COVID 19 has compromised all aspects of abortion care. A study revealed that out of 3.9 million abortions that was to have taken place in three months, 1.85 million abortions were compromised due to Covid-19 impact on access to safe abortions. COVID 19 has proved to be a gateway for the health sector and the public to realise how insignificant, sexual and reproductive health care is considered nationwide.
Women have been restrained to stay home with their male inmates subjecting them to forced unprotected sex. Foundation for Reproductive Health Services India (FRHS India) has estimated that 25.6 million could not access contraceptive services during the 6 months period of COVID lockdown. Women had to live under constant vigilance of family members making it difficult to access contraception or avail abortion services.
Apart from domestic subjection, COVID 19 constraints on public facilities made reproductive care services inaccessible for women. This has reportedly led to an extremely high number of unsafe abortions and unwanted pregnancies. Additional 2.38 million unintended pregnancies, 679,864 childbirths, 1.45 million abortions, including 834,042 unsafe abortions and 1,743 maternal deaths are expected as per the FRHS analysis.
COVID 19 constraints that has supposedly left 1.85 million safe abortions at stake include restrictions such as infection fright, lack of public transport services, increased expenditure, minimal health care facilities and insufficient chemist supply that reduced access to abortions across the different points. Though the present situation is eased out with unlock mode and relaxations, for many women and adolescent girls, the damage has already been done.
Infection fright – Even where women can access in‐person abortion services, it is at the risk of exposing themselves and their family members to contracting the COVID 19 infection. Telemedicine has been approved by the Indian government to provide no contact abortion services but the reach from remote areas has not been facilitated. Many women were not even aware that India listed abortions as essential services. The vast majority of population that goes unnoticed is this marginalised group of women unable to access any means of safe abortion services, forcing them to rely on unsafe indigenous methods of abortion.
Lack of transport – Many women could not find transport to reach abortion care in time with no option for medical abortion later as the pregnancy had already advanced. The government of India enforced strict national lockdowns for several months causing mobility restrictions, where health care providers nor needy women could reach clinics or health centres forcing the abortion care services to close. Since the beginning of lockdown, there was increased number of calls from women seeking abortion services. In India, millions of women living in hard-to-reach areas has made it impossible for them to access abortion services in time, leaving many women on the lurch.
Increased expenditure – Medical abortion being inaccessible, women had to face surgical abortion during second-trimester making it more expensive, challenging and complicated requiring the pregnant woman to undergo a mandatory COVID 19 test and the need for everyone involved in the procedure to use PPE. What had already been an expensive procedure may be even less attainable for many couples facing financial strain during the pandemic. The costs for abortion would be definitely magnified for those women who are students, single and unemployed. Second thoughts on increased expenditure would make women vulnerable to inexpensive, illegal and unsafe surgical abortions, thereby increasing risks of maternal death.
Shortfall in health care centres – There are only 16,296 approved abortion facilities in the private sector in the country, whereas abortion pills can be provided by about 60,000 to 70,000 doctors specialised in obstetrics or gynaecology. It is important that abortion takes place in a proper medical facility under the care of qualified professionals. Shortage of staff and lack of medical supplies made many private health facilities to shut down and public health facilities have been taken over for Covid-19 care. The shortfall has pushed women to look for alternate methods of abortion that could mean unsafe abortions resulting in fatalities or permanent health problems.
Although some hospitals chose to stay open, they were instructed to only provide essential and emergency services. So, many of the biggest hospitals closed down outpatient departments and cancelled elective surgeries. Abortion is a time sensitive procedure and absence of early medical abortion readily available in primary care settings has affected women by delaying pregnancy termination or resort to unsafe termination of pregnancy. The woman is forced to seek a surgical abortion clinic only when the choice of abortion methods reduce. Unavailability of medical abortion due to lockdown constraints and limited number of authorised abortion care centres thus reduce access to safe abortion and force them to seek services from unsafe providers.
Shortage of abortion pills – Medical abortion drugs are cost-effective varying from Rs.700 to 1000 in an abortion clinic for a first trimester pregnancy termination whereas Rs.2,000 to 5,000 for a second trimester surgical abortion. But a severe shortage of medical abortion drugs in many States surveyed, including Tamil Nadu, is appalling. Severe restrictions on air, trains and bus services had hindered abortion pills reaching chemists and pharmacies.
In a survey conducted, it was revealed that 79% of chemists refrained from stocking medical abortion drugs of which 54.8% of chemists stated over regulation of medical abortion drugs as compared to other prescription drugs as the reason for under stocking. State-wise regulatory and legal barriers are believed to be the key reasons specially during the lockdown despite reproductive health care declared as an essential service. Regulatory crackdown has also resulted in abortion services on the whole becoming completely inaccessible. The lack of availability of medical abortion drugs reduces women’s choice, forcing her to end the pregnancy at the earliest through other unsafe options of abortion.
National lockdown may have ended but work from home practices still continue in most parts and colleges are yet to reopen. Metropolitan cities enforce timely local lockdowns and curfews to curtail spikes in infection rates. Air travel across countries could be restricted repeatedly as the pandemic peaks with different variants in different places at different points of time. The poor access to reproductive health during COVID 19 has turned in to a disaster for many women seeking safe abortions.