Challenges and coping mechanisms, experiences of slum women in seeking abortion services during Covid-19 lockdown in 2020 and 2021: Learning from Agra, India
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International Institute for Population Sciences, Mumbai, India
Urban Health Resource Center, Delhi, India
Publication date: 2023-04-27
Popul. Med. 2023;5(Supplement):A1025
Introduction: Restricted mobility during the lockdown led to unprecedented challenges related to women’s access to reproductive health services. The purpose of this research is to learn about the experiences of women in slums who needed abortion services during the COVID-19 lockdown in Agra, India in the year 2020 and 2021.  Methods: Qualitative interviews in slums were conducted with 35 married slum women in the age group of 19-35 years who underwent induced abortion during the COVID-19  lockdown. Key Informant Interviews were conducted with 7 frontline health workers (ASHAs) and 3 private nurses. Interviews were audio recorded with  respondents’ consent and thematically analysed. Results: Demand-side challenges in accessing abortion services included fear of COVID-19 infection, hesitation, ignominy and social ridicule associated with abortion Resultsing in delayed abortions. Supply-side challenges included unavailability of government and private hospitals providing abortion services, frontline health workers being unsupportive and scared of contracting COVID-19 infection and  transportation difficulties owing to lockdown/containment restrictions. Coping mechanisms practiced by women included hastily procuring abortion pills from known chemists without prescription for a secretive, economical and effortless method to abort. Women learnt about abortion pills from friends and neighbours. Women in desperation, availed services from local dais (traditional untrained birth-attendant), private trained nurses, at social franchising reproductive health clinic and services of a traditional healer too. Consequences of inability to receive timely and appropriate abortion services included severe bleeding and intense abdominal pain (both perceived as complications by women), aggravation of pre-existing anemia manifested as weakness,  dizziness, headache. Discussion: Optimal knowledge of the process of abortion will mitigate anxiety, lead more women to the appropriate abortion procedure, minimise delay in care-seeking and reduce risk of  incomplete abortion. Government health system should set up emergency RCH services and co-opt private nurses by training them in safe abortion practices.
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