Lack of contraceptives during lockdown could lead to unsafe abortions, maternal deaths

New Delhi: The lockdown due to COVID-19 has restricted the access of millions of women to their choice of contraception. This restricted access is likely to result in millions of unintended pregnancies, unsafe abortions and maternal deaths, says a policy brief by Foundation for Reproductive Health Services India (FRHS), a Delhi-based non-governmental organisation.

The government’s family planning programme is also likely to take up to a 20% hit, with 25.6 million couples not being able to access contraception services during the lockdown that, the brief presumes, will give way to normalcy by September 2020.

In 2019, the public health sector supplied a majority of contraceptives--3.5 million sterilisations, 5.7 million intra-uterine contraceptive devices (IUCDs), 1.8 million injectable contraceptives, 410 million cycles of oral contraceptive pills, 2.5 million emergency contraceptive pills and 322 million condoms.

With the Ministry of Health and Family Welfare suspending sterilisations and insertion of IUCDs at public facilities until further notice, and restricted movement due to the lockdown making the commercial market less accessible, an additional 2.38 million unintended pregnancies are likely, the brief says.

It also estimates 679,864 childbirths, 1.45 million abortions (including 834,042 unsafe abortions) and 1,743 maternal deaths. If the availability of family planning services does not resume by the latter part of May 2020 and normalise by September 2020, 27.18 million couples would be unable to access contraception, resulting in 2.95 million unintended pregnancies, 844,483 childbirths, 1.04 million unsafe abortions and 2,165 maternal deaths, it says.

The number of births may be even higher if pregnant women are forced to carry an unintended pregnancy to term, in the absence of abortion services during the lockdown, said V.S. Chandrashekar, chief executive officer, FRHS.

In the absence of proactive measures to contain this situation, India may lose the gains made in population stabilisation and lower maternal mortality, FRHS says, making the following suggestions:

• Improving the readiness of public and private health systems to meet the surge in demand for family planning and abortion services.
• Ensuring availability of medical abortion drugs at chemists and removing unnecessary barriers on their sale.
• Expanding contraceptive choice by introducing implants (long-term reversible birth control options for women) in the public sector. 
• Removing restrictions on advertising of over-the-counter contraceptives, particularly emergency contraception and condoms.
• Strengthening the involvement of social marketing organisations and private/NGO service delivery organisations by addressing the challenges they face and mitigating the losses they incur.

(Tiwari is a principal correspondent with IndiaSpend.)