The Situation of Pregnant & Lactating Women During COVID19

THE SITUATION OF

PREGNANT & LACTATING

WOMEN DURING COVID-19

A Rapid Assessment of Barriers to Accessing SRHR/GBV Services 25 JUNE 2020

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INTRODUCTION AND PURPOSE

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With the COVID-19 pandemic and the subsequent measures instituted by government to prevent the transmission of the corona virus, pregnant women have faced significant challenges in accessing and utilizing life saving SRHR/GBV services The rapid assessment aimed to establish factors that hinder mothers from accessing health facilities for ANC, delivery, postnatal care services including PPFP and GBV response services during the COVID-19 crisis. Uganda.

Establish factors hindering pregnant & lactating women from accessing SRHR/GBV services

Propose evidenced based recommendations to inform further re-programming services in the context of COVID-19

Propose possible incentives to attract women, men and girls to health facilities during COVID-19

METHODOLOGY

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6 Districts 6 Regions

Conducted in six (6) UNFPA programme districts, selected to represent the sub-regions of West Nile (Maracha), Acholi (Agago), Lango (Otuke), Toro (Kyegegwa), Bunyoro (Kiryandongo), and Karamoja (Abim) 380 Mothers

Randomly selected 3 sub counties in each district. Used pregnancy mapping data and VHT records to randomly selected 20 women per sub county. A total of 380 women were assessed. 8% were PwDs, 63% were currently pregnant while 6% were refugees. 14% were teenagers, 38% youth 20-24 yrs, 47% aged 25-45yrs, 1% above 45 yrs

Questionnaire

Employed a questionnaire which had quantitative & qualitative questions.

The tool was pre tested in Arua

Close Engagement

Conduct with close engagement of the district technical officers; DHOs, DCDOs, CDOs, Biostatistician, Planner and Health Assistants in each sampled Sub County

ACCESS TO ANC BY CURRENTLY PREGNANT WOMEN

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No.

Services Received during ANC

%age

1.

Was your blood pressure taken

62%

2.

Were you asked about GBV

35%

3.

Were you weighed

73%

4.

Were you give tetanus injection

65%

5.

Did you receive counseling on PMTCT

55%

6.

Were you tested for HIV

75%

7.

Were you tested for Syphilis

56%

8.

Any other medication

38%

Only 53% attended 1st ANC during 1st Trimester 98% plan to deliver from facilities To access services, 25% used a boda boda, 65% walked to facilities, 5% used other means

ANC SERVICE UTILIZATION IN DHIS-2

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Comparing the 2020 to 2019 Data from DHIS2 indicates that there are significant access/ utilisation gaps to SRHR/GBV services A U-Report survey by UNICEF found out that; • More than 53% of the adolescents and youth surveyed (13,083) had not utilised any SRHR service during COVID Crisis

ACCESS TO DELIVERY SERVICES AND POSTNATAL SERVICES

Place of Delivery Non-facility delivery, 16%

80% 70% 60% 50% 40% 30% 20% 10% 0%

Facility delivery stands at 84%, 67% of mothers who didn’t deliver from facilities had transport challenges To access services, 50% used a boda boda, 35% walked to facilities, 15% used other means DHIS-2 indicates high Institution maternal deaths in 2020 compared to 2019.

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POSTPARTUM FP METHODS

Reasons for not considering Postpartum FP Plans to produce more Children 10%

Others 14% Side Effects 24%

Spouse Refusal/Fear 52%

52% of mothers not considering postpartum FP mentioned spouse refusal/fear

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PREVALENCE OF GBV AND ACCESS TO GBV SERVICES

64% of respondents surveyed in a U-Report survey GBV cases had gone up (UNFPA/UNICEF) 11% of mothers had pregnancy complication due to GBV

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PREVALENCE OF GBV AND ACCESS TO GBV SERVICES

GBV survivors mostly reached out to LCs, In-laws and family members for GBV services.

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COVID EFFECTS

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No.

Limitations to accessing SRHR/GBV services during COVID-19

%age

1.

Transport challenges (facility is far)

62%

2.

Fear of contracting corona virus at facility

46%

3.

My partner doesn’t allow

6%

4.

Health workers are no longer coming to facilities regularly

6%

5.

I am not sure of which services are now at the facility (in this situation)

10%

6.

Previous bad experience/mistreatment at the facility

2%

7.

Lack/inadequate equipment, drugs at facility

13%

8.

Others

12%

59% of mothers have been affected by the COVID-19 crisis 34% did not feel safe while accessing services 36% don’t have the right information to protect them selves

WHY MOTHERS FELT UNPROTECTED?

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Mothers are drawn away from services by: • Absence of PPEs for health workers and mothers (masks). Some noted that “Midwives didn’t wear face masks” • Over crowding and lack of social distancing at facility • No covid screening • Issues with hand washing at facility

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RECOMMENDATIONS

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Continue emergency transportation support (extend towards GBV survivors also) Advocate for the use of bodabodas by pregnant women & GBV survivors.

Provision of support equipment (mama kits, delivery kits, and mosquito nets) Intensify outreaches and provision of services through VHTs especially PNC Establishing functional handwashing facilities at HFs (provide soap, sanitizers, etc), Ensuring there is social distancing at facilities Ensuring there is COVID screening at entrance of facilities, and Provision of PPEs to mothers and health workers.

Continuous COVID risk communication integrated with a focus on GBV issues plus FP Support districts to monitor & support supervise service provision in facilities

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THANK YOU

CAO and DHO Moyo receiving fuel vouchers from the UNFPA team led

by Dr. Bernadette in CAOs office on June 10th 2020.