Kusum Nayak, 35, had to walk down two hills, take a boat across a huge reservoir, and then finally ride a rickety auto rickshaw on a bumpy road to reach a hospital and give birth.
For pregnant women like her living in one of 16 largely tribal villages in Kalahandi district in Odisha, located on the northeastern side of India, the physical toll of this difficult journey to the nearest health facility–35 kilometers away–was an added burden as they struggled with labor pains.
This report from an English-language daily in India illustrates the plight of women who have been living under these conditions even before COVID-19 struck. The lack of mobile connectivity for emergency vehicles and access to emergency health services like child delivery placed undue restrictions to women’s reproductive rights.
Across the world, the pandemic has exacerbated systemic problems confronting women and their right to reproductive health care.
In India, accessibility and availability of reproductive health services had been sparse pre-pandemic, and more than half of abortion-related deaths were due to inaccessibility of safe abortion services. Women in rural settings had a 26% higher chance of dying from complications than their counterparts in urban areas owing to limited knowledge of safe abortion centers.
The landmark Puttaswamy judgment of 2017 specifically recognized the constitutional right of women to make reproductive choices such as access to maternal care, safe abortions, and contraceptives.
Under Indian law, abortion is legal up to 20 weeks’ gestation, except in cases involving rape, incest, or a minor, which can be extended to 24 weeks. However, the law does not accommodate non-medical concerns over the economic costs of raising a child or other personal considerations.
Lives on the Margin
Amid limited health infrastructure available to women in India, levels of poverty and education are also equally concerning. Prior to the pandemic, women with poor literacy levels were at 48% more likely to undergo unsafe abortions while access to any form of contraception was sorely limited–or there was none at all. For instance, 84% of indigenous women in Jharkhand in eastern India had no access to any form of contraception, reports and surveys showed. For non-indigenous women, the percentage stood at 59%. One can only imagine how much worse the problem is amid the pandemic.
The ordeal of new mothers does not end with childbirth, as they face the punishing return journeys home with their fragile newborns. And despite challenges, women were seen opting for an institutional delivery. This, at a time when hospital care now gives priority to COVID-19 patients, further restricting women’s access to postnatal care.
For indigenous women, this strips them of their reproductive autonomy and exacerbates the disproportionate demographic, economic, and social challenges they face while risking exposure to the coronavirus. A significant number of pregnant women among migrant workers that walked back home to their villages during the lockdown had rare access to safe reproductive health services. Sanitary napkins, contraceptives and several other female hygiene products were not listed under essential goods, leading to supply issues in many places when the lockdown was imposed. Only two states–Telangana and Karnataka in southern India–included these goods as essential items. Meanwhile, medical supply chains were hit by the ban on interstate travel and the closure of factories producing family planning products.
Parivar Seva Sanstha, a reproductive health organization, was forced to close 31 clinics offering family planning and abortion services across the country in the wake of strict lockdown measures. Some women who tried to travel were harassed by the police. Having an Aadhar card, India’s national biometric ID, has become mandatory if they want to avail themselves of reproductive services.
A young woman in a major metro city, who discovered she was pregnant during the sudden lockdown, ended up taking an abortion pill without any medical consultation. This left her bleeding profusely for days, forcing her to call Hidden Pockets, a reproductive health counselling helpline. “It is very scary if you’ve been bleeding for hours and nobody has counselled you,” she said.
The Foundation for Reproductive Health Services India, an affiliate of Marie Stopes International, estimates that the lockdown disruption has resulted in the following casualties: almost 25.6 million couples unable to access contraception, leading to an additional 2.3 million unintended pregnancies and 834,042 unsafe abortions. When the lockdown was announced on March 25, reproductive health was among the most essential services allowed to continue only after a group of doctors and activists appealed to the Health Ministry on April 14, 2020. India’s 900,000 accredited community health workers who previously focused on reproductive health and distributed contraceptives have been redeployed to COVID-19 duties.
A recent modelling study conducted by Ipas Development Foundation, a non-profit dedicated to preventing and managing unwanted pregnancies, showed that in the first three months of the lockdown (from March 25 to June 24) 47% of the estimated 3.9 million abortions that would have taken place under normal conditions were compromised. This means that out of an estimated 1.85 million Indian women not being able to terminate an unwanted pregnancy, 80% compromised abortion due to lack of medical abortion drugs at pharmacy stores.
The lack of a smartphone, strong mobile connectivity, and prompt telephone response teams to handle queries aggravated the lack of access to reproductive health services during the pandemic.
Since the lockdown has eased, rural clinics have reported more cases of women going to clinics with complications from taking abortion pills without proper guidance and medical help, or without understanding the correct dosage or procedures needed. Most of the cases at clinics are related to post-abortion complications with their corresponding psychological impacts.
In India and elsewhere across the globe, COVID-19 has highlighted how women lack decision-making powers over their sexual and reproductive health. That women are bearing the brunt of the pandemic cannot be stressed enough as they lose their sources of income and are less likely to be covered by social protection measures.
As COVID-19 surges past 54 million, women’s reproductive rights and healthcare still have a long way to go.
Nayanika Konger holds a master’s degree in Peace and Conflict Studies and a bachelor’s degree in Social Sciences from Tata Institute of Social Sciences. Her interests include conflict mediation and reconciliation, international relations, gender studies, and public policy and administration.
