COVID-19 and Sexual and Reproductive Health: Challenging Abstraction and Neutrality in Public Health Emergency Responses

Debora Diniz, Sinara Gumieri & Luna Borges

University of Brasília

Among the main debated constitutional implications of COVID-19 is the impact of state interventions to protect public health on individual rights and freedoms, such as lockdowns and mobility restrictions, mask and vaccine mandates. However, there are many highly impactful measures as well as failures to respond to a global health emergency that seem to fall under the scope of constitutional rights violations. This piece argues that one of the main causes for the lack of protection for structurally oppressed populations is public decision making based on an abstract idea of equality. A glaring example to support this argument is the exclusion of sexual and reproductive health services as essential during COVID-19. 

Neither the World Health Organization’s recommendations nor the mounting evidence from previous public health crises like Ebola or Zika showing that sexual and reproductive health services must be at the center of any emergency response were able to inspire action and prevent a compound crisis for women, girls, and people who can become pregnant. According to the Pan American Health Organization (PAHO), the continued disruption of sexual and reproductive health services due to COVID-19 is obliterating more than 20 years of progress in reducing maternal mortality and increasing access to contraceptives in Latin America and the Caribbean.

Just like all public health crises, COVID-19 reinforces the importance of urgent constitutional and global health justice developments in the realm of substantive equality, namely the need to do away with the “abstract person” as the one deserving of protection. When abstract equality is the standard thinking of legal and policy decision-making, the different ways in which a pandemic impacts diverse bodies are not taken into consideration. Thus, the public rationale is based on the idea that all bodies are equally vulnerable to the virus and its consequences. This kind of reasoning is a fragile code that masks the fact that some people are empowered enough by systems of privilege in each community to have their experiences and needs considered as the basis for political and legal actions. This is at the root of the most basic COVID-19 social distancing recommendations, as well as COVID-19 vaccine research and access. 

By urging people to stay at home without robust social protection provisions to do so, governments all over the world are deliberately ignoring the geopolitical, racial, class and gender inequalities that ultimately define who will bear the brunt of the pandemic. For the past 18 months, the world has been divided into those who have a home to retreat to and those who have no shelter, or those for whom home is a site of violence; those who can order food delivery and those who leave home to cook, serve, and deliver such food; those who are able to work, study, and socialize through high-speed internet connection and those who face food insecurity and lack of any digital connectivity when schools are closed.    

No public health emergency response is neutral to class, gender, race, or geopolitics. One urgent way to move past the harmful abstraction of the universal subject who is told to stay home, wear a mask, and wait their turn for the COVID-19 vaccine is to consider how bodies of people who can become pregnant will be affected not only by the disease itself, but also by how their sexual and reproductive health needs are or are not met. No emergency puts basic sexual reproductive health needs – like contraception, pregnancy and maternal health services, abortion care – on pause. Yet in emergency after emergency, the defunding and interruption of sexual and reproductive health services is not only normalized, but also seems to intensify under conservative or authoritarian governments.  

Brazil is one of the countries in which the government’s response to the pandemic has been driven by misinformation and fake cures. Racialized Brazilian women and girls, mostly Black, got caught in the intersection between Brazil’s inequitable public health responses and the fact that COVID-19 poses alarming pregnancy and postpartum mortality risk in countries with scant sexual and reproductive health services. It doesn’t stop there: because pregnant people have been neglected in COVID-19 vaccine research. The silver lining of the vaccine took even longer to reach them. For way too long, the Brazilian government failed to include pregnant and postpartum people in the priority group for getting the vaccine, and many advances were only secured by court decisions. 

During COVID-19, Black Brazilian women and girls have been caring for others, while having very little access to health services and social protection to care for themselves. Black women aged 16 to 49 make up 43% of Brazilian essential workers (including formal and informal jobs in health and social assistance, hospital cleaning and food services, customer service in restaurants and food retail), while white women represent 28% of these workers, Black men are 18% and white men, 11%. In this sector, there are 234% more Black people among low-income and informal workers than white people. Not by accident, Black women and girls are also at the epicenter of Brazil’s failing sexual and reproductive health care. According to PAHO, as of August 2021, the COVID-19 case fatality rate among pregnant and postpartum people in Brazil was almost nine times higher than the average in the Americas. National research shows that the risk of a pregnant or postpartum Black woman dying of COVID-19 is almost twice that of a white woman.

In public health, as in rights protection, abstract subjects and neutral responses perpetuate inequalities and keep us from becoming strong constitutional democracies. In May 2020, Lidiane Frazão became one of the almost 1,200 pregnant and postpartum women who have died of COVID-19 in Brazil so far. Lidiane was a Black woman pregnant with her second child, a single mother of an eleven-year-old boy, and a primary breadwinner working at her family’s business, a funeral home. She worked into her 40th week of pregnancy, when her blood pressure spiked, and she had an emergency C-section. After the birth, Lidiane struggled with shortness of breath, which was initially diagnosed as anxiety. She spent 16 days in the intensive care unit and died before her COVID-19 test result was released, but after receiving the ineffective and often harmful hydroxychloroquine treatment that is advocated by Bolsonaro to this day. Lidiane Frazão, a funeral worker, didn’t get to have a funeral. Her death has not been framed as the result of constitutional rights violations. We believe it should.  

Debora Diniz is a Professor at the Law Faculty at the University of Brasília, and a visiting scholar at Brown University. 

Sinara Gumieri is a Ph.D candidate in Law at the University of Brasilia.  

Luna Borges is a Ph.D candidate in Constitutional Law at the University of Brasilia.

Suggested Citation: Debora Diniz, Sinara Gumieri, Luna Borges, ‘COVID-19 and Sexual and Reproductive Health: Challenging Abstraction and Neutrality in Public Health Emergency Responses’ IACL-AIDC Blog (28 September 2021) https://blog-iacl-aidc.org/covid19-future-constitutionalism/2021/9/28/covid-19-and-sexual-and-reproductive-health-challenging-abstraction-and-neutrality-in-public-health-emergency-responses.