When Shali Iminza, 27, missed her period in March, the married mother of three felt her stomach sink with dread. Iminza, whose first name has been changed for privacy reasons, works as a farmer in western Kenya, and her husband is a motorcycle taxi driver. Together, they barely make enough money to feed their family. “Sometimes we eat three times [per day], sometimes two,” Iminza told Foreign Policy and Type Investigations over the phone. “Things are very expensive, and to get money nowadays, it’s hard.”
Unable to care for another child, Iminza visited a local health clinic, walking more than 3 miles to save money on the taxi fare. When she arrived, the doctor informed Iminza that the pills she would need to terminate her pregnancy were unavailable because of shortages caused by the novel coronavirus. “I’m very angry because the more the days are going, the pregnancy is now growing, so I don’t know what to do,” said Iminza, her voice trembling from stress.
COVID-19 has created delays and disruptions in every step of the supply chain that brings critical safe abortion medication and contraceptives from Asia to East Africa—halting factory production, delaying air and sea shipments, complicating customs approvals, and restricting in-country transport from seaports and airports to hospitals, pharmacies, and health care clinics. Lockdowns and curfews have added to the crisis, preventing women from traveling to clinics to get critical family planning and reproductive health care, and blocking service providers from conducting outreach in hard-to-access rural areas.
The outcome could be disastrous for women and girls, according to experts, who expect to see a rise in unintended pregnancies and unsafe abortions in a region where thousands of women already die each year due to restrictive abortion laws and lack of access to reproductive health care and family planning supplies.
The reproductive health organization Marie Stopes Kenya, which normally operates 20 centers and 15 mobile outreach teams, has been forced to temporarily suspend its outreach programs because of Kenya’s curfew and restrictions on movements and group gatherings. In just one day, the organization says it received around 300 WhatsApp messages from women and girls inquiring if the clinics were still open and what their operating hours were.
Marie Stopes Kenya estimates that if service provision continues to be severely restricted from April through December, a worst-case scenario, the organization could be prevented from averting nearly 100,000 unintended pregnancies, 65,000 unsafe abortions, and 500 maternal deaths. “It can be just as deadly as COVID-19 itself if we turned away and closed our doors,” said Sophie Hodder, Marie Stopes Kenya’s country director.
This spring, DKT International, one of the world’s largest providers of contraception and safe abortion products and services, ran extremely low on its stock of medical abortion pills for its Kenya program when thousands of packs got stuck at the New Delhi airport for nearly six weeks due to air cargo delays. “RE: Kenya shipment, 20,000 packs of MA KARE [the abortion pill mifepristone oral] lying at Airport : Will have to wait till airport opens as it cannot be moved anywhere now,” an email from an Indian pharmaceutical manufacturer to DKT Kenya read.
DKT International had read the warning signs earlier in the year. In January, the organization experienced shipping delays in batches of condoms from Thailand. In February, one of DKT’s India programs ran out of medical abortion pills because the active pharmaceutical ingredient in the pills came from China, the epicenter of the COVID-19 epidemic at the time.
DKT International rushed to place emergency orders of contraceptives and medical abortion pills from Asian manufacturers. Luckily, it managed to accumulate enough buffer stock to fill all incoming orders in East Africa while the medical abortion pills were held up in the Indian airport. DKT Kenya just received its long-awaited shipment of MA-Kare through Kenya’s main airport last week. But the organization says the delays pushed them to the brink. “If there had been another month of delays, we would have likely run out of stock,” said Lauren Archer, DKT Kenya’s country director.
As manufacturing in Asian countries hit hard by COVID-19 stalled in the early months of this year, factories temporarily stopped producing critical raw materials for products such as condoms and intrauterine devices and medications including emergency contraception pills and medical abortion pills. The manufacturing shutdowns created temporary delays in filling orders and resulted in backlogs in supplying key reproductive health medications and commodities to countries around the world.
Severe lockdowns and restrictions on pharmaceutical exports in countries like India compounded the manufacturing delays. Even as some nations have recommenced production of critical commodities and medications, many of these goods still cannot leave their countries of origin.