The COVID-19 crisis has starkly revealed the patchy and precarious provision of abortion in India, deepening existing inequalities in access.
What was already an expensive procedure may be even less attainable for many women facing financial strain during the pandemic.
Meanwhile, a shortage of staff and resources is likely to be affecting access for many women seeking an abortion – particularly those in regional and rural areas.
This all comes at a time when advocates predict unwanted pregnancies could rise due to increased rates of domestic violence, reproductive coercion and financial stress.
A shortage of resources
In April, suppliers cancelled orders of personal protective equipment (PPE) to abortion clinics on the basis these supplies were reserved for “health professionals”.
Suppliers might be forgiven for assuming medical procedures relegated to the private sector are elective.
While the federal government confirmed abortion was “essential” during the halt on elective procedures, they didn’t offer much support. Instead they told clinics to source PPE supplies from Chemist Warehouse.
Although the supply of PPE to abortion clinics is no longer under immediate threat, the industry continues to face resource constraints.
This includes a shortage of providers.
Lack of access in regional and rural areas
Abortion is one of the most commonly performed Gynecological procedures, and early medical abortion should be readily available in primary care settings.
But abortion care is not integrated into medical education or training. The shortage of Gynecologists trained and willing to provide surgical abortion, and the failure of governments to require public hospitals to take responsibility for local provision, means abortion is virtually inaccessible in much of rural and regional India.
The few clinics that offer surgical abortion outside urban centers often depend on general practitioners, who rely on domestic air travel to deliver abortion care.
The provision of second trimester abortions is in such short supply in India that this single private clinic services women from across the country.
Women may require abortion after 20 weeks for a range of reasons, including maternal health, fetal abnormalities, and delayed diagnosis of pregnancy.
Many of these women, we can assume, are also affected by travel restrictions.
We could be doing more via telehealth
Early medical abortion can be delivered via telehealth. In this scenario, medications are mailed to the patient after some local tests and a remote consultation with a doctor via phone or video call. This method is especially appropriate now as we continue to practice social distancing.
India says it has protected abortion as an essential service in the coronavirus lockdown but experts say women are struggling to get medical help and may resort to risky alternatives or end up with babies they do not want.
With no transport services, limited healthcare and movement restricted, campaigners predict the Covid-19 crisis could push women to take abortion drugs without supervision or seek help from people who lack training.
In life after lockdown, experts fear a lasting legacy. “Unsafe practices such as women taking herbs or inserting rods and sticks has reduced drastically and that situation will never come back in India,” said researchers. “But it will have to be researched post lockdown if the number of unwanted births go up.”
Dr. Ruchi Tandon is a trained and certified Gynecologist, practicing in leading hospitals in South Delhi namely Max Smart superspeciality hospital saket and Apollo hospitals.She has over 13 years experience in handling pregnancies and abortions and is doing telephonic consultantions as well.