通过大流行病维持性健康与生殖健康
正文 · 中文译文
来自九个国家的研究证据为未来应急准备提供参考 当新冠疫情使泰国孔敬府的新妈妈们无法前往医院时，诊所主动上门服务。护士在产后五周打电话联系产妇，而不是让她们来医院，在出院前提供皮下埋植避孕剂，并通过邮寄将药物送到患者家中。在九个国家中，这样的见证展示了疫情期间如何维持性与生殖健康保健服务，以及服务缺失时发生了什么。 刚完成的一期增刊发表于《生殖健康》期刊，包含来自九个国家的14篇论文，由联合国开发计划署/联合国人口基金/联合国儿童基金会/世界卫生组织/世界银行人类生殖研究、发展和研究培训特别规划署（HRP）与世界卫生组织（WHO）牵头，合作伙伴来自巴西、布基纳法索、中国、加纳、意大利、肯尼亚、巴基斯坦、泰国和英国，追踪了危机高峰期至恢复期间的健康机构、服务对象和卫生工作者。 第一个教训几乎贯穿每个国家：性与生殖健康服务在未被优先考虑的地方受损最严重。在巴西部分地区，产前和产后护理得以继续，但避孕服务的优先级下降了。一位女性报告称，她花了一年多时间试图检查她的宫内节育器（IUD）。其他人则在没有任何医疗建议的情况下自行更换了避孕方法，将口服避孕药换成了避孕套。 第二个教训是灵活服务的必要性。应对得最好的服务是那些愿意走出诊所的服务。加纳和巴基斯坦的社区卫生工作者将护理带入因封锁而被切断的社区。布基纳法索的社区化服务覆盖了无法出行的人群。在巴西和英国，任务转移、延长处方有效期以及自我护理支持使设施资源紧张时仍能获得服务。中国同样将性与生殖健康纳入国家COVID-19应对，利用远程医疗、分诊和重新调配的人员来维持护理运转。最后，数字工具改变了人们获得护理的方式。在意大利维罗纳，第一通电话成为获得流产、避孕和性传播感染服务的入口，服务对象称其快捷且令人安心。在英格兰，服务通过确保专项资金、提供远程医疗和新的物资供应方式来适应疫情。在布基纳法索、加纳和巴基斯坦，社区卫生工作者和社区化服务将护理带出设施围墙，覆盖了因封锁而被切断的人群。 该补充材料还提供了关于照护在何处以及为何中断的证据。恐惧使许多人远离：在布基纳法索，由于女性担心感染和隔离，计划生育需求下降，服务提供者后来发现意外妊娠和堕胎并发症增多。各国普遍存在避孕和堕胎服务恢复最慢的情况，受制于人员短缺、人员重新调配和供应中断。在加纳，远程医疗可用，但未延伸至性与生殖健康领域。在巴西，政治领导人发出的相互矛盾的信息削弱了公众对健康指导的信任。在巴基斯坦信德省，女性与卫生工作者描述，随着工作岗位消失，家庭暴力上升，但在所研究的九家机构中，仅有一家在过去六个月内拥有接受过应对基于性别的暴力培训的服务提供者。正如研究人员所指出的，大流行与其说制造了这些缺口，不如说揭示了它们。 这些证据所提出的建议归结为将行之有效的做法变为常态。这意味着在下一次紧急情况开始之前，而非进行到一半时，就将性与生殖健康服务列为基本服务。这意味着制定规则，让护士、社区卫生工作者和服务对象本人承担更多工作，并在需要之前就准备好远程选项。这也意味着关照那些在所有上述国家中让服务大门保持开放的卫生工作者。 我们衷心感谢所有合作伙伴和国家团队，正是他们的协作使这项工作得以完成；也感谢分享自身经历的妇女、男子和卫生工作者。
正文 · 英文原文
Evidence from nine countries informs future emergency preparedness When COVID-19 kept new mothers in Khon Kaen, Thailand, away from hospital, the clinic went to them. Nurses phoned women five weeks after birth instead of calling them in, offered contraceptive implants before discharge, and sent medicines to patients' homes by post. Across nine countries, testimonials like this show how sexual and reproductive health care was kept alive during the pandemic, and what happened where services were absent. A just completed supplement of 14 papers across nine countries published in Reproductive Health, led by the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) and the World Health Organization (WHO), with partners in Brazil, Burkina Faso, China, Ghana, Italy, Kenya, Pakistan, Thailand and the United Kingdom, followed health facilities, clients and health workers through the peak of the crisis and into recovery. The first lesson runs through almost every country: sexual and reproductive health services suffered most where they were not prioritized. In parts of Brazil, antenatal and postpartum care continued, but contraception slipped down the list. One woman reported having spent more than a year trying to get her intrauterine device (IUD) checked. Others simply switched methods on their own, swapping pills for condoms without any medical advice. The second lesson is the necessity of flexible services. The services that coped best were those willing to leave the clinic behind. Community health workers in Ghana and Pakistan carried care into neighbourhoods that lockdowns had cut off. Community-based delivery in Burkina Faso reached people who could not travel. In Brazil and the United Kingdom, task-shifting, prescriptions of longer duration, and support for self-care allowed access to services when facilities were stretched. China likewise built sexual and reproductive health into its national COVID-19 response, using telehealth, triage and redeployed staff to keep care moving. Lastly, digital tools changed how people reached care. In Verona, Italy, a first phone call became the front door to abortion, contraception and STI services, and clients described it as quick and reassuring. In England, services adapted to the pandemic by ensuring dedicated funding and providing telemedicine and new approaches to supplies. In Burkina Faso, Ghana and Pakistan, community health workers and community-based delivery carried care beyond facility walls, reaching people whom lockdowns had cut off. The supplement also offers evidence on where and why care broke down. Fear kept many people away: in Burkina Faso, demand for family planning fell as women worried about infection and quarantine, and providers later saw more unintended pregnancies and complications from abortion. Across countries, contraception and abortion care were among the slowest services to recover, held back by staff shortages, redeployment and supply failures. In Ghana, telemedicine was available but did not extend to sexual and reproductive health. In Brazil, conflicting messages from political leaders undermined public trust in health guidance. In Sindh, Pakistan, women and health workers described rising violence at home as jobs disappeared, yet only one of the nine facilities studied had providers trained in responding to gender-based violence in the previous six months. As the researchers note, the pandemic did not create these gaps so much as reveal them. The recommendations from this evidence come down to turning what works into the norm. That means framing sexual and reproductive health services as essential before the next emergency begins, not halfway through it. It means writing rules that let nurses, community health workers and clients themselves take on more, and having remote options in place before they are needed. And it means looking after the health workers who, in every one of these countries, kept the doors open. We are sincerely grateful to all partners and country teams whose collaboration made this work possible, and to the women, men and health workers who shared their experiences.