Abortion in Pandemic: Reality Check at the end of 2020

2020 was the Annus Horribilis. The COVID-19 pandemic shook the foundations of our world. When many world leaders equated the preparations to tackle the pandemic to a war footing and asked the public to make collective sacrifices, little did we all delve into those exaggerated declarations from the leaders to sift through and analyze how best are the leaders equipping their countries to tackle the pandemic. In the initial months of the pandemic, as different countries declared different timelines for total lockdown, there was little clarity about what is essential and not essential services. Amidst all the chaos, it came across as if the government expected that all bodily functions such as menstruation, pregnancy can all be on pause mode during the pandemic!

In India, in the first weeks of the lockdown when the whole country was brought to a standstill, when the busiest of the busy roads were as empty as a clear blue sky, when people would get out of their houses only to buy groceries and medicines, there were a group of outraged netizens and activists who brought to the leaders’ attention that basic menstrual hygiene products were not declared as essential goods! After numerous likes, shares, comments, retweets amplification in the net world, knocks on the government’s doors became so loud that eventually it was declared by the government that menstrual hygiene products are essential too! Meanwhile, numerous people in the country were being turned away from hospitals and clinics when they wanted an abortion during the lockdown. The reason for denying them abortion: not an essential service!

Well, war cry indeed, citizens, activists and NGOs made to have the abortion declared as an essential service and essential service thus it became, but how many in fact were able to get a safe and legal abortion during the lockdown and post lockdown, even though abortion was declared as an essential service?

As part of the Safe Abortion Action Fund (SAAF), in the initial weeks of the unlock in India, Hidden Pockets Collective did a tele-audit of hospitals and clinics in four districts of Karnataka viz Bengaluru Urban, Mysore, Shimoga and Ballari. We wanted to find out whether safe, legal and most importantly non-judgemental abortion especially for single women, continues to be out of bounds even during the pandemic when unplanned pregnancies are on the rise. The findings were worrisome.

With the year almost ending now, and more than 6 months have passed since the initial weeks of unlock, we set out for another round of tele-audit calls to see how have the access and availability of safe, legal and non-judgemental abortion improved/ restored in this time duration. The findings were a mixed bag!

Serial Abortionists!

Dr. A from a leading private hospital in Ballari, whom we had spoken to in the first round of tele-audits in June/ July, where she came across as very sympathetic to the challenges in accessing safe and legal termination of pregnancies and even agreed to provide MMA (Medically Managed Abortion) for single women under 7 weeks of gestation, was triggered this time when we used the word non-judgemental abortion! She blasted at us and said that she has been getting numerous cases in these last few months where women came to her for MMA pills and they keep coming back to her repeatedly, instead of taking contraceptives. She said these women are “serial abortionists” and she will not give non-judgemental abortion but give them an earful for not using contraceptives. To quote her further, “You want a non-judgemental abortion? Well, I will make sure I give these women a hard lesson when they come to me for abortion.”

When we reminded Dr. A how open and understanding she was when we last spoke to her, she said, “Agreed. But I will not want this hospital as a safe and non-judgemental space for women to get abortions. This is not a walk-in and walk-out space where they all can come, take the pill and have an abortion and keep coming back again and again.” 

At our repeated presentation of facts that the pandemic, especially the lockdown, has worsened many people’s access to contraceptives and many doctors are not helping them to get a safe and legal abortion and that  forces them to approach quacks, Dr. A had a pat reply: “These women are not dumb. They are smart enough to know where to get an abortion. If they were so worried about pregnancy, they should have made it a priority to use contraception.” She strongly said that she will not help women get an abortion and questioned us with, “Do you realize what is an abortion? It is killing a baby! You are baby killers!”

Dr. A was firm on her new stand that neither she nor the hospital that she works for will  give any abortion. As the last word she said, “If you need help and support to give women good guidance and counselling on contraceptives, they can come here. But I shall not be a party to give women abortion. They keep coming back here, again and again, with some silly excuses or the other for not taking contraceptives. I will make it a point to give them a good hearing henceforth so that they don’t come back here ever again for abortion.”

Pharmacies: the shortcut to abortion

Dr. B from a well reputed private hospital in Shimoga was far more approachable and less guarded since our last call. She said that women, married or unmarried can get a safe, legal and non-judgemental abortion at the hospital. Bracing for the second wave of the pandemic, she said that if the pregnancy is above 20 weeks, the concerned parties will need to move legally, that is through a notarized legal affidavit which needs to be filed in and abortion can proceed only through legal sanction. 

For unmarried women, she reiterated her statements from our earlier calls that it is best that her parents are involved. She again recounted numerous incidents as in the earlier calls, where women were abandoned by their male company or them creating scenes in the hospital. She also narrated a recent incident wherein a couple who were engaged to be married had come for an abortion and the fiancé had abandoned the woman. The hospital was left with no option but to inform her parents as consent was needed for surgical procedures.

When we posed the question that if women are not in a position to involve her parents, Dr B. answered that any female close relatives like a sister will be sufficient. We asked her that

even if that is not a possibility but an organization that works in SRHR is there as a patient bystander to take care of the woman, she said that is also okay, as long as the NGO is legal and the proof for registration etc are submitted when the woman needs legalized consent such as in the case of surgeries. She highlighted that the hospital has given abortion to unmarried women too in these past months, and all the hospital is aiming for by having these systems in place is that they want minimal trouble by preventing patient abandonment.

Dr. B shared with us a pattern she has seen emerge during these last few months. She said she has had numerous cases where single women self-administered medical abortion pills and developed complications in abortion. On asking these women where they got the medical abortion pills from they said that they procured it from the pharmacies. Dr. B said that perhaps these women found it difficult to approach a doctor to get abortion due to the cultural taboo, or could be that they wanted to cut the costs of medical expenses that they can incur when they get an abortion done through a doctor at a hospital. Whatever may the reason be, Dr. B said it is highly risky as women take these medical abortion pills without any medical supervision. She elaborated on various complicated cases she had to intervene because the women took the medications all wrong, sometimes even overdosing. She suggested that something needs to be done such that pharmacies do not continue dispensing medical abortion pills without medical supervision. In exasperation she explained how in the end, it is always the doctors like her, who have to handle the complications and save the women’s lives when such ill advised and non supervised usage of medical abortion pills occur.

The POCSO dilemmas and love:

Dr. C, a doctor at a government hospital in Mysore, whom we spoke to for the first time in our audits, came as a breath of fresh air. In our earlier audits in June/July we had no response from any government hospital in Mysore. However, in our December calls, we were finally able to have a breakthrough.

For Dr. C, conversations on safe, legal and non-judgemental abortion for women (single or married) were all irrelevant as she said the government hospital is the go-to place for any woman. What she wanted to bring to our notice was that in these last few months there were increasing cases of minors who had come to the hospital for abortion! She said, in many cases she was put in a difficult position due to specifics of certain cases such as two adolescents who are in love or just wanted to explore sexual matters, but she had to report the matter to the police according to the laws of the country, such as the Protection of Children from Sexual Offences (POCSO) Act. The problematic part of POCSO is that those adolescents who have had consensual sex, are in fact punishable! And to add more woe to the misery, the legal age of consent in the country is in fact 18. Dr. C opined that laws in the country should change to validate consensual sex amongst adolescents because she strongly felt that the adolescents suffer social stigma and ostracization all due to the punitive nature of the POCSO Act. 

Too hectic! Too busy?

The government hospitals in Bengaluru Urban, be it the referral hospitals or the maternity hospitals or the tertiary hospitals, must have had hectic days in these last few months because most of them still did not have responsive landlines. If at all the phone did get picked up, the receiver had no clue about abortion details that the hospital provided. And to talk to the doctor was just impossible as she/he was either in the O.T or in the ward rounds. Requests for the personal number of the doctors were met with the replies “not possible.”

Conclusion:

The second wave of infection is looming ahead. Vaccinations are planned to be rolled out on a priority basis as determined by the government. Questions are always remaining whether there will be another lockdown in the coming months, whether it will just be a night curfew. Whatever may the events be, one thing that needs to be planned well ahead of time by the government who constantly espouses war footing to tackle the pandemic is: women should have access to a safe, legal and non-judgemental abortion because abortion is a time sensitive matter. 

Writer:

Dr. Nishitha Aysha Ashraf is Programme Associate for SAAF Project at the Hidden Pockets Collective. She completed her B.A. Journalism & Communication (2010) and Bachelor of Dental Surgery (2015) from Manipal, Karnataka. She has covered the Nipah outbreak in Kerala during her stint as Health Reporter with The News Minute (2018). The reportage furthered her interest to be a key player in public health/ community health. Her internship and work at SOCHARA – Society for Community Health Awareness, Research and Action (2019) was instrumental to learn more about the People’s Health Movement. She is keen on exploring the SRHR issues of Kerala, especially those amongst the Muslim and Christian communities.

Abortion in Bengaluru Urban: Part 1

*This article is a part of a series exploring the abortion services in 4 districts of Karnataka.

COVID-19 pandemic has tectonically shifted many things in everyone’s lives. When the nationwide lockdown was all about highly restricted movement and access, only essentials being available, and night curfews; then the nationwide unlock stages were all about “are we there yet questions” on getting back the pre lockdown normal life. 

When Hidden Pockets Collective started its tele-audits of service providers for abortion, we were in the cusp of the country moving from the lockdown to unlock. The month of June saw us glued to our phone, making calls after calls to every listed government-run Maternity Homes (MH), Referral Hospitals (RH), General Hospitals (GH) and Tertiary Hospitals (TH) in Bengaluru Urban district. This was just the start to an extensive project where we were to audit three more districts viz Mysore, Shimoga and Ballari in the state of Karnataka. 

To know more about this  SAAF (Safe Abortion Action Fund) project “Abortion is Care”, do read:

With unlock in full swing at various stages, we were very hopeful that Bengaluru Urban will soon be back on its buzzing feet. On that note, when we started making calls to the 30 plus listed abortion service providers that fall under the categories of MH, GH, RH, and TH, we were rushing against time to put together all the collected information for young women. Abortion is a time-sensitive matter and with lockdown cutting off SRHR access to numerous women, we were sure that we will be the SOS call for many women. But we were in for a rude shock from Bengaluru Urban!

Let’s not answer. Let them die or whatever?

Of the 30 plus listed service providers, many did not answer our calls! Mind you, these are listed landline numbers that the public is expected to use when they need information, clarification on healthcare services from the hospital. The inquiry desk of the hospitals is literally the ones who should be at the beck and call through this number. However, during the month of June, many of these hospitals chose to do a “Marie Antoniette” at the public by absolutely refusing to pick any calls. We were quick to dismiss these “refusals” by justifications such as probably busy hour, probably busy day, probably staff break hour. And day after day, hours after hours, we kept trying, again and again, to have someone from the helpdesk talk to us. Nothing worked! We just could not fathom how people in distress, say due to a miscarriage or labour pains can breakthrough this “refusal” to get help during the unlock, when the public had no clue how things are getting back to normal during the unlock. Forget about getting information on abortion, when in fact there is nobody to pick the call even to answer the most important question of that time: “I think I have Corona. What do I do? Where do I go?”

Yes, speak to us!

It was always a “hallelujah” moment when the calls were answered. When the audits for Bengaluru Urban were done, the total number of hospitals that answered our calls could be counted in fingers. However, it was not all rosy either when our calls were attended.

Volleyball the call:

One Referral Hospital had the staff unwilling to give us any answers to our inquiries on termination of pregnancy. Our call was volleyed from one staff to the other. They all came across as extremely uncomfortable to disclose any information on abortion over the call and kept dismissing us by stating that we need to come in person to the hospital, meet the doctor and get a check-up done. In spite of our repeated stand that we were currently not in a position to physically travel to the hospital due to the pandemic and that we just need some basic information regarding the cost such that we come prepared for the termination later when we make the trip to the hospital,  the staff reiterated to their tone-deaf words “come to the hospital, get the OPD ticket, meet the doctor.”

Doctors wanted:

A few hospital help desk staff were able to give us preliminary information. However, for details on gestation limits and type of abortion recommended, they were unable to help us as they openly admitted that they don’t know anything about such matters. They suggested we speak to the doctor and connected us to the department landline. Often the doctor on duty was unavailable to attend the call, as they were either in O.T or doing the ward rounds. There were also doctors who were unavailable as they were on leave or were away attending a district-level meeting with health department officials to manage the district’s response to the COVID-19 pandemic.

Only Corona please:

A leading government hospital answered our calls with promptness and professionalism. We were almost on the brink of relief thinking that this hospital will finally be the go-to-place for safe and legal abortion for all, irrespective of the marital status. All hopes were dashed when they told us that the entire hospital has been converted into a COVID-19 hospital and they can take in only COVID-19 cases! Our question on where else can a patient go to get OBG consultation, now that hospital X is COVID-19 one, were met with apologies from their end: they did not know where the patients were to go!

Conditional abortion only:

Of the two hospitals that gave us a positive response for medical termination of pregnancy, one came across as too eager to get rid of us using scare tactics. The doctor of this hospital who spoke to us said that we need to get permission from the Medical Superintendent to get an abortion! She said this is needed because the abortion is for unmarried women. 

The second hospital whose doctor was very understanding of the predicament of any women-married or otherwise- to get an abortion, did offer abortion services according to the provisions of the MTP Act, 1971. However, the doctor did put forward the suggestion that it is always best that there is a patient bystander who can help and support the patient during the abortion. She said that they have had cases in the past when the patient was abandoned by the bystander when any complication such as excessive bleeding occurred. Hence, she was of the opinion that a person who has the legal obligation to the patient be the patient bystander. 

Pre pandemic and post pandemic:

Our field trips were severely curtailed by the pandemic. Had it not been for the pandemic, we would have been stalking the corridors of all these hospitals, talking to the patients and doctors there, trying to assess and evaluate on the ground, such that we have concrete data on safe spaces for women to seek a legal abortion. With the country gradually settling into the “new normal” of post lockdown months, we are looking forward to being on the ground.

Writer:

Dr. Nishitha Aysha Ashraf is Programme Associate for SAAF Project at Hidden Pockets Collective. She completed her B.A. Journalism & Communication (2010) and Bachelor of Dental Surgery (2015) from Manipal, Karnataka. She has covered the Nipah outbreak in Kerala during her stint as Health Reporter with The News Minute (2018). The reportage furthered her interest to be a key player in public health/ community health. Her internship and work at SOCHARA – Society for Community Health Awareness, Research and Action (2019) was instrumental to learn more about the People’s Health Movement. She is keen on exploring the SRHR issues of Kerala, especially those amongst the Muslim and Christian communities.

Corona Archives: Hidden-Pockets Collective

The World Health Organization (WHO) Director General’s recent remarks on COVID-19 emphasized that “All countries must strike a fine balance between protecting health, minimizing economic and social disruption, and respecting human rights”.

When health systems are overwhelmed, we need to make difficult decisions to balance the demands of responding directly to COVID-19, while simultaneously engaging in strategic planning and coordinated action to maintain essential health service delivery. The provision of many services will become more challenging. Women’s choices and rights to sexual and reproductive health care, however, should be respected regardless of COVID-19 status.

We, at Hidden-Pockets Collective, ensured that we also are able to respond to this crisis with special focus on sexual and reproductive health.

Thought Publications : 

We ensured that sexual and reproductive health is not missed out while discussing the conversations around response to this. We produced specific articles with response to  COVID-19 crisis.

Menstrual Health Management

Pregnancy and Abortion

 

Policy focussed demands :

Social Media:

Instagram Live Sessions:

  • With Ungender Legal Advisory on Workplace Sexual Harassment: Is it still valid if you are working from home?
  • With YANSL (Youth Advocacy Network SriLanka) on Men and their support for women’s SRHR during the crisis
  • With Mission Sanscar on Menstrual health & hygiene during the lockdown
  • With The Indian Women Blog on Role of sexual and reproductive health counselor during the lockdown, How are Hidden Pockets helping the young people of our country?
  • With Sheroes on SRHR concerns during the lockdown
  • With Rangeen Khidki Foundation on How to manage your menstruation during the lockdown

Tweetathons:

  • With SAAF (Safe Abortion Action Fund) on How to ensure access to safe abortion during the COVID-19 pandemic?
  • With IndiaMeToo and Sheroes on Access to essential SRH products and Services during the lockdown
  • With Global Concerns India on Domestic violence & shelter homes during the time of COVID-19
  • With The Bachchao Project on Love in the time of lockdown (Digital privacy)
  • With YANSL (Youth Advocacy Network SriLanka) on Women’s right to choose during a crisis
  • With the Body & Data on Women, Queer Individuals and, Privacy during the lockdown
  • With Women Help Women, Safe Abortion WOmens’s Right and Gynuity Health Projects on Telemedicine and self-managed abortion: Is telemedicine the future?

Helpline Numbers: