India has listed abortion as an essential service, but problems of access persist under lockdown

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.

“There is always a stigma and silence around abortions...and women are more vulnerable now,” gynaecologist and women’s rights advocate Suchitra Dalvie said by phone. “Therefore, it is important to reiterate that even during this time – your life, your choice and your decision matters.”

Take the 19-year-old who survived rape only to find the ordeal had left her pregnant – a discovery made just as Mumbai began shutting down ahead of a three-week, pan-India lockdown.

“On regular days, we would have used a hospital ambulance. But how could we seek one now? Was abortion an essential service?,” said Sangeeta Rege of the Centre for Enquiry into Health and Allied Themes, whose counselling services are enlisted by government as essential in the lockdown.

Worldwide, authorities from the United States to Poland have been urged by rights groups to recognise access to abortion as a human right that merits protection in the pandemic. They say women are especially at risk from the virus, be it due to violent partners or for lack of contraception.

On April 14, the Indian government declared that abortion was one of more than 20 essential health services, ensuring access would continue for the millions of women in India who terminate a pregnancy each year.

But the rape survivor could only get an abortion with the intervention of Centre for Enquiry into Health and Allied Themes, which arranged both a pass and travel.

“We went and picked her up and ensured she got the abortion at a public hospital. Forced sex is a critical issue in a lockdown and abortion services are required here and now,” Rege told the Thomson Reuters Foundation.

Legacy

Advocates for women’s rights fear the pandemic will have an extra legacy on the 590-million-strong female population of India, with rising domestic violence, a strain on predominantly female carers and reduced access to a host of support services.

India’s women and child development minister Smriti Irani has asked all states to ensure women’s helplines work well, and instructions were issued to help with menstrual hygiene. Various state governments have placed ads and hung posters encouraging women to report violence in the home.

India’s 1.3 billion people are in lockdown until May 3, at least, with the latest tally of Covid-19 cases topping 12,000.

Despite its protected status, abortion is now hard to access, experts say, as public healthcare is stretched by the pandemic and many private facilities, which shoulder more than 70% of medical needs, have closed.

Add to that the high levels of stigma around abortion, despite it being legalised more than four decades ago. “A woman with fever will be able to tell cops she is going to the hospital, but what would a pregnant woman say? It is more complex,” health rights campaigner Padma Deosthali said.

Ten women die of unsafe abortions in India every day, with almost half the abortions performed in unhygienic conditions by untrained providers, according to India’s health ministry.

Fears are growing that number could rise in the crisis. “We don’t want women to go to unqualified people or fall prey to quacks and endanger their lives,” said Shantha Kumari, who heads the Federation of Obstetric and Gynaecological Society of India.

Rege said Centre for Enquiry into Health and Allied Themes had spent days helping a 31-year-old mother in an abusive marriage who wished to end her 14-week pregnancy. “It was an unwanted pregnancy out of forced sex. We contacted several hospitals, and after days, a municipal hospital finally said it would take her. But now, we are no longer able to contact her,” she said.

Tech tools

An abortion helpline running on WhatsApp says it has received far more queries than usual, most of them asking the same key question: how to get an abortion in a lockdown? In India, a pregnancy can be terminated in its first seven weeks with an abortion pill under medical supervision; a surgical procedure is needed thereafter, doctors said.

Women now fear they may miss India’s 24-week abortion deadline during the lockdown, campaigners said. “Lockdowns affect women very differently. In reproductive health, people only talk about menstruation as if nothing happens after a period,” said lawyer Jasmine Lovely George, founder of Hidden Pockets, which runs the helpline.

George said most of the women contacting her helpline worked or studied in cities, but had returned home in the lockdown and were now back with family in villages and small towns.

In most cases, their movements were restricted, according to campaigners operating the helplines, with many unable to visit the local pharmacy to get a pregnancy test kit.

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 researcher Chander Shekhar. “But it will have to be researched post lockdown if the number of unwanted births go up.”

This article first appeared on Thomson Reuters Foundation News.