Family planning disrupted

Eighteen-year-old Afia, who gave birth to a baby boy through a C-section just 15 months ago, learned she was pregnant again this April.

After consulting with her ob-gyn, she went to a local Marie Stopes clinic for a surgical menstrual regulation (MR), as she and her husband were not willing to continue with the pregnancy, only to find it closed.

Seeing no other way, Afia went to a lesser-known clinic in Mirpur where a doctor performed her MR procedure.

"A few days later, I suffered heavy bleeding and when I visited the clinic again, after examination, the doctors informed me that the procedure had not been done properly," she said.

She had to undergo the procedure a second time.

Due to the circumstances, she didn't receive any post-abortion care and was unable to plan for a suitable long-term birth control method with her ob-gyn as by this time, Mirpur had become a coronavirus hotspot in the capital.

"My husband and I were reluctant to visit a health facility. We were mostly worried for our son," said Afia.

With no reliable contraception, inevitably, she found herself one-month pregnant again at the start of this month. "We tried our best to use protection every time, but I don't know how the barrier failed."

Afia said having another child now is not an option with a young baby and with no domestic help at home. "At the same time, I cannot think of an abortion as I had one just two months ago."

This has also created tensions between her and her husband, she said, and affected their relationship.

Afia's situation depicts how the Covid-19 outbreak and shutdown has impacted family planning and women's reproductive health.

In April, United Nations Population Fund (UNFPA) projections predicted that more than 47 million women in low- and middle-income countries will be unable to access modern contraceptives, leading to seven million additional unintended pregnancies, as a result of lockdown-related disruptions to health services over six months.

During the shutdown, fear of contracting the virus by visiting health facilities or urgent domestic and financial concerns, meant many women went without contraception.

This correspondent spoke to several women who said their birth control methods were interrupted during the shutdown.

Five of seven women who use the injection method -- which needs to be taken every three months -- said they didn't go to a health facility for their shots in April and May.

Of them, 38-year-old Rahima Begum, mother of four, didn't go get her injection in April and is uneasy because she missed her last period.

"I didn't take any other precautions as I had too many worries," she said.

As a domestic help in Kazipara, Mirpur, she lost her position in several homes at the time as employers didn't want outsiders coming in to work in their homes and other families returned to their village homes during the shutdown.

Worried about how to pay rent and afford food at home, she neglected her birth control.

"If I get pregnant now, I won't be able to show my face to my grown sons. I would also have to give up my income," said Rahima.

Marie Stopes Bangladesh, a well-known organisation providing reproductive health and family planning services, noted that the number of people accessing services declined drastically during the Covid-19 shutdown.

According to the organisation, the average number of patients visiting its facilities before the shutdown was 23,000 per month; during the shutdown, this figure was 7,000.

This is despite the fact that most of its 49 clinics countrywide were open during the shutdown, according to the organisation, though these were not fully operational, especially in April.

The situation is likely to be as grave in rural areas, say NGO medical officers, where facilities are fewer and further away for villagers.

On a popular pregnancy support group with over 56,000 members on Facebook, "Pregnancy journey & motherhood", several women spoke about their unintended pregnancies and asked advice on what options they had and where they could seek safe abortions amidst the shutdown. Members include women from across the country -- in both cities and villages.

Some said they resorted to using abortion pills at home, though they would have preferred a safer, supervised procedure, due to restrictions on mobility and fear of visiting crowded health facilities.

Tawfika, who got pregnant in April, took abortion pills which eventually didn't work and she was uncertain of what to do next. She can't take the pills again and now that three months have passed, she cannot have an MR procedure performed.

She is keeping the baby for now but is worried of the effects of the abortion pills on the development of the fetus.

Two newly married women who learned they were pregnant said they were unable to consult a gynecologist about family planning before the shutdown.

Both women said they were financially and mentally unprepared to have a child now -- one woman is currently an undergraduate student, while the other's husband is uncertain of his job and receiving half-pay at the moment.

Family planning should be ensured as an essential service amidst this fear of coronavirus so people aren't deterred from accessing these services right now, said Monjun Nahar, advocacy and communication manager at Marie Stopes Bangladesh.

Widespread awareness campaigns about the importance of family planning should be undertaken and protective gear issued to field workers so they can continue to promote family planning services especially in urban slums and rural areas, she said.

[Names have been changed to protect the privacy of the interviewees]