In a discussion on Expanding the range and reach of contraceptives in India on Friday, 28 May 2021, the International Day of Action for Women’s Health, a panel of high-level experts emphasized the need for expanding contraceptive choice and optimizing access to currently available contraceptive methods, especially in the context of the continuing COVID-19 pandemic.
The webinar led by Population Foundation of India, underscored the requirement for an increase in the overall basket of contraceptives available to women in India. Initiating the conversation, Poonam Muttreja, Executive Director, Population Foundation of India, highlighted the significance of expanding the basket of contraceptive choices.
“Today on the International Day of Action for Women’s Heath, we have decided to deliberate upon a critical issue of availability and accessibility of contraceptive methods, of choice for all women no matter where they live, who they are and pledge action in the direction of expanding the range and reach of contraceptives. It is a fundamental right of every woman to be able to choose from a variety of contraceptive choices, which over the years, have been availed by women across the world. Women in countries like Thailand, Bangladesh and Indonesia have greatly benefited from the introduction of implants in the public health system given its long-term efficacy of 3-5 years. Implants and other long acting reversible contraceptives are particularly relevant in the context of the pandemic, where disruption in services have restricted women’s access to reproductive health services,” she said.
The panel underscored the need for a shift in social norms and attitudes around family planning as being primarily a woman’s responsibility. Social and behavior change communications can go a long way in challenging regressive social and gender norms and engage and educate communities on the need to address social taboos and myths around contraception. Population Foundation of India’s flagship SBCC initiative, Main Kuch Bhi Kar Sakti Hoon (MKBKSH), for instance, is a powerful example of the impact of SBCC in improving information and awareness around contraceptive methods and reproductive rights.
However, thirteen per cent of women of reproductive age – 15-49 years – in India have an unmet need for family planning. This means that women who want to avoid pregnancy do not have access to modern contraceptive methods. The availability and accessibility of contraceptive choices have been further inhibited by the ongoing COVID-19 pandemic due to restrictions in supply chain and reductions in essential services, including sexual and reproductive health care. Dr Jaydeep Tank, General Secretary of the Federation of Obstetricians and Gynaecologists in India (FOGSI), observed, “Globally, more women and children may die due to a lack of access to health services than COVID-19 itself. If we accept the fact that contraception saves lives, then it stands to reason that the lack of access to contraception is detrimental to women’s health and their lives. There is a lack of appreciation for the fact that nearly 70% of frontline health workers are women, and I am afraid that not enough attention has been paid to this particular group of women and their reproductive needs”.
Studies have shown that maternal health has been severely impacted by the pandemic, with pregnant women unable to access routine antenatal check-ups. Pregnant women under the restricted circumstances of the lockdown are more vulnerable to suffering from pregnancy-related complications. Last year, research estimated that 26 million couples in India faced disruptions in access to family planning. The resulting unintended pregnancies place major economic pressures on families or, worse, can lead to unsafe abortions and maternal deaths.
The panel highlighted the challenges and opportunities around contraceptive use and called for the inclusion of Long-Acting Reversible Contraceptives (LARC), such as contraceptive implants, considered among the most effective, in the basket of choices. Given the longer-term protection, the addition of implants has become even more relevant now in the current pandemic situation where there are restrictions in movement and challenges to frequent access to health facilities.
Dr Beena Joshi, Deputy Director of ICMR’s National Institute for Research in Reproductive Health and the Principal Investigator for the study ‘Health Technology Assessment of Long Acting Reversible Contraceptives in India’ in 2018 recommended that the government could consider a phased rollout of the Long-Acting Reversible Contraceptive, Nexplanon, as a cost effective step to expand the basket of contraceptives at this time. “We must address inequities to rural women also having access to these methods. We need to have counselling and training on the management of side-effects and follow-up and tracking mechanisms to ensure there are no adverse effects,” she said.
Responding to women’s need for contraception to exercise their choice as a critical priority, Medha Gandhi, Bill and Melinda Gates Foundation, said, “Women seeking contraceptive services are not patients and it is for us to design programs across channels to enable them to take informed decisions.
She commented that we need to be able to provide respectful care for girls and women across the continuum starting with ensuring availability of information to choosing the method of choice. We also need to focus on the advantages that a method offers to users stepping away from the focus on side effects. This is a critical step in positioning contraceptives and building confidence in improved uptake.
She further added, “Government of India has stayed focused on ensuring consistent messaging on provision of essential health services including family planning even at the peak of Covid-19. We need to continue to focus on strengthening primary healthcare towards provision of quality services and reducing the burden of mortality and morbidity for girls and women.”
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