE HEALTH RIGHTS (SRHR) SERVICES DURING THE COVID-19 ERA REPORT

May 2020

TABLE OF CONTENTS BACKGROUND

4

OBJECTIVE OF SURVEY

5

LIMITATIONS OF THE SURVEY SCOPE OF THE SURVEY

METHODOLOGY

6

DATA COLLECTION, CLEANING AND ANALYSIS

SURVEY FINDINGS

7

INTRODUCTION RESPONDENTS’ DEMOGRAPHICS

RECOMMENDATIONS AND CALLS TO ACTION CONCLUSION

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ACCESS TO SEXUAL REPRODUCTIVE HEALTH RIGHTS (SRHR) SERVICES DURING THE COVID-19 ERA

Background

R

each A Hand Uganda (RAHU), is youthfocused organisation working to empower young people with a focus on Sexual Reproductive Health and Rights (SRHR). RAHU like any other SRHR stakeholder has been appalled by the social, economic and health challenges currently faced by young people in the wake of the recent government social distancing and travel restrictions aimed at curbing the spread of COVID-19.

Since the beginning of the year, the world has been invaded by the novel Corona Virus (COVID-19) which started in the city of Wuhan, China in January 2020. On 11th of March 2020, the World Health Organization (WHO) declared the COVID-19 as a Pandemic. On 21st March 2020, Uganda confirmed its first case of COVID-19 and as of 20th May 2020, the total number of confirmed cases had grown to 260 (with 63 recoveries and zero deaths).

To control the spread of the pandemic, the president of the Republic of Uganda, His Excellency Yoweri Kaguta Museveni announced several restrictive measures which included a nationwide lockdown for 14 days effective 30th March 2020. This initial lockdown was further extended to an additional 21 days on the 14th April 2020. On 4th May, the lockdown was extended by 14 days. In preparation to lift some restrictions, on 18th May 2020, the president extended the lockdown for 14 days to ensure that all the masses receive free government facemasks as a condition for accessing public places.

As a result of the current restrictions, young people have stayed home with limited /or no access to SRHR services and this prompted RAHU to conduct a survey.

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ACCESS TO SEXUAL REPRODUCTIVE HEALTH RIGHTS (SRHR) SERVICES DURING THE COVID-19 ERA

Objective of the survey The survey sought to establish how young people are coping with the current COVID-19 restrictions and the extent to which the measures have affected their access to SRHR services.

The results aim to inform RAHU’s current program interventions and ensure that relevant stakeholders are engaged to address the SRHR needs of young people during the COVID-19 times.

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ACCESS TO SEXUAL REPRODUCTIVE HEALTH RIGHTS (SRHR) SERVICES DURING THE COVID-19 ERA

LIMITATIONS OF THE SURVEY Based on the Ministry of Health (MoH) Social distancing guidelines, and the government travel restrictions, data collection was conducted via online platforms (Twitter, Facebook, WhatsApp, and LinkedIn). The survey, therefore, might not have captured responses and feedback from those with no/or limited access to mobile devices and computer resources. However, given COVID-19 is a national emergency affecting everyone, all survey participants were eligible.

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ACCESS TO SEXUAL REPRODUCTIVE HEALTH RIGHTS (SRHR) SERVICES DURING THE COVID-19 ERA

SCOPE OF THE SURVEY The survey focused on access to SRHR services (especially Family Planning) by young people at the national level, during the COVID-19 lockdown for the period – March to April 2020.

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ACCESS TO SEXUAL REPRODUCTIVE HEALTH RIGHTS (SRHR) SERVICES DURING THE COVID-19 ERA

Methodology The survey employed quantitative data collection methods and a short questionnaire with closeended questions was developed and sent out to all young people across the country. Given the current nature of the nation-wide restrictions, young people aged 16 and over were eligible to participate in the survey. A total of 219 responses were received representing an 80% response rate. The survey focused on the current travel restrictions and access to young people’s SRHR services especially Family Planning.

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ACCESS TO SEXUAL REPRODUCTIVE HEALTH RIGHTS (SRHR) SERVICES DURING THE COVID-19 ERA

DATA COLLECTION, CLEANING AND ANALYSIS An online questionnaire was designed in the Google Forms App. The tool was pretested and validated by our Monitoring and Evaluation Team. The tool was shared with young people via the social media platforms such as Facebook, Twitter, WhatsApp, and LinkedIn which have a reach of over 50,000 followers. The 10-minute questionnaire was filled by the respondents and submitted via the google forms where results were exported into MS Excel for data cleaning. Out of the 219 responses, only 210 were valid. The invalid questionnaires came from incomplete responses, non-residents.

Additionally, participants who declined to take part in the survey were also removed during the data cleaning process. Data analysis was done using SPSS (Statistical Package for the Social Sciences) that ensures accuracy of results.

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ACCESS TO SEXUAL REPRODUCTIVE HEALTH RIGHTS (SRHR) SERVICES DURING THE COVID-19 ERA

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Survey findings INTRODUCTION

This section presents results from the survey focusing on the demographics, access to SRHR services especially Family Planning and how young people are coping with the current challenges caused by the lockdown;

RESPONDENTS’ DEMOGRAPHICS The table below(n=210) indicates that in terms of gender, male participants comprised 60% as compared to their female 40% counterpart. Half (50%) of participants were between the ages of 20-24 and only 3% were over 40 years of age. At the time of the survey, most participants were already employed (26%), were engaged in some kind of professional work (20%), and students (26%) constituted the biggest proportion and only 11% were not engaged in any form of gainful employment. More than 3 quarters (82%) were not married. The demographics also indicate that more than a half 57% (120) respondents were in the central region as compared to other regions; Eastern 9% (19), Western 15% (31) and Northern 19% (40). This signifies the fact that these groups have access to the mobile devices and computer resources.

Variables

Central

Eastern

Northern

Western

Total

Overall

120

19

40

31

210

49% 51%

26% 74%

25% 75%

32% 68%

40% 60%

3% 43% 53% 2% 1%

5% 53% 42% 0% 0%

0% 63% 28% 10% 0%

3% 58% 39% 0% 0%

2% 50% 45% 3% 0%

5% 32% 20% 37% 7%

16% 11% 26% 21% 26%

5% 10% 18% 50% 18%

10% 35% 16% 26% 13%

7% 26% 20% 36% 11%

16% 0% 84%

26% 0% 74%

18% 3% 80%

16% 3% 81%

17% 1% 82%

Gender Female Male Age 15-19 20-24 25-39 40-60 61 + Occupation Business owner Employment Profession Student Unemployed Marital Status Married Separated Single

ACCESS TO SEXUAL REPRODUCTIVE HEALTH RIGHTS (SRHR) SERVICES DURING THE COVID-19 ERA

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Respondents with disability

The figure below indicates that overall, 8% participants had some kind of disability, of which, 6% were males as compared to their female 2% counterparts.

Disability disaggregated by Gender ( n = 210 )

# Respondents

120

114

100 80

80

60 40 20

12

4

0 No

Yes Disability Female

Female

ACCESS TO SEXUAL REPRODUCTIVE HEALTH RIGHTS (SRHR) SERVICES DURING THE COVID-19 ERA

HAVE YOU OR A PERSON CLOSE TO YOU FACED GENDER BASED VIOLENCE DURING THIS COVID-19?, AND IF YES, WHAT FORM OF GENDER BASED VIOLENCE HAVE YOU WITNESSED? The survey sought if participants have faced any form of Gender-Violence during this COVID-19 quarantine period and results indicate that; Almost half 45%(210) reported to have faced some form of GBV as compared to the 55% (210). Participants were further asked about the form of GBV and they indicated; domestic violence (60%), sexual harassment 10%, police brutality 20%, and rape, acid attack, and forms accounted for 10%. This is because most people are living together for many hours during the and therefore accounting for an increased number of GBV cases. There is a need by the government and local organisations to devise mechanisms for addressing GBV related issues as well as a plan for the easing of the lockdown which largely accounts to the increases of GBV.

Gender-based Violence (n=210) 60%

55% 45%

%Percentage

50% 40% 30% 20% 10% 0% No

Yes Faced GBV

12

ACCESS TO SEXUAL REPRODUCTIVE HEALTH RIGHTS (SRHR) SERVICES DURING THE COVID-19 ERA

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HOW IS THE LOCKDOWN DUE TO COVID-19 AFFECTING YOUR ACCESS TO SEXUAL REPRODUCTIVE HEALTH AND RIGHTS (SHRH) INFORMATION AND SERVICES? Results indicate that almost all (90%) of respondents reported that the prevailing government travel restrictions do not enable them to travel to health facilities to access SRHR services. 8% reported that due to the current social distancing and travel restrictions, most health facilities have run short of health personnels as they also find it difficult to walk long distances to work. Although LC1 leaders and RDCs(Resident District Commissioners) have the responsibility to provide travel forms to the masses, the process to obtain them is prohibitively slow. There is therefore a need for the government to not only lift some targeted measures to enable young people access HC but also support the health personnels by easing their movement for them to be in position to serve the young people.

How the lockdown has affected Access to SRHR Services (n=210)

Travel restrictions limiting access to health facilities

91%

Scarcity of health commodities

Other (No internet)

8%

1%

0%

20%

40%

60%

80%

100%

ACCESS TO SEXUAL REPRODUCTIVE HEALTH RIGHTS (SRHR) SERVICES DURING THE COVID-19 ERA

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HOW ARE YOU CURRENTLY ACCESSING SRHR INFORMATION DURING THIS COVID-19?

According to the findings, less than 3 quarters 70% (210) of respondents are using social media platforms such as Facebook, Twitter and WhatsApp, among others; to access SRHR information, 16% are using radio, and only 2% are using television channels. This represents the fact that the internet and social media are increasingly the most accessible means young people can access SRHR information. There’s therefore a need by the government and other development partners to promote and make the internet accessible to most young people especially in the peri-urban setting by for example removing prohibitive levies especially the OTT so that more SRHR information can reach young people.

Access to SRHR Information (n=210) 80%

70%

70%

%Channel usage

60% 50% 40% 30% 16%

20% 10% 0%

2% Television

5% Friend

7%

Print Media

Information Channels

Radio

Social Media

ACCESS TO SEXUAL REPRODUCTIVE HEALTH RIGHTS (SRHR) SERVICES DURING THE COVID-19 ERA

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WHAT SEXUAL REPRODUCTIVE HEALTH SERVICES HAVEN’T BEEN MET DUE TO GOVERNMENT TRAVEL RESTRICTIONS RELATED TO COVID-19?

Results indicate that more than a half(68%) of respondents reported an unmet need for contraceptive (21%), psycho-social support and counselling (20%) and SRH information( 17%). The lockdown has prevented people from easily moving to health facilities to access services and this has left a bigger gap in service delivery. As a consequence, there’s a possibility that most people will end up with many unplanned pregnancies, and an increase in domestic violence caused by long hours of interaction in homes. There’s therefore a need to create mobile delivery mechanisms to ensure that critical services and FP commodities can reach all parts of the population, especially the young people so that we can avert a possible “population rise”.

Unmet SRHR Needs due to COVID-19 (n=210) Contraceptives Psycho-social support/counselling

21% 20%

SRHR information

17%

ARVs & ART

12%

Menstrual health services

11%

Antenatal

10%

Nutritional services

9%

ACCESS TO SEXUAL REPRODUCTIVE HEALTH RIGHTS (SRHR) SERVICES DURING THE COVID-19 ERA

HOW ARE YOU CURRENTLY ACCESSING SRHR INFORMATION DURING THIS COVID-19?

Results indicate that 60% of the respondents are not using any form of contraception at the time of the survey, and only 40% are using a contraception method.

This represents a significant gap especially since all people are staying in their homes. If nothing is done to revert the current trend, then Uganda could experience a population explosion. and so there is an urgent need by the government and all the relevant partners to address the Unmet need for FP in this COVID-19 situation by ensuring that people can reliably access both short-term and long-term FP options.

Currently on FP Methods (n=210) 70%

60%

60% 50%

40%

40% 30% 20% 10% 0% No

Yes

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ACCESS TO SEXUAL REPRODUCTIVE HEALTH RIGHTS (SRHR) SERVICES DURING THE COVID-19 ERA

IF YES, WHAT FAMILY PLANNING METHODS ARE YOU CURRENTLY USING? The figure below indicates that out of the 114 respondents who reported to be using at least one FP method(s), 79%(90) are using short-term family planning methods such as; Male and female condoms 53% (60), Emergency pills 16%(18), and Depo provera,, Sayana press, Combined oral contraception (COC) -microgynon (pills with different colours), Progesterone only pills (POP)- Microlut (pills with the same color) all combined constituted 11% of the short-term contraceptive. On the other hand, 20% (23) are using long-term FP methods, such as, Implanon 3yrs 7%(8), Intrauterine Contraceptive Device (IUCD or ICD) 12% (14), and Jadelle (5 years) 1%(1), and 1 percent is using permanent FP methods; Bilateral Tubal Ligation (BTL). This indicates that short-term FP options are more popular among the respondents as compared to the permanent methods. There’s therefore need to ensure that more short-term options are readily available to the young people to avert unplanned pregnancies in their families.

Family Planning Methods (n=114) 90% 79%

80% 70%

% FP Uptake

60% 50% 40% 30%

20%

20% 10%

0%

0% Permanent FP

Long-term FP

Family Planning Category

Short-term FP

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ACCESS TO SEXUAL REPRODUCTIVE HEALTH RIGHTS (SRHR) SERVICES DURING THE COVID-19 ERA

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WHAT ARE YOUR MAIN HEALTH NEEDS AT THIS MOMENT? Results indicated that 34% (210) of respondents reported that sex education 18% (210), Family Planning 10% (210) and HIV services 6% (210) were their main health needs. However, despite the shortage of SRHR services and commodities in communities, 35% of respondents reported that protecting themselves from COVID-19 was their main health needs and concern. 31% believed that eating healthy foods was their main health need. There’s therefore a need to strike a balance between protecting the masses from COVID-19 and providing access to SRHR services by delivery mechanisms are in place to ensure that SRHR services and FP commodities can be accessed by the young people.

Main Health Needs of Young People (n=210) 35%

Safe from covid-19 Health foodstuffs

31% 18%

Sexuality Education 10%

Family Planning HIV services

6% 0%

10%

20%

30%

40%

ACCESS TO SEXUAL REPRODUCTIVE HEALTH RIGHTS (SRHR) SERVICES DURING THE COVID-19 ERA

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WHAT MEASURES ARE YOU USING TO PROTECT YOURSELF FROM COVID-19?

In regard to respondents’ level of knowledge with regard to COVID-19, the survey established that almost all measures and guidelines such as stay at home 27%, Handwashing 23%, Social distancing 21% and sanitising 21% are being practices in equal measures and has demonstrated the effectiveness of the MoH strategies in sensitising the masses on the protection of COVID-19 as indicated in the figure below.

How YP are protecting themselves from COVID19 (n=210) 27%

Safe at home Hand washing

23%

Social Distancing

21% 21%

Sanitizing Wearing disposable gloves

4%

Reported suspected COVID-19 cases

4% 0%

5%

10%

20%

25%

30%

ACCESS TO SEXUAL REPRODUCTIVE HEALTH RIGHTS (SRHR) SERVICES DURING THE COVID-19 ERA

Recommendations and calls to action There is a need by the government and local organisations to devise mechanisms for addressing GBV related issues as well as a plan for easing the lockdown which largely accounts to the increases of GBV cases.

There is also a need for the government to not only support young people to access SRHR services by lifting some measures targeting young people but also support the health personnels to enable them ease their movement to health facilities to be in position to serve the young people.

There’s a need by the government and other development partners to promote and make the internet accessible to most young people especially in the peri-urban setting by for example removing prohibitive levies so that more SRHR information can reach young people.

There’s a need to double down RAHU efforts on sharing SRHR information on radio as a lot of young people have access to this There is a need to create mobile delivery mechanisms to ensure that critical services and FP commodities can reach all parts of the population, especially the young people.

There’s a need to strike a balance between protecting the masses from COVID-19 and providing access to SRHR services by delivery mechanisms are in place to ensure that SRHR services and FP commodities can be accessed by the young people.

There is an urgent need by the government and all the relevant partners to address the Unmet need for FP in this COVID-19 situation by ensuring that people can reliably access both short-term and long-term FP options and also more effort around normalization of FP because supply minus demand.

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ACCESS TO SEXUAL REPRODUCTIVE HEALTH RIGHTS (SRHR) SERVICES DURING THE COVID-19 ERA

Conclusions Although it’s critically important to ensure that young people are protected from the novel COVID-19 and the MoH has done a commendable job in doing so, the survey has highlighted very important findings that need careful consideration. While in the lockdown, young people are unable to access SRHR services especially family planning commodities and this poses a potential for population explosion in the country if this is not averted. The increasing GBV cases in homes requires urgent attention from both the government and the civil society organisation to ensure that young people can access Psycho-social support and counselling services during the lockdown period.

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get in touch Reach A Hand Uganda

Plot 7502, Block 244, Heritage Village (Kitaranga) - Kansanga, on Kansanga - Ggaba Road P.O. Box 21288 Kampala,Uganda T. +256 414 697 037, E. info@reachahand.org W. www.reachahand.org