The coronavirus pandemic and the subsequent lockdown has adversely affected many communities and subsections of society especially the poor, migrant labourers, marginalised communities and women. Particularly, pregnant women, new mothers and women seeking abortions have been affected due to lack of resources during the lockdown.
The Ministry of Health in its note on providing essential healthcare services said, “Focusing on COVID-19 related activities, and continuing to provide essential services, is important not only to maintain people’s trust in the health system to deliver essential health services, but also to minimise an increase in morbidity and mortality from other health conditions.”
Taking into consideration the need for abortion services, the government declared them under ‘essential non-Covid services’. However, even though abortions are marked as essential services, women are finding it difficult to access this medical service.
Closure of clinics
The closure of private clinics, nursing homes and small medical facilities in the first two weeks of lockdown has curtailed women’s access to abortion care. Dr Jaydeep Tank, General Secretary of Federation of Obstetrics and Gynaecological Societies of India (FOGSI) who has been operating his maternity clinic during this time tells HerStory that not all private clinics are open for abortions, but some are opening as knowledge about the disease improves.
VS Chandrashekhar, the CEO of Foundation of Reproductive Health Services India (FRHS), a not-for-profit that works in the area of reproductive and sexual health and rights says that in Bihar literally all private clinics and hospitals were shut during the early days of the lockdown.
Even FRHS that operates six clinics and is the largest provider of clinical family planning in the country by a NGO was closed in Bihar, Rajasthan and Uttar Pradesh. It managed to open three of its clinics in Bareilly, Ajmer and Jaipur after 10 days of the lockdown as the need became apparent.
“With abortion in particular, a majority of them are sought from the private sector hospitals. Around 93-95 percent of all abortions happen in the private sector and a huge amount using medical abortion drugs, which are either sourced from a private clinic or from a chemist under a doctor's prescription As private clinics and providers are not offering services, due to the lockdown a lot of people who would have wanted an abortion are unable to access it,” says VS Chandrashekhar.
On the non-availability of abortion care Dr Jaydeep says, “The question is if those 10-15 days made a material difference to all the women who were seeking abortion or not. Over this the perspective is that abortion done early is the safest available abortion. So even if it's a matter of 10-15 days, that still advances the pregnancy by that much time and sometimes abortion is time sensitive.”
It would have particularly affected women who have completed 18-19 weeks of pregnancy and were not able to access abortion care during that time and after the pregnancy advances into the 20th week abortion is not permitted legally.
Due to closure of several clinics and hospitals, Dr Jaydeep’s clinic in Ghatkopar, Mumbai has seen a spike in number of patients as people from other areas were also visiting him.
Lack of mobility and lockdown rules
Another hindrance for women wanting to access abortion facilities was the lack of mobility due to the lockdown. As hospitals are not always available in one’s neighbourhood, many women were not able to visit clinics that were at a considerable distance from their homes.
FRHS encountered many cases in which women found it extremely difficult to access clinics. In Ajmer, a woman and her husband who were on their way to the clinic were stopped by the police. Fortunately, they were able to call the ASHA worker from their village who had to explain to the cops the purpose of the visit, following which they received permission.
In another instance, the clinic had to send an ambulance to bring a woman to the clinic and send her back home. In Bareilly, a woman had to travel 45 kms because the FRHS clinic was the only facility that was open.
"Women faced difficulties on the road because an abortion client is not sick, she is a healthy client and she wouldn't have a prescription to come to the facility. So she is stopped by either the police or in many rural areas, where villagers and community members have taken the role of enforcing the lockdown. It is difficult for people to understand how a “healthy-looking woman” needs medical assistance,” says VS Chandrashekhar.
Apart from these troubles, women also have had to face the stigma attached to seeking abortions, more so in the case of single women.
Jasmine Lovely George, the founder of Hidden Pockets, a sexual and reproductive healthcare counselling organisation says their careline has seen a spike in queries about abortion during this time with several people noting instances of doctors refusing to perform abortions without the approval of parents of young single women aged 23-25.
Hidden Pockets has been helping women find small clinics and hospitals in their cities to seek abortion care. It is also counselling women through its WhatsApp careline.
“In the last 40 days the helpline has been counselling and providing assistance because the fear is real. We have had cases where people are willing to walk 5 kms to get medication. Even for counsellors, the burnout is real ,” she adds.
Clinics and hospitals are opening up as the lockdown restrictions have eased in my states but the challenge to find abortion care still remains. These facilities will be made available in a phased manner, and VS Chandrashekhar believes facilities will be difficult to find in May and to an extent in June as well.
During these difficult times, women looking for abortion care facilities and counselling can reach out to the Parivar Seva Sanstha - FRHS’s partner agency’s helpline 1800 123 7075. Women looking for counselling or facilities in their cities can also reach out to Hidden Pockets on their WhatsApp careline 886171356.
(Edited by Rekha Balakrishnan)