The COVID-19 impact on sexual- and reproductive-health rights and gender-based violence

COVID-19 arrived in South Africa at a critical time for women’s rights. The lockdown has brought with it an increase in reports of domestic violence and threatens to disrupt access to sexual- and reproductive-health services - a cornerstone of gender equality. Interventions to protect sexual- and reproductive-health rights during the crisis need to be part of an intersectional effort that takes into account vulnerabilities brought about by diverse identities and experiences, including those faced by lesbian, gay, bisexual, transgender, transsexual, queer, questioning, intersex, asexual, ally, pansexual (LGBTIQ+) individuals. By Dr Ingrid Lynch and Andrea Teagle

An activist holds up a rape crisis number during a protest against gender-based violence protest outside Parliament in Cape Town (September 2019). Photo: Andrea Teagle

The COVID-19 pandemic is exacerbating many of the factors that intersect to increase the risk for interpersonal violence, and in particular intimate partner violence. Reports from around the world reflect that gender-based violence (GBV) has increased during lockdown, with women unable to escape from perpetrators.

Added to this, resources that reduce the probability that an individual becomes a perpetrator of intimate partner violence have thinned, as income, food security and access to basic services become increasingly perilous. While individuals grapple with uncertainty about the future, means of safeguarding against stress, like exercise and social support, have also been cut off. Mental-health experts, including Professor Crick Lund from the University of Cape Town, have called for a public mental-health response to the pandemic that addresses upstream risk factors.

On 12 April, President Ramaphosa issued a statement acknowledging and condemning the rising tide of GBV during the lockdown and reiterating that the Emergency Plan to combat it remained in operation. Women who leave their homes to seek support for GBV would not be persecuted for breaking restrictions, Ramaphosa said.

Access to health care
Another concern is access to sexual- and reproductive-health (SRH) services for women and sexual and gender minorities, as human resources are diverted to the COVID-19 response. The impact of the pandemic means that, globally, such services and support - ranging from condoms, contraceptives, HIV testing and treatment, and uninterrupted hormone treatment for transgender persons - are limited if available at all.

Shortages of medication have been reported around the world, with some countries already experiencing stockouts of SRH supplies. In South Africa, many SRH care clinics have closed or reduced their hours, while others have had to redirect human resources and clinic space to the COVID-19 response.

In addition to possible supply-side issues, lockdown might also restrict women’s ability to access health care and SRH services. South Africa’s repeat collection prescription strategies allow individuals to collect antiretroviral medicine refills from alternative pick-up sights to reduce hospital visits. However, fear of exposure to the coronavirus might discourage women from attending clinic appointments and seeking other SRH services. Reduced transport options during lockdown also disproportionately impact women, for whom walking carries a greater risk of assault.

One Khayelitsha resident told the HSRC Review how a visit to the local clinic meant that she and a friend had to walk home afterwards because no taxis would be operating for another four hours. Her friend, who lived even further away, ordered an Uber ride the rest of the way. “What if you don’t have money?” she asked. Walking in Khayelitsha as a woman, she added, could cost you your life.

‘Invisible’ groups in an already overlooked area of health
Particularly marginalised groups are at risk of falling through the cracks in efforts to maintain access to SRH services and support. LGBTIQ+ persons are confronted with the current crisis as a population already marginalised and lacking access to affirmative health-care services, where discrimination against sexual and gender minorities remains rife. Consequently, LGBTIQ+ NGOs are often their only access point for SRH services and support. Some clinics, such as the Wits Reproductive Health and HIV Institute (WITS RHI), have remained open, offering hope to transgender people — however, many have stopped accepting new patients and have reduced their clinic hours.

Joan, a transgender woman from Johannesburg, told the HSRC Review that she struggled to get an appointment at My Sexual Health, a clinic in the private sector, to have her hormone treatment implant replaced. “I was due to go in literally two weeks after lockdown started. I was so worried about it, because when I tried to arrange appointments before lockdown, it was just “No, we’re booked full”. She was fortunate enough to get one of the limited slots after lockdown started.

Others were not so lucky. Polite is a 39-year-old transgender woman who lives in Tembisa, Johannesburg. She had been trying to access gender-affirming services for nine years, but as a foreign national, she was not able to access free treatment from the public sector, and she could not afford it herself. Then, in 2019, she found the WITS RHI Trans Health Centre, which provides treatment regardless of nationality, and she was finally set to begin the process.

Now, however, due to lockdown, Polite and others who have not yet initiated hormone treatment, must wait. There is a long waiting list, she says. “This thing is now killing me because I don’t know what to do … If I’m coming to the transgender clinic and I see the others [who have transitioned], I’ll feel so disappointed in myself and so ashamed.”

As a young adult, Polite struggled for years to express her identity in the face of rejection from family and friends, before she connected with the transgender community. School’s Out, the HSRC’s collaborative project with civil society organisations across the continent, has found that sexual and gender minority teens often struggle to access LGBTIQ+ organisations due to social stigma, and beliefs about what constitutes ‘acceptable’ and ‘decent’ youth sexuality and gender identity.

“When you’re outside of the community, you have no one to talk to, no one to ask, and that makes it incredibly hard,” Joan said. Lockdown makes attempts to travel to and from LGBTIQ+ clinics even more conspicuous, especially for those who cannot afford their own transport and must walk.

Considering the extent of homophobic and transphobic police-perpetrated abuse, individuals face the further risk of violence from authorities enforcing lockdown.

In a context of high levels of sexual and gender-based violence against sexual minority women, access to services such as emergency contraception, abortion and counselling is critical. Many of these are time-sensitive services with dire implications if delayed.

These interwoven vulnerabilities speak to the need for an intersectional approach to mitigating the impact of the pandemic. Blanket approaches necessarily mean that the needs of those with identities and experiences that compound their vulnerability - such as sexual orientation, gender identity, age and nationality - cannot be appropriately attended to.

Note: Here is a list of GBV services provision across South Africa during lockdown, compiled by the Shukumisa coalition.

Authors: Andrea Teagle, science writer in the HSRC’s Impact Centre, and Dr Ingrid Lynch, senior research specialist in the HSRC’s Human and Social Capabilities division and co-investigator in the Amplify Change-funded School’s Out project.
ateagle@hsrc.ac.za
ilynch@hsrc.ac.za