By Dumisani Nyoni
Young women in Gwanda district are struggling to access contraceptives due to lockdown measures introduced to minimise the spread of Covid-19 pandemic, raising fears of more unplanned pregnancies that often lead to unsafe abortions.
Information gathered by this publication shows that many women in Gwanda were struggling to access sexual reproductive health rights (SRHR) services as many of them do not have clearance letters offered to essential service providers, which allows them to move around.
Gwanda’s only referral clinic Phakama, which also serves as a Covid-19 isolation centre, is overwhelmed, managing to serve a limited number of people a day.
“The situation is dire. I stay outside Gwanda town, about 10 kilometres away, so for me to get into town to access health care services is a struggle. Firstly, there is are transport challenges. Since the introduction of lockdown, transport to get into town has been a challenge. Secondly, I don not have an exemption letter,” Sibusisiwe Nxumalo, 28, from Matshetsheni said.
Nxumalo said she was once turned away by police because she had no clearance letter.
"I intended to go and collect contraceptive pills from Phakama clinic but the police wouldn't allow me. I tried to explain myself to them with no success. Now my biggest worry is that I will end up getting pregnant, something which I don’t want at the moment," she said.
In a bid to curb the spread of deadly virus, the government on January 2 imposed a national lockdown following a surge in Covid-19 cases, with only essential services, such as hospitals, pharmacies and supermarkets remaining operational for the next 30 days.
Essential services are only allowed to operate for seven hours a day.
Government first imposed a nationwide lockdown in March last year to contain the spread of Covid-19, but had eased most of those measures amid fears of further economic malaise.
Covid-19 cases doubled in two months from 8 374 at the beginning of November 2020, to 32 004 as at January 26, 2021.
The lockdown specified that all non-essential services and travel be put on hold. Public transport, including commuter omnibuses used by a significant number of women, has been unavailable.
“Since the introduction of the lockdown, I have been unable to access SRHR services due to Covid-19 restrictions. I now fear of getting pregnant,” Nombulelo Phiri (33) of Spitzkop suburb said.
Access to information on SRHR, which is vital in preventing unplanned pregnancies, has been limited because of the lockdown as door-to-door mobilisations have been hindered.
SRHR activist Mojalefa Mokoele who is also a Sexual Rights Centre programmes officer, said government should not prioritise Covid-19 over other diseases.
“What we are seeing at the moment which the government should actually take note of is that Covid-19 is prioritised. Yes, we understand the fatalities and the need to prioritise it but in terms of general health of the population, it does not mean that other critical health needs of people are neglected or no longer be a priority,” he said.
“We are critically facing a challenge where many people who are on life dependent drugs like antiretroviral treatment will end up defaulting on their medication that they need because they have no letters of authorisation to access health care centres where they get their refills.”
“While it is so, we read every day that these health care centres are overwhelmed with Covid-19 related-cases, hence those cases are prioritised and anything else that is no longer Covid-19 will have to wait,” Mokoele said.
Mokoele said the country risked losing all the gains it has made on issues such as HIV and AIDS among others.
“We need to find the balance. What we are seeing now is not only abuse of women but it is also neglect of people who need other critical health services, all done in the name of protecting people against Covid-19 which eventually to me is a violation of basic human rights of many people at this point in time,” Mokoele said.
“We are hearing very little of other measures to make sure that gains made in addressing other health needs are not lost. We are not hearing so much spoken about social services that people will need during these difficult times.”
Mokoele said it was very sad that a town as big and as rich as Gwanda in gold, even today has one clinic yet its population has grown drastically just over a period of 15 years.
He said there was a need for the authorities to build more clinics to match the population.
“Covid-19 cannot be an opportunity where we downplay, abuse or deny women and children their rights. We need to make sure there is a balance in all this,” he said.
Sichasisile Ndlovu, coordinator of the Gwanda-based Community Youth Development Trust (CYDT) said since the introduction of restrictions and regulations as a way of flattening the pandemic curve, Phakama clinic has made access to health care a dream for many young women and the entire population.
“People wake up in the morning and queue in the sun in anticipation to be saved. However, as a youth focused organization, CYDT condemns the practise by officials that have seen people forced to queue for the greater part of the day only for officials to serve only 5 to 10 people a day,” Ndlovu said.
“This alone exposes patients or clients who are mainly young women to the virus considering that no social distancing, hygiene is maintained while in the queue. Some patients would have walked from more than 10km to access their monthly supplies in Gwanda town but fail to be saved.”
“Therefore, we call for authorities to focus on sustainable health decisions, meaning decisions to be made by the local authority and the ministry should take into consideration the plight of citizens. What is currently happening forces people to default on their daily medication and young women fail to access SRHR leading to unwanted pregnancies,” she said.
She said children as young as a week old are observed being held by their mothers and spend the day in the sun, something that has the potential of influencing young women to ignore necessary immunisations for their children.
“Council should look into this lest the centre will be a death trap for children and young women. We continue to implore relevant authorities to consider adapting and adjusting measures when making lockdown decisions while anticipating future impact, and using a rights-based framework,” she said.
“This will entail that specific regulations and standards are given to health instructions so that they continue offering quality services to the community,” Ndlovu said.
Ndlovu said institutions should note that for the country to achieve the 2030 agenda for sustainable developments “we need to balance three dimensions of sustainable development that is economic growth, social inclusion and environmental protection.”
“Moreover, sustainable development requires us to balance our needs with the ability of future generations to meet their own needs,” she said.
Gwanda town clerk Priscilla Nkala said the situation was being exacerbated by the outbreak of Covid-19 pandemic.
“Phakama is a referral clinic, meaning before patients go to Gwanda Hospital, they should first go there. This is also creating pressure for the clinic. As council we have realised that and we have plans to decongest the clinic by having a satellite clinic somewhere like in Spitzkop,” she said.
Matabeleland South proportional representation legislator Lindiwe Maphosa said the clinic was overwhelmed as it catered to the entire Gwanda town and surrounding areas.
“So people spend much of their time queuing to access health care services. With Covid-19 regulations, the pressure is too much,” she said.
Gwanda ward 9 Thulani Moyo said the situation at the clinic needed urgent attention.
“Yes, it's true that people are struggling to access health services at Phakama clinic. Those on ART (antiretroviral therapy) are greatly affected including TB patients, babies, nursing mothers, pregnant mothers among others. The staff compliment at the clinic does not correspond with the demand,” he said.
Moyo said their wish is to have another clinic to meet demand.
“We have this on budget from the previous council. In 2015, if not mistaken, we resolved to come up with a satellite clinic. We have a stand for that purpose at Spitzkop. The challenge is funding,” he said.
“We had also option B to rent a full house and use it as a satellite clinic. The challenge with that is that the rentals were too high. Now that the case is like this, we might consider revisiting that issue again (of renting a house) whilst we are working on our long term plan of building a satellite clinic,” Moyo said.
Matabeleland South provincial Medical Director Ruth Chikorodze said she will look into the issue.
“I will have to look into it because I have not yet received that report. You can also find out from the council…but as far as I know the services are continuing. There was a time, some weeks back, when some of the staff members ended up getting Covid-19 and (the clinic temporarily) closed down but now they continue offering services..,” she said.
Gwanda town mayor Njabulo Siziba said: “Yes, we have a problem at Phakama clinic but the issue of people having challenges in getting contraceptives I am not aware of. However, I am aware that reception at Gwanda Provincial Hospital is becoming poor. People are being referred to Phakama Clinic.”
“The clinic recently built an isolation centre and what is happening is that they want to refer everyone to Phakama, putting more pressure on the clinic. With Covid-19 regulations like the need for social distancing, temperature check and testing, people end up queueing outside and being scotched by the sun and soaked by rain,” he said.
Apart from serving Gwanda residents, Phakama serves surrounding rural villages like Matshetsheni and new resettled farmers.
According to the Office of the High Commissioner for Human Rights (OHCHR), women’s sexual and reproductive health is related to multiple human rights, including the right to life, the right to be free from torture, the right to health, the right to privacy, the right to education, and the prohibition of discrimination.
The Committee on Economic, Social and Cultural Rights and the Committee on the Elimination of Discrimination against Women (CEDAW) have both clearly indicated that women’s right to health includes their sexual and reproductive health.
This means that States have obligations to respect, protect and fulfil rights related to women’s sexual and reproductive health.