Honduras: Contraception care is always essential health care

Choloma is the third largest city in Honduras and one of the most populated areas of Cortés department. The city attracts people from across the country looking for work in Choloma’s many factories, known locally as maquilas. But low wages and abysmal working conditions mean that many still live in poverty.

Violence is also widespread, and women and girls are often most at risk. But there is no government protocol for the care of victims of sexual and gender-based violence. With this in mind, in the spring of 2017, MSF began supporting a local Ministry of Health clinic in Las Trincheras neighborhood of Choloma. It’s a little pink building surrounded by palm trees. Today, it’s still the only public maternity clinic in Choloma and the only center that offers 24-hour-care. 

Here, Dr. Lainez Vaquiz talks about how the COVID-19 response has reduced women’s access to contraception services.  

COVID-19 is spreading fast in Honduras, we now have almost 20,000 confirmed cases. On March 17, the Honduran government put in place an absolute quarantine, which means they closed all borders, stopped all taxis and public transport, and—except for essential workers—we are now only allowed out of our houses every two weeks based on the last digit of our government ID. 

But the streets are still busy—many people live day-to-day and just don’t have the option of staying home. It's really hard to see parents who don't have enough money to buy two weeks’ worth of food for their families. They have to debate whether to go out to make money and expose themselves to the virus or stay in and starve. 

Adapting to the lockdown 

I usually work on MSF’s community outreach team, travelling to community health centers and schools around Choloma to provide health education and counseling to women and health care workers and to let them know about the free services MSF’s clinic offers. We’re really linked to the community. But when the lockdown started MSF was forced to suspend the outreach program, so my team had to find a way to continue our work from home.

With new government protocols, we were able to start up telehealth where patients can call in and have a consultation over the phone. With this new service, we’re trying to reach everyone who is in need of a consultation because they can't go to a health center or they're too scared to go to a health center during the epidemic. 

It’s challenging as I don’t have the patient’s file in front of me, but I do ask for their medical history. Once the phone consultation is complete, I write a prescription and send them a photo of it via WhatsApp. And then they have to try and find a facility that will fill it—which is hard, especially for contraceptives. 

MSF supplies all staff in our clinic—no matter if they work for MSF or the MoH—with PPE. But people working in community health centers have to buy their own personal protective equipment, which has become more and more expensive. 

So, I’m not really surprised that many of these clinics have had to close completely.

The only option 

But this means that our clinic is the only facility currently providing sexual and reproductive health care in Choloma. It’s also the only maternity center in the area—the only other facility women can go to have their babies is a 35 to 40-minute drive away in San Pedro Sula. And some women are afraid to go to those hospitals as they are now COVID-19 treatment centers and they’re overcrowded.

Throughout the lockdown, our clinic has stayed open 24 hours a day. But last week, 18 of our staff members were being quarantined at home with COVID-19 symptoms, so we had to reduce some services, like prenatal care for women who are not high-risk pregnancies. 

We’ve continued most other services including contraception care and deliveries. In fact, our average births per month have increased from 55 to 75, even though it’s almost impossible to travel anywhere during the lockdown as there is no public transport—not even taxis—and most people don’t own cars. 

We’ve also set up a tent outside the clinic—to allow for social distancing—so we can continue offering contraception services. We have started to give women longer supplies of contraceptives, like the pill, as MSF is really the only facility still providing this service during the lockdown. 

I think it’s completely outrageous that women have been denied access to family planning at this time; it is an essential service. Honduras is one of only six countries in the world where abortion is completely illegal. Not only that, but the law also prohibits the use of emergency contraception.

Even if she’s been raped, or if the pregnancy means she’ll have to drop out of school or lose her job—abortion and emergency contraception is illegal. Even if she can’t afford to feed her child, or if she is a child herself. She cannot even have an abortion if the pregnancy will risk her life. 

Neglected health care

Family planning is always an essential service, especially for women in Honduras. It’s not just a right, but it's a decision women make: when, how, and if we want to have a baby or not. It's frustrating to women not to have access to this during the lockdown, and it's frustrating to me as a doctor, not being able to help them. 

Last night a patient called me crying. She told me that she went to the community health center for her contraception care appointment, but it was closed. She said to me, “I don’t want another baby and my husband doesn’t want another baby. And if I get pregnant, he will leave me.” Those stories are really hard to hear. 

I hope we can continue providing telehealth even after the pandemic. If we can expand it, we will be able to reach so many more women who cannot get to a facility. 

But the needs are greater than the care MSF can provide, and I just feel like women’s access to sexual and reproductive health during the pandemic, especially family planning, is just being neglected. 

It’s like we are going backwards. Denying women access to family planning is like taking away the power we have over our bodies—the power of choosing if we want a baby or not. It feels like we are walking backwards and losing everything that we fought for.