Abortions run into many hurdles

While the government has declared it an essential service, getting the procedure in time is not easy

Last month, online delivery service Dunzo released a list of the top items delivered from pharmacies for the month of March. Pregnancy kits topped the list in Bengaluru. I-Pill and condoms were also top sellers.

This seems to be in line with a United Nations Population Fund study that states the lockdown, if extended for six months, will see around seven million unwanted pregnancies.

So on April 14, when the government added abortions to the list of essential medical services, it was seen as a step in the right direction.

“Asking whether abortions should happen during this time is like asking if deliveries should. There is no question about it in my mind as long as the procedure is safe and within the limits of legality. It is every woman’s right,” says Dr Prathima Reddy, director, senior obstetrician and gynaecologist at Fortis La Femme Hospital.

Jasmine George, founder of sexual and reproductive health collective Hidden Pockets, says that when the lockdown began, there was an increase in the number of calls the helpline received.

“Many were distressed calls about girls who had missed their period and were worried if they were pregnant and what the next steps would be.”

She adds that they saw a spike in calls from tier 2 and 3 cities as many women from metropolises had moved to stay with their families during this time.

“There is already a deep stigma surrounding abortions, especially for single women, and that had increased. No one wanted to talk about these things during a pandemic,” she says.

This meant that having access to abortions, both in terms of getting to hospitals and finding doctors willing to do the procedure was difficult. Jasmine says that they received a backlash when they were campaigning for abortions to be made essential.

“When the government shows it’s important, the stigma around it will reduce. This kind of legal language also empowers women,” she explains.

Priority to the pandemic

It was still difficult to access for a few weeks after the announcement. One major hindrance was that the healthcare infrastructure was overwhelmed due to Covid-19. “Many hospitals had Covid-19 wards or a significant number of patients with respiratory illnesses. Gynaecologists too were asked to pitch in for the pandemic response. There was a prioritisation of cases and abortions were not high on that list,” says Jasmine.

Specialised clinics were also closed. Dr Chitra Ramamurthy, Senior Consultant, Obstetrics & Gynaecology, Apollo Hospitals says her private clinic is not functioning during this time.

“The nurses and receptionist can’t make it due to the lack of transport so I’ve been forced to shut it down for now. Many of my patients have thankfully been able to come to the hospital,” she says. She adds that the number of abortions have slightly increased during this time.

Jasmine cautions that going to a general hospital does carry a risk of contracting the virus which is why women and child clinics or hospitals are preferred.

Doctors are also prioritising cases as per the number of weeks as abortion is only legal until the 20th week under normal circumstances.

Where to go

“This is a concern for many who phone in. There are doctors who refuse to provide abortions even in top metropolitan cities. Many ask single women to bring in their parents along with them even though this is not legally required,” says Jasmine.

While in normal circumstances it is not that difficult to find another doctor, in such times where travel is a hassle and doctors are unavailable, finding a willing doctor becomes a challenge.

While people who are aware of and have access to helplines such as the one by Hidden Pockets, others have to go physically get to a hospital. And if turned down, they have to try another one.

To try and alleviate this tension, Dr Prathima says that Fortis La Femme has begun tele and video consultations. “They can avail these options before coming to the hospital. It avoids unnecessary visits for issues that can be dealt with remotely and also provides clarity on whether the services they require will be accessible now,” she explains.

All major hospitals should be performing abortions as per the government guidelines, but the best practice is to call and check if the hospital has specific parameters they are following in terms of visits.

Time is of the essence

Abortions are only legal in India in the 20 weeks since conception. In special cases, it may be permissible for up to 24 weeks. The less traumatic non-surgical methods of abortion are only available up until 6 weeks, after which a surgery would be needed. While this may seem like a long time, most pregnancies are only detected five to six weeks after conception, making it a very time-sensitive procedure. Surgery is complicated and requires a longer recovery period.

The stigma attached to it

Jasmine George, founder of sexual and reproductive health collective Hidden Pockets, says that a lot of women, especially single women, have moved in with family or friends during the lockdown. Jasmine says that when women miss their period, it creates more panic than usual due to the stigma surrounding being sexually active and considering an abortion. Everything has to be done discreetly.
“In most homes, it is one person who is going to get groceries, and the lack of pads on the shopping list is enough to raise alarms,” she says.
Movement is closely monitored, making it difficult for women to slip out and consult a doctor or even get a pregnancy test.
Having enough privacy to consult a doctor remotely or ordering a kit online is also not a luxury many have.
“This way access and availability is greatly reduced,” she adds. Pharmacies are stocked up, Hidden Pockets has checked major ones in the city. Two doctors Metrolife spoke to also say that their patients had no problem in accessing these items.
“The stigma plays a role in going to a pharmacy as well. Many of them have long queues due to social distancing and you have to shout your order out to the chemist. Buying these items is already an embarrassing ordeal for many but in these circumstances, it becomes even more so,” says Jasmine.