New Delhi: India’s projected “post-pandemic baby boom” does not seem to be happening. If anything, many gynaecologists across the country say they are still conducting fewer deliveries than they did in pre-pandemic days. Instead, several doctors told ThePrint, there has been an uptick in requests for abortions.
The reasons cited are many, including a continuing fear of Covid-19, pandemic restrictions that don’t allow hospitals — especially government facilities — to admit patients at the same rate as before, and lack of access to contraceptives during the lockdown period.
Additionally, there are fears in the government that the pandemic may have undone the gains made by India in widening access to institutionalised deliveries.
“Before the lockdown, we were doing about 100 deliveries a month. We have not yet crossed 100, which could also be because there is still an element of fear,” said Dr Anuradha Kapoor, a consultant gynaecologist at Max Healthcare at Saket, Delhi.
“We have one building dedicated to Covid, so it is possible that people are still hesitant to come to us and that is why deliveries are not picking up. However, requests for medical termination of pregnancies are up by about 20 per cent. In fact, we are getting these requests even from 39-40-year-olds,” she added.
In May last year, the United Nations projected that, at 20.1 million births in the nine months after Covid was categorised as a pandemic, India would top the list of nations that would see a post-pandemic baby boom. This was largely attributed to the breakdown of contraceptive services during the Covid-19 lockdown.
“That number did not take into account Indian realities. But I can say this for a fact that, in the last 10 months, we have done more abortions than we have done in the last three four years. We were surprised by the numbers,” said Dr Prakash Trivedi, a Mumbai-based doctor who serves as president of the Indian Society of Assisted Reproduction, an organisation dedicated to helping address infertility-related issues, and is a former president of the Federation of Obstetric and Gynaecological Societies of India (FOGSI), a professional body.
“We never closed, so people who needed an abortion had some options,” added Trivedi, who has a clinic in Ghatkopar East. “Also, abortions can happen between 6-20 weeks, so that is a fairly long window. The lockdown was for about nine weeks. Deliveries, on the other hand, are status quo. It is definitely a fact that there were more pregnancies during the lockdown but we are not looking at more babies,” he said.
A similar trend in government facilities
Government hospitals, too, have seen a decline in deliveries. The Lok Nayak Hospital in Delhi, a Covid facility, has just opened its OPD and IPD facilities so numbers have not picked up yet. However, at Lady Hardinge Medical College and Hospital, another facility in the national capital, Covid restrictions have meant that deliveries are not yet up to pre-lockdown levels.
A senior doctor in the hospital’s department of gynaecology said: “We now have a rule of one patient in one bed because of Covid. We cannot double or triple up like we used to do earlier. We used to do about 800-1,200 deliveries per month. Now, they are down to 600.”
Speaking to ThePrint, sources in the Union Ministry of Health & Family Welfare said data from the National Health Mission had shown a dip in deliveries too, but urged caution in interpreting the data as a trend.
“It is not possible to take that data at face value because updation on the portal has been affected,” said a ministry official. “Healthcare workers have been engaged in Covid management, so there is a lag in the data. We are trying to get it back on track.”
The official, however, expressed apprehensions that India’s rising graph of institutional deliveries may have been affected by the pandemic, saying the numbers may reflect just that, and not an actual reduction in births.
Contraceptive services impacted
According to figures available with the Condom Alliance, a consortium of India’s leading contraceptive manufacturers and marketers, there was a definite dip in access to condoms and short-term contraceptive options such as pills during the lockdown.
“Surveys suggested there was a 26 per cent rise in unwanted pregnancies and about 10 per cent women could not access the centres where they get contraceptive services…” said Vivek Malhotra, CEO of the Population Health Services International.
“While pharmacies were open, supply chains got disrupted. It was only in May that the Ministry of Health brought out a document that classified family planning as an essential service but even then it was about July before police allowed carriers to ply,” he added.
Each year, India manufactures about 2 billion condoms and it is one of the leading exporters along with countries like Malaysia and China, according to data from the Condom Alliance.
The reluctance of women to talk about condoms or procure them is an added impediment.
“It is important for people to understand that contraceptives are an essential item. Like we keep stocks of food grains for emergencies, this is also something we need to stock up on. There may be more pandemics in the future too,” said Ravi Bhatnagar, director of External Affairs and Partnerships in Asia, Middle East and South Africa at Reckitt Benckiser.
Despite India’s “young” population, both Bhatnagar and Malhotra said condom sales have increased only at the rate of 1 per cent per year for the last couple of years.
‘Migrant movement affected numbers’
The trend of rising medical abortions seems to hold across cities. Dr Jaideep Malhotra, a former president FOGSI who practises in Agra, said requests for abortions have risen by about 10-15 per cent in the last six months.
But the dip in deliveries has been significant, she added.
“We (gynaecologists) have been discussing it. Delivery numbers have not risen not just in my practice but in none of the major metros. It is possible that is because migrants have left the big cities and that is why numbers are down,” she said. “Whether that is the case will be clear once data from the peri-urban and rural areas are available.”
In Bengaluru, Dr Aparna Versova, a consultant gynaecologist at Abhayastha Hospital, said the patient load has reduced, “probably because of migrants moving back to their native places”.
“So far as deliveries are concerned, they are still not back to pre-lockdown levels. Personally, I am doing about 25-30 deliveries a month. Before March 2020, it used to be 40-45. But I can definitely say abortion requests (medically terminated pregnancies) went up at least by 15 per cent,” she added.
“This was both during the lockdown months and after. Reasons varied, sometimes it was the third pregnancy, at other times, the couple was not ready to start a family. My guess is that pregnancies did happen more during the lockdown but at least 10-12 per cent people chose to end them.”