A woman stands in front of a health care clinic advertising a variety of insurance options and services, March 19, 2018, Nairobi, Kenya. Photo by International Telecommunications Union [1] via Flickr CC BY 2.0. [2]
Editor's note: This story is part of a two-part series on women and health care during COVID-19 in East Africa. Read Part II here [3].
Maternal health [4] is a crucial part of sexual and reproductive health and an indivisible component of health care rights. However, maternal mortality [5] continues to threaten the health of women and girls globally — especially in sub-Saharan Africa.
In recent years, states have instituted priority measures to reduce unintended pregnancies and unsafe abortions, and enhance access to skilled health care providers — in line with the United Nations Sustainable Development Goals [6].
But to ensure the effectiveness of these measures, guaranteed access to information for girls and women is key.
The COVID-19 pandemic highlights the critical obligation of states to ensure the accurate provision of information as a fundamental component of health care rights [7]. This demands proactive communication by states in a timely and effective manner.
During the pandemic, some governments have struggled [8] to ensure that women and girls have uninterrupted access to sexual and reproductive health-related information and education, on and offline.
In Kenya, the public has not always received regular, clear and accessible information [9] regarding exemptions to curfew and lockdown restrictions. While exemptions unreservedly allow pregnant women facing obstetric emergencies to leave their homes to travel [10] to health care facilities, a lack of clear information on these exemptions and how they are implemented can cause undue stress and confusion [11].
Kenyans were also not fully aware of the duty and roles of security agents [12] and public transport providers to facilitate and ensure the safe passage of pregnant women and girls to health care facilities. Access to this information enables women and girls to vindicate their rights.
A new family visits a health clinic with their infant, March 19, 2018, Nairobi, Kenya. Photo by International Telecommunications Union [1] via Flickr CC BY 2.0 [2].
Excluded from online resources
Primarily disseminating information online — especially through social media — is potentially dangerous because it excludes and discriminates against many women and girls who have limited or no access to smartphones, internet services, or digital literacy skills necessary to access this information. Some have limited or no economic means to meet internet data costs.
According to the World Wide Web Foundation [13], despite massive global growth in internet usage, there are still more men online than women due to existing gender disparities. In sub-Saharan Africa, only 28 percent of women have access to the internet. This means that sharing information online or requiring consumers to access the internet to gain access to health care services often excludes women.
In Kenya, 86 percent [14]of women have access to mobile phones, but only 32 percent [14] have access to and use internet services. Out of this latter group, it is unclear if they enjoy regular and uninterrupted access to internet services which requires the economic means to pay for internet bundles and electricity to charge smartphones.
Telemedicine for all?
The Ministry of Health in Kenya issued guidelines [15] for continuity of reproductive, maternal, newborn and family planning care during the COVID-19 pandemic, including the use of telemedicine [16] – an innovative model encouraged by numerous countries to ensure health service provision during COVID-19.
Telemedicine is critical to ensure access to health-related information, including how to access emergency services during labor, as well as to facilitate contact between health care providers and patients.
However, telemedicine guidelines are mainly disseminated online — which is not accessible to everyone. This means that many communities may not be aware of the telephone numbers to call to access these services.
Further, telemedicine is not accessible to women who do not have mobile phones, and for those with limited funds required to make phone calls, if hotlines are not toll-free.
Standards under the right to health
States are bound by ratified [17] human rights treaties and conventions. Consequently, human rights treaty monitoring bodies at the regional level [18] and the global United Nations level [19] have developed standards universally accepted by states to measure and facilitate the realization of health care rights [20] — including maternal health.
The United Nations Committee on Economic Social and Cultural Rights [21] and Committee on the Elimination of all Forms of Discrimination against Women [22] developed General Comment 14 [23] and General Comment 22 [24], and General Recommendation 24 [25] respectively, outlining state obligations and standards toward realizing health rights.
At the regional level, the African Commission on Human and Peoples’ Rights [26] developed in 2014 the General Comment 2 [27] on the right to health, including reproductive health, provided for in Article 14 of the ground-breaking 2003 Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa – popularly referred to as the Maputo Protocol [28].
Collectively, these human rights instruments outline African states’ obligations to ensure that high-quality health care is available, acceptable and accessible to all, including access to health-related information and education.
Information must be available to all people on an equal basis and without discrimination — especially to vulnerable and marginalized populations such as those living in poverty, in rural and remote areas, and persons with disabilities.
Direct, public engagement
The use of diverse forms of information dissemination and communication ensures that all women — young and old, living in rural, peri-urban or urban areas, all income levels — have access to relevant health information.
Overall, states could do more to ensure the provision of accurate information to the public, including the use of conventional media such as TV, radio and newspapers and free mass texting through the Short Message Service (SMS) and USSD services.
Engagement with community leaders, activists, groups, community health workers and volunteers, also supports the open and transparent flow of information in communities with limited access to mobile phones, TVs, radios, newspapers, et cetera.
Regular access to health-related information — especially for women and girls — will undoubtedly improve access to maternal health care services. This will likely mitigate a projected increase in maternal and newborn mortality and morbidity in Africa during the COVID-19 pandemic.
Lydia Muthiani and Nelly Warega are human rights lawyers living and working in Kenya. They have specialized on the advancement of women’s and girls’ rights, and are part of Utu Wetu, a collective of human rights experts particularly working on women’s rights.