Improving access to contraception in post Covid world

By Dr. Ranjana Dhanu

India, as a developing country, has been afflicted by overpopulation, with the latest statistical estimates putting the country’s population at 1.3 billion people.

Overpopulation obviously has a direct influence on public health and diseases such as TB, malaria, dengue, and waterborne infections, and economic development is also jeopardised owing to the enormous financial needs to cater to such a big population. And for a country like India, population management is a national emergency.

Contraceptive measures are methods adopted by sexually active couples to avoid unwanted pregnancies. They are classified as male and female, and also as temporary and permanent methods. The pearl index determines the efficacy of a contraceptive technique.

The oral contraceptive-combination pill is by far the most effective confirmed contraceptive, followed by the Intrauterine Contraceptive Device (IUCD), which has a contraceptive effectiveness of 99.5 percent. The IUD comes in second with a contraceptive effectiveness of 96%. Condoms or barrier contraceptives have an efficacy of only 90%, and the efficacy of a condom can be increased by simultaneously taking Nonoxynol-9 (Spermicide). Other methods, such as withdrawal, cervical cap, and safe period, have a failure rate of more than 30% and are unreliable.

The pandemic has been like a hurricane that has swept over the entire world. The virology of COVID-19, the severity of the disease, its significant impact on morbidity and death, and the difficulty to comprehend the early stages of the pandemic have all had an impact on the Indian and worldwide populations. Due to lockdown and social distancing measures in metropolitan areas, access to medical shops was hampered. Fearing the virus, individuals avoided visiting medical stores, and maximum demand at the stores was for gloves, caps, and emergency medicines to combat the Coronavirus.

Loss of jobs leading to financial crisis at domestic level and increase in domestic violence and sexual abuse also lead to unwanted pregnancies. Due to the lockdown, women were unable to gain access to gynaecology OPDs in general municipal hospitals and private clinics thus leading to lack of availability of emergency and routine contraceptive measures.

In India, 68.4 percent of the population lives in rural areas. Women in rural areas rely significantly on ASHA and public health centres for oral contraceptive pills, condoms, and IUCDs.

Due to a shortage of supplies, regular IUCD insertions post-delivery in rural regions were severely impacted. All of this has resulted in a large number of unintended pregnancies. According to UNICEF, extended lockdown can result in over 7 million unwanted pregnancies worldwide. Lack of postpartum contraception has resulted in an increase in neonatal morbidity and mortality, as well as maternal morbidity in the form of anaemia and preterm births. Despite the fact that India’s literacy rate is currently at 75% and there is widespread awareness of the necessity for contraception, a scarcity of supply severely impacted the population, resulting in unwanted pregnancies.

The government has taken huge measures via social media to create awareness about birth control, hygiene and social distancing. This approach via social media along with telemedicine and online consultations has proved beneficial for providing the relevant information and achieving awareness during the pandemic.

The availability of mobile clinics by government authorities, vaccination against the coronavirus has instilled a reasonable amount of confidence amongst the population at large.  As the society through this entire journey from March 20 to September 21 has given us a better understanding of the disease wherein people are now focused on lifestyle modulation, exercise keeping morbidities and co-morbidities under control and practising social distancing. These are baby steps for a bright future but yet we have miles to go before the economic situation in the countries is globally rectified.

(The author is Consultant, Gynaecology & Obstetrics, P D Hinduja Hospital & Medical Research Centre, Khar, Mumbai. The article is for informational purposes only. Please consult health experts and medical professionals before starting any therapy or medication. Views expressed are personal and do not reflect the official position or policy of the Financial Express Online.)