Safe Abortion in India during the Rising Pandemic

Nearly 15.6 million abortions take place in India every year ^[1]. In a study published by The Lancet in 2015, 73% of the estimated abortions happen by medical abortion, with 16% taking place in private healthcare facilities and 6% in public facilities. The remaining 5%are conducted through traditional and relatively unsafe methods.

How the Pandemic Affected Abortion Access

In March 2020, India enforced a nationwide lockdown to curb the spread of the coronavirus. Restrictions included travel (air, train, and buses) and gathering in public places, confining people to their homes. While hospitals remained open during this period they provided only essential services, with many shutting down their outpatient departments. Public health facilities that offered reproductive and sexual health (SRH) services were converted to COVID-19 care centers. Similarly, private health facilities were shut down or operated on limited services due to inadequate protective gear, mandatory COVID-19 testing, and in many cases, provider unavailability.

Even though abortion and contraception access are considered essential services, the pandemic, and subsequent lockdown only made it difficult for women to find reproductive health and/or sexual health services. In these circumstances, the options for women who could not access contraception and had unintended pregnancies were limited. They had to either continue the unplanned/unwanted pregnancy or attempt an abortion through safe or unsafe methods.

According to a modeling study released by the Ipas Development Foundation, nearly 1.85 million abortions were compromised because of the pandemic in India. The study also found that reduced access to both private and public healthcare facilities and lack of availability of medical abortion drugs were the primary reasons ^[2]. While women’s access to confidential and safe abortion services can be a challenge even during non-pandemic circumstances, the restricted mobility during the lockdown thwarted women from accessing or visiting healthcare facilities even more severely. Many were either turned away from hospitals or were asked to come back later forcing women to consider a surgical abortion probably after they had already crossed the 12-week limit for medical abortion according to the law.

India also reported an increase in gender-based and intimate-partner violence during the lockdown. According to a report released by Marie Stopes International, one in 10 women asked for help against domestic abuse, and at least a fifth of the survey respondents sought abortion services. These women were not able to seek abortion-related services owing to fear of leaving home due to COVID-19 risks, lack of financial autonomy, and/or domestic abuse ^[3].

Abortion access was particularly harder for women in rural India ^[4]. Stigma, traditional belief systems that dismiss the use of contraceptives, limited transport facilities, cross-border restrictions, and disrupted supplies in the pharmacies and health facilities were significant factors. Additionally, COVID-19 also impacted the community-level health-system services (temporary cessation of IUCD and sterilization facilities and engagement of ASHA workers in COVID-related work) forcing millions of women to continue with unintended pregnancies or choose a later-term or unsafe abortion.

Ensuring Safe Reproductive Health Access during the Pandemic

Poor or limited access to sexual and reproductive health services is not exclusive to India. But, India needs a comprehensive plan to ensure that SRH services are included in the country’s disaster management plan ^[5]. The current pandemic has significantly increased the need for facility-based abortions due to delayed access to medical abortion drugs and restricted movement. This means that women will have to bear the additional and increased costs of tests, travel, and hospital services; make more hospital visits; and travel longer distances.

To ensure that women continue to have access to safe abortion, the government should continue SRH services throughout the crisis and implement mechanisms to streamline the supply chain and ensure the availability of contraceptives and medical abortion drugs at all times. There is also a need for considering telemedicine, mobile clinics, and easy access to experts and doctors where feasible and necessary. Clear and updated public health information should be made available to the community along with referrals and community-level links for better abortion access to women.

More importantly, the government should map out public and private healthcare facilities to highlight those offering first and second-trimester abortion services ^[6]. And the costs of these services, including travel and out-of-pocket expenditure, should be capped, particularly for women from poor or marginalized backgrounds.

The Medical Termination of Pregnancy Act in India allows women the right to control their bodies and fertility choices. And while the Supreme Court of India holds freedom of choice and privacy as a fundamental right, the legislature still needs to create healthcare systems where women can access diverse, effective, and safe options.

Unsafe abortions, while among the leading cause of maternal mortality in India, are preventable and the easiest way to prevent them is by creating a healthcare system that responds to women’s needs and removing obstacles to accessing safe abortion services.