In Tunisia, Women's Healthcare Is Collateral Damage Of COVID-19

The pandemic added an extra layer of obstacles for patients with already limited access to quality attention for their sexual and reproductive health needs.

Checking a patient's blood pressure at a hospital in Tunis on May 11
Frida Dahmani

TUNIS — Malek has been nursing for three weeks, but she still can't believe her eyes. "This birth is a small miracle," she says. "I was very afraid of the coronavirus and that something would happen to the baby."

The young mother says the anguish and confinement made her see the virus everywhere, even though she delivered her child in a private clinic where all precautions were taken. As her obstetrician, Faouzi Ariane, explains: "My facility has the strictest hygiene rules. It was especially important to manage the apprehensions of new parents."

For him, the coronavirus has not changed the well-established routine of gynecological procedures. But that's not been the case for all pregnant women. A survey conducted by the Tawhida Ben Cheikh Group and the Tunisian Association of Midwives (ATSF) found that during confinement, 10% of Tunisian women gave birth at home — far more than the usual 0.1%.

"Each birth has its own story," says Jamila, a midwife in Menzel Bourguiba, near Bizerte. "Some women had no means of transport, others were in an emergency and physically unable to move."

The anguish and confinement made her see the virus everywhere.

Jamila was even more concerned about the quality of the support she could provide to patients when she lacked the minimum equipment required.

"The equipment went first and foremost to the medical professionals dedicated to the care of COVID-19," she says. "We were able to rely on civil society to provide masks, gloves and gowns. I didn't want to be a danger to a mother-to-be, but I also wanted to protect myself because I'm in a hospital environment where no one is safe from infection."

The midwife also noted a lack of respect for patient triage and access routes in some hospitals.

"Curfews and widespread confinement, as well as the fear of contamination, create additional difficulties for women, especially during childbirth or in reproductive health emergencies," says the Tawhida Ben Cheikh Group, named after the first Tunisian woman gynecologist who pioneered family planning in the early 1960s. "There is a real risk of an increase in home deliveries and underground abortions, with the complications that can result."

There are approximately 2,200 practicing midwives in Tunisia. Together they oversee 210,000 births and nearly 1 million prenatal visits per year while dealing with the challenges of the country's reproductive health sector. From the beginning of the pandemic, maternal and neonatal health consultants as well as contraception and abortion service providers have faced obstacles.

A health worker seen at Tunis's Charles-Nicolle hospital on May 11 — Photo: Jdidi Wassim/SOPA/ZUMA

The results of the study on pregnant women are indisputable: The deterioration of sexual and reproductive health (SRH) service delivery in frontline settings is a cause for concern, as is the closure of some centers of the National Office for Family and Population (ONFP). This is due to a lack of adequate information on the virus and on protection procedures, as well as the poor dissemination of guidelines and codes of conduct. These shortcomings are at the root of the complications encountered in accessing essential sexual and reproductive health services.

Dr. Amira Yaacoubi denounces this attempt to reduce women's right to health and self-determination. "Under the pretext of the pandemic, three family planning centers have closed," she says.

Women's health is threatened by increased domestic violence, morbidity and unsafe abortions.

A midwife from Douz adds that it's also a question of inequalities between territories. She notes, for example, that the United Nations Development Program has been warning since 2012 of the persistence of maternal mortality in southern Tunisia.

"Access to healthcare is not easy. Populations are scattered and means of transport are not always available," says Dr. Hédia Belhaj, president of the Tawhida Ben Cheikh group, who is particularly concerned about the decline in family planning.

She initiated an appeal, signed by some 50 associations and 70 personalities, urging the Ministry of Health to resume frontline services, including prenatal and postnatal consultations, contraception and medical abortions.

Women's health is threatened by increased domestic violence, morbidity and unsafe abortions. Pregnant women face challenges accessing services to monitor their pregnancy and identify any potential risks. The coronavirus pandemic has only exacerbated these issues.

Dr. Belhaj attributes the deterioration in sexual and reproductive health, which began long before the pandemic, to a lack of leadership from the ONPF and government support. She also highlights the emergence of a conservatism that often conveys erroneous or ideological messages.

"Not only is contraceptive use declining due to a shortage of contraceptives, but also many women are denied abortions for non-medical reasons," she says.

*This article was translated and published with permission of the author.

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Thousands of migrants in Del Rio, Texas, on the border between Mexico and the U.S.

Hannah Steinkopf-Frank, Bertrand Hauger and Anne-Sophie Goninet

👋 Сайн уу*

Welcome to Friday, where the new U.S.-UK-Australia security pact is under fire, Italy becomes the first country to make COVID-19 "green pass" mandatory for all workers, and Prince Philip's will is to be kept secret for 90 years. From Russia, we also look at the government censorship faced by brands that recently tried to promote multiculturalism and inclusiveness in their ads.

[*Sain uu - Mongolian]


• U.S. facing multiple waves of migrants, refugees: The temporary camp, located between Mexico's Ciudad Acuña and Del Rio in Texas, is housing some 10,000 people, largely from Haiti. With few resources, they are forced to wait in squalid conditions and scorching temperatures amidst a surge of migrants attempting to cross into the U.S. Meanwhile, thousands of recently evacuated Afghan refugees wait in limbo at U.S. military bases, both domestic and abroad.

• COVID update: Italy is now the first European country to require vaccination for all public and private sector workers from Oct. 15. The Netherlands will also implement a "corona pass" in the following weeks for restaurants, bars and cultural spaces. When he gives an opening speech at the United Nations General Assembly next week, unvaccinated Brazilian President Jair Bolsonaro will defy New York City authorities, who are requiring jabs for all leaders and diplomats.

• U.S. and UK face global backlash over Australian deal: The U.S. is attempting to diffuse the backlash over the new security pact signed with Australia and the UK, which excludes the European Union. The move has angered France, prompting diplomats to cancel a gala to celebrate ties between the country and the U.S.

• Russian elections: Half of the 450 seats in Duma are will be determined in today's parliamentary race. Despite persistent protests led by imprisoned opposition leader Alexey Navalny, many international monitors and Western governments fear rigged voting will result in President Vladimir Putin's United Russia party maintaining its large majority.

• Somali president halts prime minister's authority: The decision by President Mohamed Abdullahi Mohamed marks the latest escalation in tensions with Prime Minister Mohamed Hussein Roble concerning a murder investigation. The move comes as the Horn of Africa country has fallen into a political crisis driven by militant violence and clashes between clans.

• Astronauts return to Earth after China's longest space mission: Three astronauts spent 90 days at the Tianhe module and arrived safely in the Gobi desert in Inner Mongolia. The Shenzhou-12 mission is the first of crewed missions China has planned for 2021-2022 as it completes its first permanent space station.

• Prince Philip's will to be kept secret for 90 years: A British court has ruled that the will of Prince Philip, the late husband of Britain's Queen Elizabeth who passed away in April at 99 years old, will remain private for at least 90 years to preserve the monarch's "dignity and standing."


With a memorable front-page photo, Argentine daily La Voz reports on the open fight between the country's president Alberto Fernández and vice-president Cristina Kirchner which is paralyzing the government. Kirchner published a letter criticizing the president's administration after several ministers resigned and the government suffered a major defeat in last week's midterm primary election.



An Italian investigation uncovered a series of offers on encrypted "dark web" websites offering to sell fake EU COVID vaccine travel documents. Italy's financial police say its units have seized control of 10 channels on the messaging service Telegram linked to anonymous accounts that were offering the vaccine certificates for up to €150. "Through the internet and through these channels, you can sell things everywhere in the world," finance police officer Gianluca Berruti told Euronews.


In Russia, brands advertising diversity are under attack

Russian sushi delivery Yobidoyobi removed an advertisement with a Black man and apologized for offending the Russian nation, while a grocery chain was attacked for featuring an LGBTQ couple, reports Moscow-based daily Kommersant.

❌ "On behalf of the entire company, we want to apologize for offending the public with our photos..." reads a recent statement by Russian sushi delivery Yobidoyobi after publishing an advertisement that included a photograph of a Black man. Shortly after, the company's co-founder, Konstantin Zimen, said people on social media were accusing Yobidoyobi of promoting multiculturalism. Another recent case involved grocery store chain VkusVill, which released advertising material featuring a lesbian couple. The company soon began to receive threats and quickly apologized and removed the text and apologized.

🏳️🌈 For the real life family featured in the ad, they have taken refuge in Spain, after their emails and cell phone numbers were leaked. "We were happy to express ourselves as a family because LGBTQ people are often alone and abandoned by their families in Russia," Mila, one of the daughters in the ad, explained in a recent interview with El Pais.

🇷🇺 It is already common in Russia to talk about "spiritual bonds," a common designation for the spiritual foundations that unite modern Russian society, harkening back to the Old Empire as the last Orthodox frontier. The expression has been mocked as an internet meme and is widely used in public rhetoric. For opponents, this meme is a reason for irony and ridicule. Patriots take spiritual bonds very seriously: The government has decided to focus on strengthening these links and the mission has become more important than protecting basic human rights.Russian sushi delivery Yobidoyobi removed an advertisement with a Black man and apologized for offending the Russian nation, while a grocery chain was attacked for featuring an LGBTQ couple, reports Moscow-based daily Kommersant.

➡️


"Ask the rich countries: Where are Africa's vaccines?"

— During an online conference, Dr. Ayoade Olatunbosun-Alakija, of the African Vaccine Delivery Alliance, implored the international community to do more to inoculate people against COVID-19 in Africa and other developing regions. The World Health Organization estimates that only 3.6% of people living in Africa have been fully vaccinated. The continent is home to 17% of the world population, but only 2% of the nearly six billion shots administered so far have been given in Africa, according to the W.H.O.

✍️ Newsletter by Hannah Steinkopf-Frank, Bertrand Hauger and Anne-Sophie Goninet

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