A post-quarantine baby boom: Why reproductive health will be a concern

A family health facility run by FRHS India in Bareilly, Uttar Pradesh. Photo Courtesy: FRHS
A wag once said that it’s no coincidence that Children’s Day comes exactly nine months after Valentine’s Day. Today, in the same vein, public health researchers fear that the real impact of the Covid-19 pandemic and lockdown on India’s demographics will become apparent only after nine months.

Which is why for VS Chandrashekar, CEO of Foundation for Reproductive Health Services India, or FRHS, India’s largest non-government provider of clinical family planning services and formerly known as Marie Stopes India, the exclusion of reproductive health from essential medical services allowed during the lockdown is deeply concerning. Pre-Covid, the Foundation used to provide contraception and medical abortion services in 72 districts in Bihar, UP and Rajasthan through government health centres, outreach teams and their own clinics. “Our clients haven’t been able to access these services for two months now,” says he. “It’s become hard for them to access their choice of contraception, while patriarchy has always made it hard for them to say no to their husbands…”

Operational since 2009, FRHS’s clinics reopened on April 6 but only for time-sensitive abortion services. “Our teams have noticed a drop in footfalls in public health facilities due to the lockdown,” Chandrashekar says. They have also observed a drop in the over-the-counter sales of contraceptives during this time. “We’ve seen over the years, that people prefer to buy contraceptives from unknown chemists rather than their friendly neighbourhood store,” says he.

“The lockdown has made this difficult.” This lack of easy availability of reproductive health services is going to have adverse consequences for Indian families. Abortions are time-sensitive and the majority are performed within the first nine weeks using drugs. “Nine months from now, not only will many of these unwanted pregnancies come to term, a majority of these would be in families that have been financially impacted by the lockdown and can ill-afford another child,” he predicts.

FRHS has used health management information systems, social marketing statistics and retail audit data to estimate the impact of the lockdown on India’s demographics. Assuming that family planning services are fully resumed by September 2020 and commercial sales of OTC contraceptives by third week of May, they estimate that 25.6 million couples would have not been able to access contraception services during the period of the lockdown. Comparing with services provided in 2019, they reckon this means 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 reproductive health services are delayed further, the worst case scenario estimates 2.95 million unintended pregnancies, 1.04 million unsafe abortions and 2,165 maternal deaths.

“The overall adverse impact on India’s family planning programme in 2020 is estimated at between -15 to -23 per cent compared to 2019,” he adds.

From the perspective of women, this could be a bigger disaster than the pandemic itself. “Our work to enable women to take control over their own bodies in some of the most backward parts of India could come to naught,” says Chandrashekar, recalling a woman in Bihar who had come to their clinic to be sterilised. “She clasped our hands gratefully and said that this would save her life by ensuring she did not bear any more children,” he recalls.

“There are so many more like her out there…”

As they wait for lockdown restrictions to ease, Chandrashekar and his team are developing new clinical service delivery protocols in the light of Covid-19. They advocate that government and private health services prepare to meet the surge in demand for family planning and abortion services.

“To this end, we want medical abortion drugs and newer contraceptive choices to be more easily available in the public sector,” he says. “At the end of the day, childbirth should always be a matter of choice not chance…”



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