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With clinical family planning services suspended due to the nation-wide lockdown and the access to contraceptives disrupted, India may see at least two million unintended pregnancies, with more than half of them ending in abortions, a large proportion of which would involve unsafe procedures, a study has concluded. Just a little over half a million of these pregnancies might result in live births.
The number of unintended pregnancies, abortions and live births will be higher if the clinical family planning services, expected to resume operations by the third week of May, takes a long time to operate at full capacity and commercial availability of contraceptives remain affected.
These estimates were made by the Foundation for Reproductive Health Services India (FRHS India), an NGO that is engaged in providing clinical family planning services. The NGO has studied three scenarios for making estimates of unintended pregnancies, abortions, live-births and maternal mortality.
In the best case scenario, it estimates that clinical family planning services will resume by the third week of May and operate at full capacity by July 2020. It also assumes contraceptives will be easily available commercially by the third week of May. In the likely case scenario, family planning services are expected to operate at full capacity by September 2020 and contraceptives will be commercially available by the end of May.
The study points out that public health facilities had stopped providing clinical family planning services – sterilisation and intra-uterine contraceptive devices (IUCD) – a week before the lockdown was imposed from March 25. The states were also advised by the Ministry of Health and Family Welfare to keep sterilisations and IUCD services suspended till further notice. Sterilisation is the most popular method of family planning in India, accounting for 76 per cent of the modern contraceptive prevalence rate. It is largely provided by the public sector.
About 3.5 million sterilisations, 5.7 million IUCDs, 1.8 million injectable contraceptive services were provided by the public sector in 2019, according to the Health Management Information System (HMIS). The public sector healthcare centres also distributed 41 million cycles of oral contraceptive pills, 2.5 million emergency contraceptive pills and 322 million condoms. The commercial market sold 2.2 billion condoms, 112 million cycles of oral contraceptive pills, 3.6 million emergency contraceptive pills, 1.2 million doses of injectable contraceptives and 0.79 million IUCDs.
Using historical data on sale and use of various method of contraception, the study estimates that in the best case scenario, 24.55 million couples might not have been able to access contraceptives. “Method-wise the loss is estimated at 530,737 sterilisations, 709,088 IUCDs, 509,360 doses of injectable contraceptives, 20 million cycles of oral contraceptive pills, 827,332 emergency contraceptive pills and 342.11 million condoms. This is likely to result in an additional 1.94 million unintended pregnancies, 555,833 live births, 1.18 million abortions (including 681,883 unsafe abortions) and 1,425 maternal deaths.”
In the worst case scenario, there could be 2.95 million unintended pregnancies, 844,483 live births, 1.80 million abortions (including 1.04 million unsafe abortions) and 2,165 maternal deaths. The worst case scenario assumes a slower phased availability of clinical family planning services, with full capacity returning in September 2020, and 75 days loss of commercial sales of contraceptives.
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