Nguyen Toan Tran, Désirée Lichtenstein, Benjamin Black, Alice Rosmini & Catrin Schulte-Hillen
The recent Ebola virus disease (EVD) outbreaks in 2021 illustrate how sexual and reproductive health services are too often considered non-essential during health emergencies. Bleeding for reasons other than Ebola virus disease, such as pregnancy complications or rape, can be interpreted as symptoms of Ebola virus disease, reinforcing fear and stigma and delaying access in time timely to adequate care. In this commentary, we urge all humanitarian actors to integrate the minimum initial service package for sexual and reproductive health in crisis situations into current and future EVD preparedness and response efforts.
Sexual and reproductive health (SRH) conditions are among the leading causes of death among women of reproductive age, with fragile countries and low resilience health systems accounting for two-thirds of maternal deaths globally . Ebola virus disease (EVD) is a serious zoonotic disease with an average case fatality rate of 50%. It is spread among humans through bodily fluids. Past outbreaks of EVD suggest that shutting down health services deemed unrelated to the outbreak response has caused more deaths than the outbreak itself.
At the intersection of EVD and SRH, health problems arise from the disruption of vital services, including maternal and newborn care, and the care of people with abortion complications, sexual violence, and others. forms of gender-based violence. . Women and girls are at risk of gender-based violence due to increased exposure to abusers during curfews, school closures, and economic hardship, among others. Mortality among EVD-positive pregnant women is not higher than that of non-pregnant people with EVD. However, almost all pregnancies affected by EVD end in miscarriage, stillbirths, or neonatal death. EVD-positive pregnant women may exhibit signs and symptoms that do not meet the EVD case definitions. Conversely, bleeding for reasons other than EVD, such as pregnancy, rape, and menstruation, can be misinterpreted as symptoms of EVD, reinforcing fear and stigma by the community and health care providers. , delaying timely access to adequate care.
The 2021 EVD epidemics in Guinea and the Democratic Republic of the Congo illustrate how regional and national humanitarian actors must actively protect SRH interventions in contingency planning, resource mobilization and responses. Therefore, the Interagency Reproductive Health Crisis Working Group released field guidelines on SRH and EVD. The guidelines are based on the precondition that ministries of health and humanitarian stakeholders, including SRH leaders, must coordinate and plan to ensure that EVD preparedness and response integrates services. , SSR supplies and referral mechanisms. To allow for systematic prioritization of SRH in current and future responses to EVD and to minimize SRH-related deaths, the following recommendations should also be considered.
First, all essential services and supplies defined by the Minimum Initial Services Package (MISP) for SRH in crisis, a standard in humanitarian response, should be prioritized throughout the EVD response. It includes intrapartum care, emergency obstetric and neonatal care, postabortion care, safe abortion care to the fullest extent of the law, contraception, rape care, and prevention and treatment of HIV and other sexually transmitted infections. Women and adolescent girls with suspected EVD should be offered a pregnancy test at EVD triage stations, supported by standard operating procedures that ensure safe and dignified isolation until EVD detection and referral. from confirmed cases to EVD treatment centers. These centers should have adequate SRH supplies, staff, and protocols, including emergency obstetric and newborn care, and offer counseling on potential outcomes and options to people who test positive for EVD and pregnancy. Safe sex and contraceptive counseling are equally important for all people of childbearing potential, regardless of EVD and pregnancy.
Second, involving health workers, EVD survivors, and representatives of the community and target audiences is essential for developing clear and relevant public health information. This information should reiterate the importance of seeking care for childbirth and other SRH needs and medical emergencies. Risk communication and community engagement strategies should cover SRH and EVD, the risk of poor health outcomes for women and girls, help individuals differentiate “inexplicable bleeding” (EVD) from “bleeding” explainable ”(eg rules) and tackle the associated stigma. Equally essential is information on contraception, safe sex, breastfeeding, prevention of unsafe home births and where to access care, including the Ebola vaccine.
Third, infection prevention and control measures, including personal protective equipment, should be part of the management of labor and delivery, abortion care, and all procedures with contact with bodily fluids. , such as care for rape survivors, regardless of EVD status. Reliable supplies for applying these precautions in EVD treatment centers and SRH facilities should be carefully planned during coordination meetings. These facilities should also optimize waste management practices for menstrual hygiene products and pregnancy-related fluids and tissues, including the safe disposal of the placenta. Finally, SRH providers, including community midwives and other frontline health workers, should be a priority in national Ebola immunization programs.
Our guidance on SRH and EVD has been published to galvanize national and regional stakeholders to protect essential health services, including SRH, during EVD preparedness and response efforts. We call on them to view life-saving SRH services as an essential part of the package of EVD interventions, one that does not weaken but strengthens health systems while meeting the health needs of women, girls. and the whole community.