By: John Kennedy Mosoti, UNFPA Representative for Bosnia and Herzegovina

The COVID-19 pandemic has left a trail of devastation in its wake: health systems overwhelmed, economies in a downward spiral, people’s futures in doubt. The “new normal” hardly includes any normality at all. And as the virus keeps spreading at an alarming rate, the vulnerabilities of global and national systems have been exposed, leaving many countries with tough decisions to make: How to balance the demands of responding emphatically and decisively to COVID-19 while ensuring that other necessary services continue to be provided?

In particular, the pandemic has pushed health-care systems to their limits and compelled governments and health-care institutions to make difficult, and increasingly urgent choices about how to deliver care. But by highlighting existing gaps when it comes to sexual and reproductive health, the pandemic has also made the case for embracing a comprehensive approach to health care, both now and after the recovery period.
Given the unprecedented scale and impact of COVID-19, and the sheer panic it has brought about, it is critical that responses to this crisis recognize that sexual and reproductive health services are essential while respecting people’s rights to make decisions about their bodily autonomy and integrity. 

Quality sexual and reproductive health services are essential to the well-being of all people, especially women and girls. The need for these services does not disappear during a pandemic. In fact, restrictions put in place to contain the spread of COVID-19 can also negatively affect access to essential reproductive, maternal, newborn, child, and adolescent health services.

While the global response has rightly focused on reducing the spread of COVID-19 and treating those infected with the disease, we know that girls and women – particularly amongst the poorest and socially marginalized groups – are likely to be most affected by the pandemic. And even though the global community recognizes and has developed guidelines to address their unique vulnerabilities, the sexual and reproductive health needs of women and girls continue to be not fully met during times of crisis. This situation is exacerbated for women who are pregnant or new mothers.
A number of maternal deaths have been reported by the media in Bosnia and Herzegovina (BiH) during COVID-19 pandemic, raising questions about whether they could have been prevented. Though we hope that such cases do not become commonplace, it would be derelict of us to ignore these warning signs given the magnitude of the challenges we face. The relevant BiH health authorities were notably forthcoming about discussing the cases, promising to investigate and take necessary measures. Such urgent action is crucial.

BiH has a good health-care system, has worked steadfastly toward genuine universal health care, and rightly prides itself on having zero maternal mortality at a time when many other countries are reeling from unacceptably high maternal mortality rates. This success has been achieved as a result of immense investments in knowledge management, best practices, information sharing, training, and care for pregnant women and mothers. But as good as the situation may be, a rigorous assessment needs to be carried out of the system, especially how it responds to vulnerable or marginalized members of society. With health facilities and health-care workers overwhelmed by COVID-19, women are understandably anxious about accessing medical services, especially reproductive health services, including those for prenatal care, delivery, and postnatal care. The health of women, especially pregnant women and new mothers, must be a priority, whether there is a crisis or not. 

One of the key lessons we are quickly learning about the “new normal” is that it does not mean the end is in sight. Other pandemics will likely come along, so we must maintain our vigilance. No matter how efficient the infrastructure, any system is only as strong as its weakest link. The determination and dedication shown by health workers are undermined by systemic gaps that leave out the most vulnerable, as the recent cases of maternal mortality in BiH demonstrate.

As the United Nations sexual and reproductive health agency, UNFPA is closely monitoring and working with its partners, governments, and other UN agencies to address the challenges faced by pregnant women and new mothers, in BiH and globally. This is part of our commitment to ensure that every pregnancy is wanted, every birth is safe and the potential of every young person is fulfilled. UNFPA continues to work with ministries of health in developing strategies for sexual and reproductive health and clinical guidelines for improving the quality of women’s health care related to pregnancy and childbirth, and in implementing the Obstetric Surveillance and Response System to prevent life-threatening complications for pregnant women.

Currently, UNFPA is also working with its partners on developing COVID-19 patient pathways in health-care institutions, especially focusing on mothers; building digital applications and a call centre for COVID-19-related support to citizens while strengthening self-help groups; and expanding a counselling programme, call centre and an application for mothers and pregnant women to help them navigate pregnancy and childbirth during the pandemic.

Despite the laudable job done by our health care front-line workers, and the optimism about an imminent vaccine against COVID-19, we must continue working to further strengthen responses until a lasting solution is found. The following actions can help protect pregnant women and new mothers, now and in the long term:
•    Recognize that sexual and reproductive health is important to everyone. The 2030 Agenda for Sustainable Development elevates as a core principle the objective to “leave no one behind.” Any actions to effectively respond to crisis situations must prioritize the delivery of sexual and reproductive health services – not just during the crisis phase, but also before its onset, during the recovery and beyond. 
•    Prioritize mothers and pregnant women in our health-care response. 
•    Simplify the protocols that relate to new mothers and pregnant women and identify dedicated resources to expand prevention measures as well as testing and treatment of pregnant women and mothers during this pandemic.
•    Strengthen health systems to provide equitable access, with emphasis on embracing a comprehensive approach to health care that will continue after the crisis abates.

The recent cases of maternal mortality in BiH remind us of our obligation to the most vulnerable and marginalized members of society. Caring for pregnant women and new mothers is not just a moral imperative but make economic sense, especially in a region struggling with low fertility and high out-migration. We can, should, and know how to do better. Let’s go forth and do it.