India: COVID-19 and Women’s Reproductive and Sexual Health

07 Aug, 2020    ·   5711

Akanksha Khullar argues that women's reproductive and sexual health care should be an essential component of India's COVID-19 response strategy.

Due to a wide range of factors, Indian women have historically faced multiple barriers to accessing sexual and reproductive health (SRH) care products and services. The COVID-19 pandemic and consequent disruptions have exacerbated these barriers and their adverse effects.

Pre-Pandemic State-of-Affairs
In 1952, India became the world’s first country to launch a national family planning programme. Since then, New Delhi has become a signatory to various international covenants and conventions related to feminine health and hygiene, and has launched several relevant national programmes. However, despite these efforts, India still has a long way to go vis-à-vis ensuring women’s comprehensive access to SRH care.

For instance, there are several shortcomings in India’s maternal care landscape. On one hand, there is limited provision of antenatal and postnatal care services within the Indian public health system. On the other, there are challenges—such as socio-cultural and financial factors, lack of public awareness about the significance of maternal care, etc—that negatively impact women’s access to antenatal and postnatal care. According to the National Family Health Survey, in 2015-16, only 21 per cent of women in India received complete antenatal care during pregnancy, and about 62.4 per cent received postnatal care within two days of delivery.

Access to contraceptives and abortion services—which are also essential for women to exercise agency over their own bodies—is even more complicated. Although abortion is legal in India (albeit in certain circumstances), millions of women continue to undergo unsafe abortions, risking injury and death. While there are several risk factors contributing to India’s high maternal mortality rate—including anaemia, sepsis, hypertension, etc—unsafe abortions have become one of the most common causes of maternal mortality, with nearly 8 per cent of all maternal deaths attributed to complications from unsafe procedures.

Moreover, nearly 12.9 per cent of women in India do not have access to their preferred method of contraception, and 5.7 per cent have no access to spacing methods that could be used between pregnancies to maintain their health. Additionally, regressive social norms and limited legal reform along with various other structural factors only exacerbate the problem, impeding women’s access to comprehensive SRH care.

Access to SRH care is even more problematic for women from smaller towns or rural areas. They typically rely on traditional methods where their family planning needs, pregnancy care, and access to SRH products are often made possible by locally accredited social health activists (ASHA) and anganwadi workers. These workers form the backbone of primary healthcare in the country’s 6 lakh villages. However, they continue to face several challenges—including lack of access to essential medicines and pregnancy testings kits, hurdles to working at night time etc—to rendering essential services, which in turn deprives women in rural India of necessary SRH care.

The Impact of COVID-19
The onset of the COVID-19 pandemic and ensuing physical restrictions have negatively impacted even existing access to SRH products, services, and information for many Indian women from diverse backgrounds across various socio-economic groups.

This is largely because a majority of public healthcare resources—even those reserved for SRH care—have been redirected towards mitigating the impact of the virus and treating infected patients. Thus, in addition to prevailing shortcomings in India’s SRH landscape, the availability of medical amenities, diagnostic centres, and doctors trained SRH care related services has reduced further.

Anecdotal evidence shows that some women seeking essential SRH services were turned away as medical facilities are overwhelmed by COVID-19 services and thus unable to accommodate them at that juncture.

Compounding this is the problem of disrupted pharmaceutical supply chains. The nationwide lockdown, transportation limitations, and a shrinking labour market have forced several drug manufacturing plants to close down or reduce capacity. Production has dropped, thereby affecting the availability of SRH products such as contraceptives, antibiotics to treat sexually transmitted diseases, and antiretroviral medicines for AIDS/HIV etc.

The disrupted supply chains could in turn cause price hikes, forcing women to look for alternatives. This could potentially increase health and mortality risks, placing a severe strain on their overall well-being.

Given the pre-existing challenges in women’s access to over-the-shelf contraceptives, these product shortages, coupled with the Ministry of Health and Family Welfare’s decision to temporarily suspend sterilisations and insertion of intra-uterine contraceptive devices at public facilities, could also result in millions of unintended pregnancies, unsafe abortions, and even maternal deaths. An analysis by the Foundation for Reproductive Health Services in India predicts that the lockdown and subsequent lack of facilities will lead to an additional 1.94 million unintended pregnancies; 1.18 million abortions (including 681,883 unsafe abortions), and 1,425 maternal deaths.

Women in rural India are all the more vulnerable due to limitations in access to treatment, products, and information. With restrictions on movement and the threat of infection, locally assigned maternal care attendants are finding it difficult to travel to patients’ homes, which leaves several pregnancies and health unmonitored.

In India, women’s access to essential SRH services has been deeply compromised in the ongoing crisis. While the central government’s approach has rightly focused on containing the spread of the virus, SRH care cannot become collateral damage, should instead be an essential component of the immediate response strategy.