The country still battling with COVID 19, only few women requiring abortion facilities have found relief even after the declaration of safe abortion as an essential health service by the Indian government on April 14. The implementation of women availing abortion services amidst the pandemic has not been simple and safe. On-ground reality specially during the COVID 19 situation has differed from observing safe abortion and family planning services as priority. It is feared that almost 50 percent of the number of abortions that would have been normally accessed between March to June 2020 may have been compromised. This means that the pandemic situation could lead to unsafe abortions and maternal deaths additional to such cases already prevalent due to social stigma that surrounds abortion along with ignorance on awareness about safe available abortion services. Reproductive and sexual health of women are likely to be in stake, contributing to a large number of unwanted pregnancies and unsafe abortions leading to maternal deaths.

Diversions that may burden access to abortion services during this testing situation are:

• Public health facilities are converted into COVID-19 treatment centres
• Health care staff have been rostered from standard services to coronavirus care
• Temporary shutting down of health facilities due to unavailability of staff and proper protective equipment
• Higher price of abortion services at private facilities due to increased demand
• Added costs of pandemic-related personal protective equipment required during abortion procedures
• Interrupted supply chain of medical abortion drugs
• Lockdown restrictions on travel and public transport services
• Division of entire nation into three zones of red, orange and green based on the risk profile with varying levels of restrictions and relaxations.

Above factors leading to limited access to abortion services can result in five possible scenarios, where :-

1. Women are able to access abortion in their preferred point of care but delayed
2. Women are able to access abortion, but not as per their preferred choice. Delayed access to timely abortion owing to restrictions may push women to seek surgical procedures instead of drug-induced medical abortions which are legally permissible only up to nine weeks of pregnancy
3. More women have had to risk delaying their abortion to the second trimester abortions (beyond 12 weeks). These late term abortions impose difficulty in execution as the law mandates two doctors to sign their approval for the procedure as against a single doctor for early abortions.
4. Women continue their unintended pregnancy with forthcoming financial uncertainty and social insecurity.
5. Women seeking unsafe abortions place additional responsibilities on the health system that has to provide remedial measures in the interest of safeguarding women’s health both during and post recovery period.

It is necessary that all abortion care services take measures to ensure availability of medical and surgical abortion procedures to minimise the negative impact of restricted access  to the existing insufficient abortion service network during these months. Therefore, at Chennai Abortion Clinic, we consider it extremely important that our abortion care facilities are open for emergency services and are prepared to meet the needs of these women even under COVID 19 lockdown. The Indian government has permitted telemedicine that allows medication abortion at home obtained through a prescription and medical guidance from a doctor over the phone or online. Increased access to abortion services is being achieved through telemedicine for medication abortion and the abortion care centre open with all surgical abortion safety protocols in place for the increased demand in second trimester abortions.

It is challenging for women to access abortions at an approved facility and the COVID 19 has made it even more difficult specially for abortion services beyond 12 weeks. In spite of telemedicine being supported as an option to overcome the impact of COVID-19, it is observed that majority of women in India rely on facility-based first or second trimester abortion. Therefore, being the state of the art abortion care centre, we find it imperative to gear up our facilities and strengthen our services to ensure that we are equipped to fulfil the rights of women for abortions and meet the evolving needs of women. We are open with approved facilities to offer:

• Best first trimester medical abortions
• Safe surgical services for second trimester abortions
• Information for women and partners about availability of safe services
• referrals that enable women seeking abortion to access safe and legal services
• Procurement of medical abortion drugs and contraceptives
• Follow up on post abortion recovery and women health
• Counselling for emotional and social supportive care as pre and post abortion services

If not for the Coronavirus outbreak, Medical Termination of Pregnancy (Amendment) Bill, in March 2020 would have been introduced in the parliament. The amendment bill was to state that a pregnancy may be terminated within 20 weeks with the approval of a single doctor, while for abortions between 20 and 24 weeks of pregnancy, approval from two doctors would be mandatory. This means that abortions for specific categories of women up to six months of pregnancy  would become legal. The amendment bill is also supposedly to allow unmarried people to approach for legal, safe abortions as the bill replaces “married woman or her husband” with “woman or her partner.” The pandemic has hauled such expanded amendments of the MTP act but the rights of every woman for safe abortion has to be of utmost importance in the welfare of reproductive and maternal health.

It is estimated that access to abortion is highly compromised during this pandemic where around 59 per cent of women seeking an abortion could not access the services. Abortion facilities were compromised at all points of care, including public and private sector facilities and pharmacies during lockdown days. It is highly essential that health facilities ensure the right for information about available services reaching every woman in need of abortion. This can help women on easy and fast decision making and receive appropriate abortion care on time. Collective efforts of the government, the healthcare sector and the society can ensure that women have access to sexual and reproductive healthcare services, even during this COVID 19 crisis. It is also significant that there is an absolute need for a specially designed and integrated recovery plan for improving abortion care services and facilities in our country.