Fieldset
The power we have over our bodies: How COVID-19 is affecting family planning in Honduras

For women and girls living in the city of Choloma, widespread violence and poverty mean that access to family planning services is absolutely critical. However, COVID-19 restrictions have closed clinics and cut off vulnerable patients. MSF doctor Maura shares this powerful and passionate report.

COVID-19 is spreading fast in Honduras, we now have almost 20,000 confirmed cases*.

On March 17, the Honduran government put in place an absolute quarantine, which means they closed all borders, stopped all taxis and public transport, and – except for essential workers – we are now only allowed out of our houses every two weeks based on the last digit of our government ID. 

But the streets are still busy – many people live day-to-day and just don’t have the option of staying home.

It's hard to see some parents, who don't have enough money to buy two weeks’ worth of food for their families at once. They have to debate whether to go out to make money and expose themselves to the virus, or stay in and starve. 

Adapting to lockdown 

I usually work on MSF’s community outreach team, travelling to community health centres and schools around Choloma. We provide health education and counseling to women and healthcare workers and let them know about the free services MSF’s clinic offers.

We’re really linked to the community. But, when the lockdown started, MSF was forced to suspend the outreach program, so my team had to find a way to continue our work from home.

I think it’s completely outrageous that women have been denied access to family planning at this time; it is an essential service

With new government protocols, we were able to start up “telehealth”, where patients can call in and have a consultation over the phone. With this new service, we’re trying to reach everyone who is in need of a consultation because they can't go to a health centre, or they’re too scared to during the pandemic.

It’s challenging as I don’t have the patient’s file in front of me at home, but I do ask for their medical history. Once the phone consultation is complete, I write a prescription and send them a photo of it via WhatsApp. Then they have to try and find a facility that will fill it, which is hard, especially for contraceptives. 

Closed clinics

At the beginning of the lockdown, the government ordered all hospitals and clinics – except our clinic in Las Trincheras – to stop all non-emergency services. And according to the Ministry of Health (MoH), sexual and reproductive health care is not emergency care.

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An MSF outreach team setting-up in Choloma
An MSF outreach team setting-up in Choloma

They’ve also reallocated staff away from smaller community health clinics to work on the COVID-19 response. Others are forced to stay home due to their age or other health conditions that might put them at greater risk of death if they contract COVID-19.

In total, between 30 and 40 percent of community health workers have already become infected with the disease. 

MSF supplies all staff in our clinic – no matter if they work for MSF or the MoH – with PPE. But people working in other community health centers have to buy their own personal protective equipment, which has become more and more expensive. 

So, I’m not really surprised that many of these clinics have had to close completely.

We are the only option 

This means that our clinic is the only facility currently providing sexual and reproductive health care in Choloma.

It’s also the only maternity centre in the area, as the only other facility women can go to have their babies is a 40-minute drive away in San Pedro Sula. However, some women are afraid to go to those hospitals as they are now COVID-19 treatment centres and they’re overcrowded.

Even if she’s been raped, or if the pregnancy means she’ll have to drop out of school or lose her job – abortion and emergency contraception is illegal

Throughout the lockdown, our clinic has stayed open 24-hours-a day. But last week, 18 of our staff members were being quarantined at home with COVID-19 symptoms, so we had to reduce some services like prenatal care for women who are not high-risk pregnancies. 

We’ve continued most other services including contraception care and deliveries. In fact, our average births per month have increased from 55 to 75, even though it’s almost impossible to travel anywhere during the lockdown as there is no public transport, taxis or ambulance service, and most people don’t own cars. 

One of only six countries

We’ve also set up a tent outside the clinic – allowing for social distancing – so we can continue offering contraception services. We have started to give women longer supplies of contraceptives, like the pill, as MSF is really the only facility still providing this service during the lockdown. 

I think it’s completely outrageous that women have been denied access to family planning at this time; it is an essential service.

Honduras is one of only six countries in the world where abortion is completely illegal. Not only that, but the law also prohibits the use of emergency contraception.

Even if she’s been raped, or if the pregnancy means she’ll have to drop out of school or lose her job – abortion and emergency contraception is illegal. Even if she can’t afford to feed her child, or if she is a child herself.

She cannot even have an abortion if the pregnancy will risk her life. 

An essential service

Family planning is always an essential service, especially for women in Honduras. It’s not just a right, but it's a decision women make: when, how, and if we want to have a baby or not.

It's frustrating for women not to have access to this during the lockdown, and it's frustrating to me as a doctor, not being able to help them. 

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An outreach team speaking to young women about family planning
An outreach team speaking to young women about family planning

Last night, a patient called me crying. She told me that she went to the community health center for her contraception care appointment, but it was closed. She said to me, “I don’t want another baby and my husband doesn’t want another baby. And if I get pregnant, he will leave me.”

Those stories are really hard to hear. 

The power

I hope we can continue providing telehealth even after the pandemic. If we can expand it, we will be able to reach so many more women who cannot get to a facility. 

It feels like we are walking backwards and losing everything that we fought for

But the needs are greater than the care MSF can provide alone, and I just feel like women’s access to sexual and reproductive healthcare during the pandemic, especially family planning, is just being neglected. 

It’s like we are going backwards.

Denying women access to family planning is like taking away the power we have over our bodies – the power of choosing if we want a baby or not. It feels like we are walking backwards and losing everything that we fought for. 

*Update: Since this post was written, Honduras now has more than 33,000 COVID-19 cases and 900 deaths

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