Document Type : Letter to The Editor


1 Department of Health in Disasters and Emergencies, Iran University of Medical Sciences, Tehran, Iran

2 Department of Health in Disasters and Emergencies, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran

3 Health Management and Economics Research Center, Department of Health in disasters and emergencies, Iran University of Medical Sciences, Tehran, Iran




Dear Editor


he World Health Organization had announced an emergency COVID-19 situation officially on March 11, 2020, and since then millions of people around the world have been infected (1). These emergency conditions have endangered both the public health and health care systems (1, 2). Coronavirus is considered a greater threat to people affected by complex crises and those living in camps without proper infrastructure and poor health systems (3). The field of health, especially reproductive and sexual health have been greatly affected by the turbulence caused by the coronavirus disease epidemic (4). Women and girls are affected differently from men during epidemics and are faced with a variety of risk factors that often need to be addressed urgently. Gender inequality is exacerbated in critical situations (5).

It is natural for health and medical care centers, including reproductive health facilities, to be closed due to transferring the resources to control the epidemic (6), and thus, reproductive health services are overlooked (5). Lack of health facilities and restriction in providing medical services including obstetrics and gynecology leads to an increase in maternal and infant mortality. For these reasons, thorough and careful planning with all the details is required for the performance and response of the medical personnel without any ethnic, racial, religious, or gender discrimination (7). Experiences from past epidemics have shown that women's participation in the response phase has been very influential and valuable. Therefore, educating women about disease control methods is one of the most important measures in vulnerable communities (6). In the pregnancy and childbirth services centers, before accepting a pregnant mother who is suspected of COVID-19, the necessary preparations such as creating an isolated room, providing PPE equipment, and measures to prevent the spread of the virus should primarily be taken place. The staff of the obstetrics and gynecology services should be educated and the officials of these centers should assure the correct perception of personnel regarding the ways of controlling the infection and managing the delivery of a pregnant woman infected with this disease. (8)

It is recommended that the localized guidelines for pregnancy and childbirth in COVID-19 disease be prepared for the management of clients in treatment centers in camps. Isolation of pregnant women is not completely recommended. It should be ensured that all women in the camp have easy access to emergency obstetric care, pre and postnatal monitoring, and abortion care (9). After delivery, if the mother and baby are kept separate, the breast milk should be handled hygienically and fed to the baby by a healthy person. On the other hand, if the mother and baby are kept nearby, it is recommended that the mother covers her face with a mask while breastfeeding and washes her hands with soap and water before breastfeeding (8).

Due to the concern about pregnancy in the conditions of the prevalence of the disease, the demand for receiving contraception services has increased (4). Moreover, quarantine practices reduce people's access to contraceptives, resulting in the expectation of the risk of unwanted pregnancies and an increase in unsafe abortions (10). In order to reduce the women’s referrals to medical centers and being exposed to risk, family planning instruments such as condoms, pills, and injectable contraceptives can be distributed among people within 3 months (9).

Quarantining individuals (6) due to close contact and group life (10), economic problems, and stress caused by epidemics increase the risk of sexual abuse, domestic violence, and various other forms of sexual violence, leading to unwanted pregnancy and abortion. The Ebola epidemic experience reported an escalation in sexual exploitation of women and children (5). Therefore, preventive measures against sexual violence, as well as an appropriate response to victims of sexual violence should be considered in the planning to deal with the COVID-19 crisis (6). Providing mental support services for women and girls who have been subjected to gender and sexual violence should also be considered in the planning to deal with COVID-19 (11). Consequently, in this situation, we must ensure that reproductive health services are provided in humanitarian settings and women and girls have access to sexual and reproductive health care.


Not applicable.

Funding source

No funding source was allocated to this study.

Conflict of interest

The author declares no conflict of interest.

Authors' contribution

All authors contributed to this project and article equally. All authors read and approved the final manuscript.


1. WHO. Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020. World Health Organization, accessed March 29, 2020. available from : https:// speeches/detail/who-director-general- s- opening- remarks- at- the- media-briefing- on-covid-19---11-march-2020. 
2. Boyd AT, Cookson ST, Anderson M, Bilukha OO, Brennan M, Handzel T, Hardy C, Husain F, Cardozo BL, Colorado CN, Shahpar C. Centers for Disease Control and Prevention public
health response to humanitarian emergencies, 2007–2016. Emerging infectious diseases. 2017;23(Suppl 1):S196.
3. Gostin LO, Sircar NR, Friedman EA. Fighting novel diseases amidst humanitarian crises. Hastings Center Report. 2019;49(1):6-9.
4.Ahmed Z, Sonfield A. The COVID-19 outbreak: Potential fallout for sexual and reproductive health and rights. Guttmacher Institute. Retrieved May. 2020;15:2020.
5. As pandemic rages, women and girls face intensified risks (News), United Nations Population Fund. 19.03.2020. available from : https:// pandemic- rages-women-and-girls-face-intensified- risks
6. Covid-19: Inclusive Programming – Ensuring Assistance And Protection Addresses The Needs of Marginalized And At-Risk People International Committee of The Red Cross
(Icrc) available from: https://resourcecentre. savethechildren. net/library/ covid-19-inclusive-programming- ensuring- assistance- and-protection- addresses-needs8.
7. Truelove S, Abrahim O, Altare C, et al. COVID-19: Projecting the impact in Rohingya refugee camps and beyond. Available at SSRN 3561565. 2020 Mar 22.
8. Interim Considerations for Infection Prevention and Control of Coronavirus Disease 2019 (COVID-19) in Inpatient Obstetric Healthcare Settings, Centers for Disease Control and Prevention(CDC). available from: 2019_covid-19_in_inpatient_ obstetric_ healthcare_ settings_ cdc.pdf
9. Scaling up COVID-19 Outbreak Readiness and Response in Camps and Camp Based Settings (jointly developed by IASC/ IFRC/ IOM/ UNHCR/ WHO). available from: scaling- up-covid-19-outbreak-readiness-and- response- in-camps-and-camp-based-settings-(jointly-developed-by-iasc-ifrc-iom-unhcr-who)
10. How will the coronavirus affect access to safe abortion? International Planned Parenthood Federation (IPPF) 20 March 2020. available from: https:// www. ippf. org/ blogs/how-will-coronavirus-affect-access-safe-abortion
11. Inter-Agency Standing Committee. Addressing mental health and psychosocial aspects of COVID-19 outbreak. See https:// interagency standing committee. org/system/ files/ 2020-03/IASC% 20Interim% 20Briefing% 20Note% 20on% 20COVID-19% 20Outbreak% 20Readiness% 20and% 20Response% 20Operations. 2020 Feb.
impact a forceful consequence; a strong effect More (Definitions, Synonyms, Translation)