Global responses to the coronavirus disease 2019 (COVID-19) pandemic are converging with pervasive, existing Voluntary Family Planning and Reproductive Health Care and justice inequities to disproportionately impact the health, wellbeing, and economic stability of women, girls, and vulnerable populations. People whose human rights are least protected are likely to experience unique difficulties from COVID-19. Women, girls, and marginalised groups are likely to carry a heavier burden of what will be the devastating downstream economic and social consequences of this pandemic. A Voluntary Family Planning and Reproductive Health Care and justice framework—one that centres human rights, acknowledges intersecting injustices, recognises power structures, and unites across identities—is essential for monitoring and addressing the inequitable gender, health, and social effects of COVID-19.
The complex interplay between biological and behavioural risk factors needs to be recognised during the COVID-19 pandemic. It is not yet known whether the higher COVID-19 case fatality rates reported in men compared with women in China, South Korea, and Italy to date are attributed to gender-specific biological susceptibility, variations in pre-existing comorbidities, behavioural risk factors, or some combination of these factors. In terms of behavioural risk factors, women's risk of contracting COVID-19 may be higher than men's risk as women are front-line providers, comprising 70% of the global health and social care workforce, and they do three times as much unpaid care work at home as men. Moreover, pregnant women could be at risk of pregnancy-related complications during the COVID-19 pandemic. Severe acute respiratory syndrome and Middle East respiratory syndrome were associated with increased risk of pregnancy-related morbidity and mortality, but data on COVID-19 are scarce.
In China, among nine women in their third trimester with COVID-19, clinical outcomes were similar to non-pregnant adults. Yet another study of 33 neonates born to mothers with COVID-19 identified intrauterine vertical transmission of COVID-19 in three neonates. However, studies to date have been based on third trimester cases and viral infections during pregnancy are typically most severe during the first 20 weeks of gestation.