A temporary ban on family planning services at government facilities and poor access to over-the-counter contraceptives, such as oral pills and condoms, during the nationwide lockdown will result in lakhs of unwanted pregnancies, leading to a spurt in unsafe abortions and maternal deaths, experts have warned.
An analysis, conducted by the Foundation for Reproductive Health Services (FRHS) India, estimates that nearly 2.56 crore couples may not be able to access contraception services during the period after the lockdown and until the return of normalcy by September. This will lead to a loss of 6.9 lakh sterilisation services, 9.7 lakh intra-uterine contraceptive devices (IUCDs) and 40.59 crore condoms, among other forms of contraception. As a result, there will be an additional 23 lakh unintended pregnancies, 6.79 lakh child births, 14.5 lakh abortions (including 8.34 lakh unsafe abortions) and 1,743 maternal deaths. The numbers will be higher if there is a longer lockdown period and a slower resumption of family planning services after the restrictions are lifted.
“Footfall at OPDs [outpatient departments] and community health care centres has gone down. Private clinics have stopped providing general medical services. While chemist shops are open, restrictions on mobility mean people’s access to condoms, oral pills and emergency contraceptives is compromised. The purchase pattern behaviour of buyers is that most don’t buy contraceptives from neighbourhood shops but from a shop away from their home to maintain anonymity,” says V.S. Chandrashekar, chief executive officer, FRHS India. “At the same time, as the lockdown continues there are likely to be more pregnancies. Many will continue these pregnancies to term, either out of choice or because of inability to access clinical and medical abortion at the right time.”
Raymond Consumer Care, which manufactures and markets the KamaSutra brand of condoms, has registered more than a 50% fall in sales, its chief executive officer, Sudhir Langer, says. “In March, our domestic market sales were down by 50%, and in April, there was a fall of 60%. While condoms are included in the list of essential items, on the whole they are looked at with disdain. So, Police personnel don’t accept that these are essential items, which impacts the movement of our stock from warehouses to distributors and to retailers,” he adds.
A lack of access to family planning services also results in the loss of women’s agency in child birth, claims Poonam Muttreja, Executive Director, Population Foundation of India.
“There is evidence that shows that when migrant workers return from cities to their families in villages during Holi in March, there is a spurt in pregnancies. This is when we see that women opt for IUCDs or three-monthly injectables, which they discontinue after their husbands go back to the cities. But under lockdown they won’t be able to access these services. IUCDs give women the power to have a say in child birth, which they can’t exercise with male condoms as insisting on their use may tantamount to questioning male authority.”
Ms. Muttreja was referring to a study by the Population Council, which records that 10 lakh women undergo sterilisation or accept IUCDs or an injectable in March alone. This demand declines by 2-3 lakhs per month in April and May when men return to work. These numbers are likely to be higher during CoVID-19-related lockdown as men return home in large numbers and spend more time at home in situations of high stress.
More children in a family also result in a higher out-of-pocket expenditure on child birth and hospitalisation, which during financial distress may result in malnutrition-related morbidity and mortality.
The Population Council recommends a set of creative solutions to ensure access to contraceptive methods during the lockdown such as distribution of pills and condoms through self-help groups, chemists and ration shops and counselling through social media platforms instead of accredited social health activists (ASHAs), who have been asked to suspend door-to-door services to check the spread of COVID-19.
Ms. Muttreja also underscores the need to “expand the basket of contraceptives after the lockdown to include implants which can be used for three to five years and will reduce the burden on public health facilities and give greater choice to women”.
