Evidence from nine countries informs future emergency preparedness
When COVID-19 kept new mothers in Khon Kaen, Thailand, away from hospital, the clinic went to them. Nurses phoned women five weeks after birth instead of calling them in, offered contraceptive implants before discharge, and sent medicines to patients' homes by post. Across nine countries, testimonials like this show how sexual and reproductive health care was kept alive during the pandemic, and what happened where services were absent.
A just completed supplement of 14 papers across nine countries published in Reproductive Health, led by the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) and the World Health Organization (WHO), with partners in Brazil, Burkina Faso, China, Ghana, Italy, Kenya, Pakistan, Thailand and the United Kingdom, followed health facilities, clients and health workers through the peak of the crisis and into recovery.
The first lesson runs through almost every country: sexual and reproductive health services suffered most where they were not prioritized. In parts of Brazil, antenatal and postpartum care continued, but contraception slipped down the list. One woman reported having spent more than a year trying to get her intrauterine device (IUD) checked. Others simply switched methods on their own, swapping pills for condoms without any medical advice.
The second lesson is the necessity of flexible services. The services that coped best were those willing to leave the clinic behind. Community health workers in Ghana and Pakistan carried care into neighbourhoods that lockdowns had cut off. Community-based delivery in Burkina Faso reached people who could not travel. In Brazil and the United Kingdom, task-shifting, prescriptions of longer duration, and support for self-care allowed access to services when facilities were stretched. China likewise built sexual and reproductive health into its national COVID-19 response, using telehealth, triage and redeployed staff to keep care moving.
Lastly, digital tools changed how people reached care. In Verona, Italy, a first phone call became the front door to abortion, contraception and STI services, and clients described it as quick and reassuring. In England, services adapted to the pandemic by ensuring dedicated funding and providing telemedicine and new approaches to supplies. In Burkina Faso, Ghana and Pakistan, community health workers and community-based delivery carried care beyond facility walls, reaching people whom lockdowns had cut off.
The supplement also offers evidence on where and why care broke down. Fear kept many people away: in Burkina Faso, demand for family planning fell as women worried about infection and quarantine, and providers later saw more unintended pregnancies and complications from abortion. Across countries, contraception and abortion care were among the slowest services to recover, held back by staff shortages, redeployment and supply failures. In Ghana, telemedicine was available but did not extend to sexual and reproductive health. In Brazil, conflicting messages from political leaders undermined public trust in health guidance. In Sindh, Pakistan, women and health workers described rising violence at home as jobs disappeared, yet only one of the nine facilities studied had providers trained in responding to gender-based violence in the previous six months. As the researchers note, the pandemic did not create these gaps so much as reveal them.
The recommendations from this evidence come down to turning what works into the norm. That means framing sexual and reproductive health services as essential before the next emergency begins, not halfway through it. It means writing rules that let nurses, community health workers and clients themselves take on more, and having remote options in place before they are needed. And it means looking after the health workers who, in every one of these countries, kept the doors open.
We are sincerely grateful to all partners and country teams whose collaboration made this work possible, and to the women, men and health workers who shared their experiences.