A few days ago, Zareena took a pregnant woman to a nearby hospital post-midnight after all the emergency helpline numbers failed to respond. She had to arrange a bike after her numerous calls for an ambulance went unanswered. "The lady is safe now. She gave birth to a baby boy," added Zareena, an ASHA worker in Noida.
Pregnant women in India, be it from the rural or urban regions, are severely facing the brunt of the coronavirus-induced lockdown. Although lockdown 3.0 has brought some relaxations across the less-infected zones in India, scattered health facilities continue to disrupt family planning to a huge extent across the country. Although the government has recognised abortive healthcare under 'essential non-COVID services', women seeking abortions are finding it difficult to access healthcare amid the ongoing lockdown.
Prevalent lockdown rules, closure of private facilities, lack of mobility, and disruption in the supply chain have led to limited access to healthcare for women. At least an estimated 1,400 to 2,000 maternal deaths might occur due to the lockdown because of poor access to family planning during this period, according to Foundation of Reproductive Health Services India (FRHS), a non-profit organisation that works in the area of reproductive and sexual health.
BusinessToday.In talked to several gynaecologists in Delhi-NCR, the majority of them said that they had to close their private clinics amid the lockdown due to staff unavailability. Many of them said they were working with private hospitals or were giving advice to their patients on phones in case of emergencies.
Anita Gupta, a senior gynaecologist in GK 2 Fortis La Femme said, "All of us are attached to some hospital. We are doing deliveries there. Most of the doctors have closed their private clinics amid the ongoing lockdown".
Another Delhi based gynaecologist stated that there has been a significant decline in pregnant women's footfall in hospitals due to fear of coronavirus infection. She also talked about the spike in cases of unintended pregnancies. "In every five days, at least one case of unintended pregnancy comes to me," the gynaecologist added.
According to the CEO of FRHS, VS Chandrashekhar, around 20- 24 lakh unintended pregnancies might happen between March to June period due to the inaccessibility of contraceptives or abortion process. These unintended pregnancies might result in 5.50 lakh to 7 lakh additional births in 2020 as many women who end up with an unintended pregnancy will be forced to carry their pregnancy to term, because of inaccessibility to abortion care.
Restrictions on mobility and lack of public transport have acted as a double whammy amid the lockdown. Pregnant women seeking doctor supervision are unable to go to gynaecologists or health facilities due to restrictions imposed by the police. Chandrashekhar added that both private and public facilities have reported a sharp decline of almost 70 per cent in OPD clients amid the nationwide lockdown.
The emergence of coronavirus cases has forced district authorities across India to close down several private facilities. According to FRHS, "In Bihar, private facilities were shut for the entire month of April and all activities were suspended as district authorities were over-cautious. But later, the authorities encouraged them to open services". Another reason for the closure of private facilities during lockdown is the absence of hospital staff due to lack of public transport. Every year in India around 15.6 million abortions take place, out of which, almost 93-95 per cent happen in private facilities.
"A huge amount of patients undergo medical abortion using drugs, which are either sourced from a private clinic or from chemists using a doctor's prescription. A lot of people who would have wanted an abortion are unable to access it due to the disruption caused by this lockdown," Chandrashekhar said.
Poor and marginalised women are severely impacted by the lockdown. Shehnaz, an ASHA worker based out of Delhi NCR stated that she is unable to attend pregnant women as she is re-assigned to treat coronavirus patients in government hospitals. "We are handling emergency cases only. In the last 40 days, I have attended only one pregnant woman. Sometimes, we send these women to other hospitals. Since the lockdown, we have stopped regular check-ups. Women seeking abortion are also getting overlooked due to this," Shehnaz added. Pre-lockdown ASHA workers used to do at least five deliveries in a month apart from the regular door-to-door check-ups. Now, as the majority of these ASHA workers are deployed to COIVD-19 related duties, women seeking pregnancy-related healthcare are largely going overlooked.
Contraceptive market, too, has taken a huge hit amid the coronavirus-triggered lockdown. According to Chandrashekhar, "In this scenario, there would be a loss of 6.9 lakh sterilisation services, 9.7 lakh intra-uterine contraceptive device (IUCDs), 5.8 lakh doses of injectable contraceptive (ICs), 23.8 lakh cycles of Oral contraceptive pills (OCPs), 9.2 lakh emergency contraceptive pills (ECPs) and 40.59 crore condoms. This is likely to result in an additional 23.8 lakh unintended pregnancies, 679,864 childbirths, 14.5 lakh abortions (including 834,042 unsafe abortions), and 1,743 maternal deaths".
In 2019, as per the Health Management Information System (HMIS), 35 lakh sterilisations, 57 lac IUCDs, 18 lakh IC services were provided by the public sector. Public health facilities also distributed 4.1 crore cycles of OCPs, 25 lakh ECPs, and 32.2 crore condoms. In addition, the commercial market sold 220 crore condoms, 11.2 crore cycles of OCPs, 36 lakh ECPs, 12 lakh doses of ICs, and 8 lakh IUCDs.