-Ashfaque Raza Mikrani
New research paints a devastating picture of the potential effects the novel coronavirus could have on reproductive health around the world, describing a chain reaction of unmet needs, unintended pregnancies, unsafe abortions and tens of thousands of maternal and newborn deaths.
A potential unintended baby boom has been debated around the world, as most of the countries are following nationwide lockdown or remaining on house due to novel coronavirus outbreaks. If the situation remains same for some more few days, UNFPA projects that 47 million women in low and middle income countries are unable to use modern contraceptives, leading to seven million unintended pregnancies in the coming months. In case of Nepal, we cannot reject outright possibility of a baby boom if the lockdown continues for more than three months. Though this may not be anticipated in urban Nepal due to anxiety, awareness, and access to contraceptives, but there is a higher possibility of a spurt in birth of children in rural Nepal, particularly in populous and high fertility states.
There is already evidence of how the pandemic is affecting reproductive health. Contraceptive supply chains have been disrupted as manufacturers focus on COVID-19, leading to shortages of condoms. Abortion clinics have been forced to close because governments have not deemed them essential services during lockdowns. As countries throw everything they can at the pandemic, worries grow that it could come at the expense of other healthcare.
Marie Stopes International warned that because of travel restriction and lockdown, "Coronavirus crisis may deny 9.5 million women access to family planning “Up to 9.5 million women and girls could miss out on vital family planning services this year because of Covid-19, potentially resulting in thousands of deaths."
The Nepal Demographic Health Survey (NDHS) data shows that the overall fertility rate (TFR) in Nepal declined from 2.6 in 2011 to 2.3 in 2016.Despite such reduction, Overall, 81% of births were wanted at the time of conception, 12% were mistimed, and 7% were unwanted. The total wanted fertility rate is 1.7 children per woman, while the actual total fertility rate is 2.3 children per woman. The gap between wanted and actual fertility shows that women are having an average of half a child more than they want.
Such an unmet need for contraceptives followed by unintended pregnancy may further increase due to several reasons such as limited service by hospitals, absence of public transport, inadequate supply of contraceptives in local chemist shops. Firstly, during lockdown health workers are busy with preparedness of Covid19. Secondly, couples might restrain their visits to health facilities looking for abortion and other family planning methods fearing infection and because of afraid of beaten up by police. Finally, especially among the poverty-stricken couples who have fewer means of economic engagement and meaningful entertainment. In these uncertain times, women “have to lock down their uterus.”
Husband and wife, what else can they be doing in the house? I think we’re going to have a lot of pregnancies and, unfortunately, unintended. And most will result in unsafe abortions, domestic violence. Our community is paternalistic. If something goes wrong in the home, it’s the mother’s fault, even if the man initiated it, which may lead to violence.
While nationwide lockdown is unavoidable and is a wise decision to contain the spread of the virus, there is a need to address the possibility of an unintended baby boom among poor and vulnerable groups. Unwanted pregnancy is a tremendous public health concern in Nepal that leads to unsafe abortions and high maternal mortality.Children born due to unintended pregnancy may suffer from malnutrition, negligence, illness, and even death. At the societal level, it has far-reaching socio-economic implications.
To avoid a baby boom or unwanted abortions, massive awareness on family planning methods is needed during the ‘Stay Home’ period. The availability of family planning methods should be considered as an essential service and delivered in Nepal. It is also important to train health workers to provide consultation on family planning services by alternative modes such as digital tools, home visits, mobile clinics, etc. At the same time, incentives may be provided to the health workers for continuing maternal and child health services during lockdown.
(Public Health Professional)