Public and private healthcare set-ups are likely to see a spike in demand for clinical family planning methods and abortion services
With the focus of the healthcare apparatus squarely on the pandemic, troubling reports have begun to emerge on other fronts of public health that are facing neglect. While such an outcome is somewhat expected, it is also important to track and analyse these developments in order to generate appropriate systemic responses, both during and after the crisis. One such area is the increased need for access to contraception, given that people are confined to their homes these days. A combination of increased sexual activity and decreased access to contraception will result in a surge of unintended pregnancies later this year. This, in turn, will lead to troubling consequences, such as women being forced to carry unwanted pregnancies to term or resorting to unsafe abortions. It is critical for the Ministry of Health and Family Welfare (MoHFW) to take stock of this situation and address it.
In 2019, approximately 34 lakh women opted for sterilisation, 57 lakh went for Intrauterine Contraceptive Devices (IUCDs) and 18 lakh chose injectable contraceptives from the public health system. Public health facilities also distributed 32.2 crore condoms, 4.18 crore cycles of oral contraceptives pills (OCPs) and 25 lakh emergency contraceptive pills (ECPs). The MoHFW has advised States to suspend the provision of sterilisation and IUCDs during the lockdown, with several States opting for suspensions days before this advisory. A large number of couples access contraceptives from the private sector, which sells around 220 crore condoms, 11.2 crore OCPs and 36 lakh ECPs annually. The lockdown has, therefore, put a big question mark on the availability of these solutions for women, stifling reproductive choice across the country. Notably, despite exemptions for healthcare facilities and chemists, many establishments have closed their shutters for a variety of reasons (chief among which is the risk of contracting the virus). Among those open, most have reported a sharp decline in footfall anywhere between 30 per cent to 70 per cent, owing to movement restrictions. Outpatient Departments (OPDs) in many public facilities have also reported a sharp decline of 50 per cent.
The overall impact is that a large number of sexually-active couples under lockdown do not have adequate access to clinical methods of contraception. Meanwhile, restricted mobility has reduced access to over-the-counter contraception as well, since most consumers opt to purchase items such as condoms away from their neighbourhoods. Clinical family planning services, sterilisations and IUCDs continue to be suspended and the market is recovering at a slower pace due to supply chain bottlenecks and limited public transport. The spike in cases in Uttar Pradesh, Bihar and Jharkhand due to returning migrant labourers means health services will continue to be preoccupied with COVID-19 for a much longer time.
According to an analysis, the pandemic has impacted the ability of over 2.78 crore couples to access their choice of contraception (12.8 lakh IUCDs, 8.9 lakh sterilisations, 5.91 lakh injectables and 2.4 crore over-the-counter contraceptive users). The demand destruction is estimated to be to the tune of 50 crore condoms, 2.8 crore OCPs and 10.8 lakh ECPs. As a result, the expected impact could be over 29.5 lakh unintended pregnancies and over 17.9 lakh abortions, many of which are likely to be unsafe. Projections suggest this could result in an additional 8.45 lakh births and 2,165 maternal deaths. This would be in addition to the mental and financial burden taken on by women as a result of being unable to exercise their reproductive choices.
Once movement restrictions are eased, private and public healthcare set-ups are likely to see an increased demand for clinical family planning methods and for abortion services. However, with the ever-looming threat of COVID-19, there will be an urgent requirement for safeguards that protect healthcare workers and women from transmission of the virus. It is, therefore, imperative that the MoHFW and medical associations draw up revised guidelines for the provision of contraceptive and abortion services to address this changed context.
A related factor that needs to be noted is that an overwhelming majority of abortions (81 per cent) involve the use of Medical Abortion drugs (MA drugs). Yet, recent years have seen several State drug control authorities impose unnecessary distribution barriers on the sale of MA drugs, resulting in chemists not stocking them. A study by the Pratigya Campaign for Gender Equality and Safe Abortion revealed that no chemist in Maharashtra or Rajasthan stocks these drugs. A follow-up study at the beginning of this year showed that most chemists in Punjab, Haryana, Madhya Pradesh and Tamil Nadu do not stock them, the primary reason being avoiding compliance hassles with the drug control authorities. Non-availability of MA drugs may force many women to opt for unsafe abortions risking their health and lives. It is vital for the Drug Controller General of India and MoHFW to issue guidelines ensuring the availability of MA drugs, treating them like any Schedule-H drug. As with any disaster, the adverse impact is disproportionately high on women. India’s healthcare apparatus needs to acknowledge this and undertake steps to address it. If not, the gains made by the country’s family planning programme will be hit.
(The writer is Pratigya Campaign Advisory Group member and Chief Executive Officer, FRHSI)