An unintended fallout of the nationwide lockdown since 25th March is the inability of millions of women to access their choice of contraception leading to unintended pregnancies.
In 2019, as per the Health Management Information System (HMIS), 35 lac sterilizations, 57 lac IUCDs, 18 lac injectable contraceptive (IC) services were provided by the public sector. Public health facilities also distributed 4.1 crore cycles of Oral contraceptive pills (OCPs), 25 lac emergency contraceptive pills (ECPs) and 32.2 crore condoms. In addition, the commercial market sold 220 crore condoms, 11.2 crore cycles of OCPs, 36 lac ECPs, 12 lac doses of ICs and 8 lac IUCDs.
Inaccess to contraception
The lockdown has meant access to and use of contraception has been compromised to a large extent. In line with the Ministry of Health and Family Welfare, Government of India’s advisory, public facilities have suspended provision of sterilizations and IUCDs till further notice. Curbs on movement have made access to over-the-counter contraceptives, condoms, OCPs and ECPs difficult.
In an attempt to understand the impact, the NGO Foundation for Reproductive Health Services India (FRHS India) has released a policy brief highlighting the estimates of loss of services. FRHS India has made use of secondary sources such as Health Management Information System (HMIS), Social Marketing Statistics and retail audit data to arrive at the potential loss of sales and services in 2020 and resultant impact on health indicators.
The findings do not present a pretty picture. In the most likely scenario (where clinical family planning services operate at full capacity by September 2020 and commercial sales of OTC contraceptives are able to resume in a phased manner by third week of May), it is estimated that 25.6 million couples would have not been able to access contraception services during the period of the lockdown and weeks leading up to complete normalcy i.e. September 2020.
In this scenario, there would be a loss of 6.9 lac sterilization services, 9.7 lac IUCDs, 5.8 lac doses of ICs, 23.08 million cycles of OCPs, 9.2 lac ECPs and 405.96 million condoms. This is likely to result in an additional 2.38 million unintended pregnancies, 679,864 child births, 1.45 million abortions (including 834,042 unsafe abortions) and 1,743 maternal deaths. If the disruption continues for longer, the impact will worsen.
The worst case scenario is likely to result in 2.95 million unintended pregnancies, 844,483 live births, 1.04 million unsafe abortions and 2,165 maternal deaths. In the worst case scenario with slower and phased availability of FP services, 27.18 million couples would be unable to access contraception services due to a loss of 890,281 sterilizations, 1.28 million IUCDs, 27.69 million cycles of OCPs, 1.08 million ECPs and 500.56 million condoms.
“The number of live births may be actually higher, since access to abortion services have also been impacted during the lockdown period. Many women who ended up with an unintended pregnancy may be forced carry their pregnancy to term, since they may not have been able to access abortion care,” said VS Chandrashekar, Chief Executive Officer, FRHS India.
“The overall adverse impact on FP programme in 2020 is estimated to be between -15% to -23% in terms of Couple Years of Protection compared to 2019” he added. The disruption in family planning services during the lockdown will result in increased demand for sterilization and abortion services once the lockdown is eased/ lifted. That can be an added pressure on our health systems and can be overwhelming.
Recommendations for Family Planning programme
FRHS India’s recommendations in managing this adverse impact include:
a) Improving the readiness of public and private health systems to meet the surge in demand for FP and abortion services.
b) Developing and disseminating changes to clinical service delivery protocols in light of COVID 19 and procuring required supplies, consumables, drugs etc.
c) Ensuring availability of MA drugs at chemists by advising states to remove unnecessary barriers on its sale.
d) Expand contraceptive choice by introducing Implants in public sector.
e) Remove restrictions on advertising of OTC contraceptives particularly ECPs and condoms
f) Strengthen the involvement of social marketing organizations and private/NGO service delivery organizations by addressing challenges and mitigating the losses incurred by them.
If proactive measures are not taken, the significant gains made by India in population stabilization and reducing maternal mortality could be compromised. The loss of services and access to contraception can have serious implications for the family planning programme and should see a commensurate response from the Indian government.
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