As we all have had to dramatically change our professional and personal practices in the last few weeks – changes which will last for weeks, if not months or longer – what are the implications for cross-sector collaborative research in sexual and reproductive health and rights (SRHR) and social justice? While our research may be stopped, temporarily paused, or shifted to virtual methods to accommodate new material conditions, much more than our methodologies will be affected by COVID-19. We have already witnessed significant disruption to health care practices and services, where existing services have been temporarily suspended, moved online or continue in extremely challenging circumstances; and we are now faced with the immediate impact of physical distancing, increased ill-health within communities and radical transformations of livelihoods on the social, sexual and health practices of communities.
The demands of SRHR and social justice do not stop during a global pandemic. This public health crisis presents a complex set of challenges, implications, and – potentially – innovations – for sexual and reproductive health, and research should play a key role in documenting, understanding and supporting these changes. Below, we pose a number of questions that are intended as a starting point for a collaborative SRHR and social justice agenda. That is, we aim to start conversations, encourage dialogue between and across research, community, clinical and policy partners and to support our much-needed collaborative efforts in the midst of the current crisis.
What are the immediate responses to current public health measures (including but not limited to physical distancing), and how can SRHR and social justice be safeguarded and supported in this context?
As services and practitioners respond in uncertain times, we need to ensure that existing SRHR and community support services are safe, that ongoing access is facilitated, and that these transitions to new modes of delivery and models of service do not exacerbate already existing inequalities. Where some services have significantly restricted or stopped entirely (e.g. Gender Identity Clinics, in-clinic STI testing), others have moved to telemedicine and online support (e.g. abortion services, private home testing, intimate partner violence services). How will these transitions affect not only the experience and effectiveness of these services, but the disproportionate burden of ill health, inequalities and injustices for those in already precarious positions? Beyond access to services, what are the material implications – and strategies for support – for those communities who rely on physical outreach support (e.g. people who live in remote and rural locations with limited/no internet connection or phone reception, people who are not digitally literate, and/or support for harm reduction amongst people who use drugs and/or who may be homeless) or who rely on income and/or provisions that necessitates physical contact (e.g. people who engage in sex work)?
How will increased and long-term delays to already over-stretched services and care affect existing socio-economic and socio-cultural inequalities and how can these be mitigated?
Even before COVID-19, support for sexual and reproductive health was already operating in a challenging environment; budget cuts, increased complexity of sexual health interventions, and the realities of structural barriers to health provided significant challenges and long waiting lists. What, then, will large-scale disruption to, and pausing of, services mean for the ongoing health and wellbeing? What does the absence of state provision mean for community care practices? Will this gap be filled by individual and/or more privatised health practices (e.g. self-sourcing of PrEP or gender-supporting hormones) and how might this affect more marginalized communities as well as government commitment to state services?
What role for community voice, involvement and rights?
Public patient involvement (PPI), and the meaningful engagement and participation of communities is recognized as an essential component of effective and sustainable SRH services. At times of crisis, how can the lived experiences and concerns of affected communities continue to be included in multi-sectoral responses? How can communities play a key role in the design of responses to COVID-19 and the re-organisation of services in the short, medium and potentially long-term? And how can we support the meaningful and ethical involvement of diverse communities at a time when physical contact is minimised and when ongoing inequalities and socio-economic disparities are heightened?
What are the longer-term implications of this crisis for SRH?
We know that testing and access to medications will be affected by COVID-19 as supply chains, physical mobility and staff capacity are disrupted. We also know that socially complex SRHR issues will feel the effects of this crisis for months and likely years to come. How resilient are communities, practitioners and even researchers, and how can they best be supported? What creative and generous responses will emerge from community need and how might these affect relationships with healthcare provision? What will the longer-term economic implications of this crisis be on funding for health services and organisations (third sector, community research) and how might this affect both how we work together and on what we prioritize?
These questions and concerns are by no means the only questions we need to consider. We would welcome further thoughts on the immediate, and longer-term implications of COVID-19 on sexual and reproductive health, rights and social justice.