New Delhi, May 11, 2020: An unintended fallout of the nationwide lockdown since March 25, 2020, is the inability of millions of women to access their choice of contraception. In 2019, as per the Health Management Information System (HMIS), 35 lakh sterilisations, 57 lakh IUCDs, 18 lakh 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 lakh 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 lakh ECPs, 12 lakh doses of ICs and eight lakh IUCDs.
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, Foundation for Reproductive Health Services India (FRHS India) a leading NGO and the country’s largest provider of clinical family planning services in the private/NGO sector has released a policy brief highlighting the estimates of a 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 the 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 the 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 lakh sterilisation services, 9.7 lakh IUCDs, 5.8 lakh doses of ICs, 23.08 million cycles of OCPs, 9.2 lakh ECPs and 405.96 million condoms. This is likely to result in an additional 2.38 million unintended pregnancies, 679,864 childbirths, 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 sterilisations, 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, Foundation for Reproductive Health Services India. “The overall adverse impact on FP programme in 2020 is estimated to be between -15 per cent to -23 per cent 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 sterilisation and abortion services once the lockdown is eased/lifted. That can be an added pressure on our health systems and can be overwhelming.
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 the 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 organisations and private/NGO service delivery organisations by addressing challenges and mitigating the losses incurred by them.
If proactive measures are not taken, the significant gains made by India in population stabilisation 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 government.