key: cord-0942325-575cvubk authors: Bar-Zeev, S.; Breen-Kamkong, C.; Ten-Hoope Bender, P.; Sahbani, S.; Abdullah, M. title: UNFPA supporting midwives at the heart of the COVID-19 response date: 2020-08-25 journal: Women Birth DOI: 10.1016/j.wombi.2020.08.005 sha: 9cba86754f22cf1801f1f7659539329930c5a053 doc_id: 942325 cord_uid: 575cvubk nan Author details a. Bar-Zeev, S.* b. Breen-Kamkong, C. c. Ten-Hoope Bender, P d. Sahbani, S. e. Abdullah, M. The novel coronavirus (SARS-CoV-2) that causes COVID-19 emerged in late 2019 and the outbreak was declared a global pandemic by the World Health Organization in March 2020 1 . As the world has begun to deal with the full impact of this pandemic, low-and middle-income countries are facing a series of challenges: Communities are facing loss of livelihoods and incomes, uncertainty for their future, fear and stigma. Weak and poorly equipped health systems are struggling with break-downs in supply chains, lack of adequate water and sanitation facilities, capacity constraints within the health system, including the ability to address training and personal protective equipment (PPE) needs of health care providers, as well as limited ability to provide testing and treatment services for those infected with coronavirus 2 . In many of these settings, midwives are being redeployed away from providing their essential core services and women are being denied access to life saving and time critical services. Women are being actively discouraged from, or are afraid to seek care at health facilities. In Kenya, at the beginning of the outbreak media reports indicated that strict night time curfews have confined women to their homes, and on one night in April 2020, four women died due to delays accessing emergency obstetric and J o u r n a l P r e -p r o o f newborn care because of these strict curfews 3 . In Uganda, a pregnant woman experiencing a placental abruption, unable to access transportation services as a result of the lockdown, walked almost two hours to reach a health facility. She and her unborn child died soon after. As of this writing, Uganda has reported no COVID-19 deaths, but seven women have died in similar tragic circumstances 4 . Women and girls in lockdown have less access to protective services in case of intimate partner-or family violence or abuse. Unemployment, with consequent poverty and undernutrition is straining families, especially women and children. Sexual agency and the right to be free from abuse or discrimination needs extra protection during periods of upheaval and sudden economic disempowerment 5 . Women's and adolescent girls' menstrual hygiene needs do not change during an emergency. However, adequate and dignified menstrual hygiene management is often overlooked during an emergency including during COVID-19 pandemic 6 . Sexual and reproductive health demands sustained attention and investment even in the midst of an appropriate pandemic response. Affording women and girls the quality care that is their right means prioritizing systems to facilitate access and availability. Sexual and reproductive health services must continue to be essential services that are continued during the pandemic and persons with local authority should support access and not hinder it for fears of pandemic transmission. Midwives are an essential and limited human resource; highly educated and skilled at providing sexual and reproductive health care across the continuum for girls and women, and their newborns. They should be dedicated for this purpose, and be protected from pressures to provide general care to COVID-19 patients. They should be protected from infection, by access to sufficient PPE and have a safe work environment dedicated for providing sexual, reproductive, maternal and newborn health care (SRMNH), and be free from violence, stigma and discrimination 7 . Midwives, as one of the main frontline female health workers, are under a lot of strain, not only physically but also mentally due to their double caring role at work and at home. Across Asia and the Pacific, UNFPA works in partnership with partners and local authorities to ensure essential SRH services are functioning and accessible for all the women who need them. In Bangladesh, UNFPA has supported health authorities to set-up special maternity areas where UNFPA-trained midwives have been delivering care to pregnant women affected by COVID-19 with supplies and PPE procured by UNFPA. Mentoring support has also been provided to midwives to ensure that evidencebased care is provided and that midwives are supported at this challenging time. Access to crucial SRH information becomes of the utmost importance at a time when many countries have imposed lockdowns and restrictions on movement: in Nepal, a popular phone-in radio programme J o u r n a l P r e -p r o o f World Health Organization. WHO Director-General's opening remarks at the media briefing on Challenges of COVID-19 in children in low-and middle-income countries The COVID-19 nightmare for pregnant women. Daily Nation Kenya In Uganda, mothers die in labour amidst coronavirus lockdown. Reuters News Estimates of the Potential Impact of the COVID-19 Pandemic on Sexual and Reproductive Health in Low-and Middle-Income Countries Mitigating the impacts of COVID-19 on menstrual health and hygiene Global Call to Action: Protecting Midwives to Sustain Care for Women, Newborns and their Families in the COVID-19 Pandemic Factors Associated with Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease