Covid-19 and a surge in unplanned pregnancies in India
Covid-19 has wreaked havoc on many aspects of our lives across the globe, reproductive health and family planning are no exception. Over the last 18 months, access to women’s health care services, including contraception, family planning and abortion, has been severely disrupted. As a result, an estimated two million women have experienced unwanted pregnancies. Furthermore, a survey conducted by the World Health Organization suggested a 68% disruption to family planning and contraceptive services across 105 countries.
Safe contraception services are essential to upholding women’s reproductive rights and preventing pregnancies, these can have significant implications for the mother, family and larger society. At a micro level, planned pregnancies help eliminate poor health outcomes like risk of maternal or infant mortality; At a macro level, it helps minimise negative outcomes of large family sizes like strain on resources, poorer economic outcomes for the mother, increased anxiety for the parents, and financial stress. Thus, facilitating a reduction in unplanned pregnancies can have cascading family and society-level benefits.
Covid posed a significant barrier to accessing such care, owing to a reduction to in-clinic consults, travel restrictions and overwhelmed infrastructure and practitioners, adding to existing limitations with regards to women’s health – social stigma, misinformation or lack of awareness and family pressures. Particularly during the first lockdown, the health system was made to prioritise temporary contraceptives, such as condoms and the oral contraceptive pill over longer-term options like Intra-uterine Contraceptive Devices (IUCDs) and sterilisation, which also limited the basket of care offerings for women.
Another reason for the rise in unplanned pregnancies and declining contraception trend was the limited access to counselling services. It has become evident that counselling significantly contributes to the uptake and continuous use of contraception. Thus, contraception usage also declined due to the unavailability or limited access to counsellors specific to women’s sexual and reproductive health needs during the pandemic. It must form a key component of our strategy to spur contraception usage going forward.
Although still reeling from the effects of the sudden pandemic onset, the health system over the last year attempted to adapt to meet the growing need for effective women’s care and foster preparedness. One shining example of this was the sudden rise in the provision and adoption of online teleconsultations and digital resources. Availability and accessibility posed two critical components that needed strengthening in care delivery. With the advent of digitalization in the country, spearheaded by the government’s flagship Digital India initiative, we have advanced forward every day, reaching women from more remote and far-flung corners of rural India with digital platforms.
By scaling access to health resources and reliable information about sexual and reproductive health, women nationwide can be educated and empowered to make informed choices on family planning and contraception. Digital solutions such as chatbot ‘Ask Tanu’ and mobile app – ‘Bare Your Pain’ aim to reach the younger age group of adolescents and foster awareness about reproductive health.
While addressing the twin problems of access and awareness, another roadblock must be addressed. This is to percolate recent and adequate sexual and reproductive health knowledge amongst non-OBGYNs across the medical community. Many women may approach their family physicians with queries or immediate issues, generating an understanding about contraception and family planning across practitioners is essential. This information should ideally reach non-OBGYNS in every state, both in urban and rural areas, particularly to avoid any misconceptions translating into unaddressed concerns or health complications. In the same vein, persistent myths about sexual and reproductive health must be combatted so women can make well-informed decisions about their care. The same holds true in providing adequate and recent to nurses and healthcare givers at grassroot level.
Safeguarding the health and rights of women must remain an utmost priority in the country to reduce the incidence of unplanned pregnancies. With efforts to educate and empower them, particularly driven by technological innovations, we can contribute to a future where women are freely able to take control of their own health.
The article has been authored by Dr Ratnabali Chakravorty, Obstetrician and Gynaecologist; Director, MAGS IVF and Infertility Centre, chairperson, National Advocacy Committee, Indian Menopause Society.