How will COVID-19 affect global access to contraceptives — and what can we do about it?

By Chris Purdy
WED, APRIL 15 2020-theG&BJournal-The outbreak of COVID-19 has induced fear across the world and impacted most of us in some form or another. There are reasons to think that there will be additional impacts on the availability of condoms and other contraceptives globally.
Firstly, many of the condoms and contraceptives in the world are manufactured in Asia. During the recent outbreak, many Chinese factories were shuttered and factory workers asked to stay home or work at reduced hours. Many of these contraceptive suppliers are not back to full capacity. As a result, the global health community now expects delays in production and shipping schedules. For example, family planning products and services provider DKT has reported stock-outs of implants in Myanmar, and we anticipate a condom shortage in Mozambique as delivery times from our Malaysian manufacturer have doubled from two to four months.
In addition, because many Asian production facilities provide critical raw materials to other manufacturers worldwide, there may be shortages in the near future. For example, we are already hearing that some pharmaceutical manufacturers in India are now expecting to experience slowdowns due to a lack of the requisite active pharmaceutical ingredients, or APIs, from their Chinese suppliers.
Over concerns of supply shortages, the Indian government has now prohibited manufacturers from exporting any products containing progesterone, a critical hormone used in many contraceptives. If manufacturers are forced to source from new API suppliers, this can trigger the need to reregister products with the relevant oversight bodies in some countries, a process that can take months or even years.
Other ripple effects of supply chain disruption should be expected. If labor forces are unable to resume workloads at full capacity or if packaging companies cannot supply on time, there will be additional stress on supply chains in the coming weeks and months. While factories are working to mitigate such risks, there are sufficient unknowns to warrant anticipated delays in production.
In addition, there is also a capacity issue for the health workers themselves. Given the increase in cases worldwide, we are hearing reports that health workers are asking patients who present with fevers to reschedule visits if they are receiving services for noncritical procedures such as an IUD insertion or family planning counseling visit.
As concern grows around transmission of COVID-19, we are seeing heightened vigilance by oversight bodies, including around the import, freight, and clearance of contraceptives and all other shipments. There is an increase in scrutiny and requests for paperwork on products arriving from other countries, resulting in delays in clearance approvals. In Uganda, delays and complications in shipping from Asia may result in a lack of condoms as we wait for two containers to arrive. In Iran, which has a large number of coronavirus cases, imports of intrauterine devices have been halted due to restrictions on transportation into the country.
In countries where inventories are not well managed, such delays will result in stock-out situations in the weeks ahead.
Most countries require some kind of regulatory approval for the import of contraceptives, and many countries demand that such approvals be renewed on a periodic basis. These approvals often require site visits to the manufacturer as well as the provision of significant paperwork that is generated by the factories and often certified by national agencies. Many businesses and governments have already taken the decision to limit travel, and some nations have closed their borders to visitors from select countries.
Without such travel, it is a sure bet that approvals and reauthorizations of some contraceptive products will be delayed for months at the least. Obtaining paperwork required for these approvals is an onerous process in the best of circumstances. Should ministries of health and related agencies redirect their resources to address the new coronavirus, obtaining the requisite certifications will almost surely require more time and work.
Like many other sectors of the economy, business is slowing down. Gatherings and meetings for clinicians, medical workers, or donors, which are designed to accelerate action around increasing access to contraception, have been postponed or have seen travel curtailed.
Medical detailers and salespeople — who, under normal circumstances, would be visiting doctors and pharmacies to ensure product availability — are finding that the doctors and midwives won’t meet with them now, as is the case in Myanmar. In China, sales of condoms to motels and hotels have come to a halt, although condom sales through vending machines appears to be on the rise, according to our sales team.
And from major wholesalers and periurban pharmacies to small roadside shops, entrepreneurs are increasingly holding onto cash or investing in face masks and antiseptic gels instead of stocking up on contraceptives. Experience suggests they will order the minimum required amounts or reduce the range of products on offer. Such actions serve to both reduce choice for consumers but also increase the chances of a stock-out at the local level.
Recommendations
Those who work in the field of family planning will want to examine and address these issues where relevant.
To mitigate risks, build inventories to reduce stock-outs, and take measures to reduce the potential impact on women and men who want and need contraception, here are a few suggestions:

1. Don’t panic. A steady hand and informed mind improves decision-making. So far, the impact of the new coronavirus, while concerning, is not insurmountable. We must also remind ourselves of the context. Each year, millions of people are diagnosed with or die from malaria, HIV, and unsafe abortions. The health impact of COVID-19 is still negligible in comparison. It is the uncertainty that causes panic.

Those who work in the field of family planning will want to examine and address these issues where relevant.
To mitigate risks, build inventories to reduce stock-outs, and take measures to reduce the potential impact on women and men who want and need contraception, here are a few suggestions:

1. Don’t panic. A steady hand and informed mind improves decision-making. So far, the impact of the new coronavirus, while concerning, is not insurmountable. We must also remind ourselves of the context. Each year, millions of people are diagnosed with or die from malaria, HIV, and unsafe abortions. The health impact of COVID-19 is still negligible in comparison. It is the uncertainty that causes panic.
2. Where possible, programs that provide contraception should invest in inventory now to avoid potential stock-out situations in the months ahead — particularly given the fact that we do not have a clear picture of the longevity of this crisis. Cash liquidity may be an issue since stocking up on inventory comes with a price tag.
3. To reduce uncertainty among business people who stock contraceptives, family planning organizations may want to consider finding ways to offset risk with special discounts and promotions.
4. Counseling and support to family planning health care providers may help them better support couples exploring their contraceptive options.
5. Organizations should ensure their own employees are well informed and supported, with free flu shots, hand sanitizer, and plenty of reassurance.

COVID-19 may be changing the way many of our societies operate and, as of today, it’s unclear how long these changes will last. In the meantime, it behooves those committed to ensuring access to contraception to prepare as best as they can for what are sure to be shortages and strains on the health care systems that deliver such products and services.
Chris Purdy is the President and CEO of DKT International
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