Written by Sneha Sharma, Senior Research and Program Associate (ICRW ASIA); Sharmishtha Nanda, Technical Specialist (ICRW ASIA); Kuhika Seth, Technical Specialist (ICRW ASIA); Aishwarya Sahay, Research Associate (ICRW ASIA) and Pranita Achyut, Director-Research and Programs (ICRW ASIA)
Our lives have radically changed since the onset of the pandemic at the beginning of the year. COVID-19 has impacted all spheres from food security, health, to education, and has also deepened social and economic inequalities, especially for those already marginalized. Health systems around the world have suffered from the pressures of the pandemic and increased load of patients. To contain the virus, several countries, including India, implemented countrywide lockdowns which were later lifted in phases. Urgency for health system to respond to COVID-19 infections combined with lockdown measures resulted in major disruptions in delivery and access to essential health services for women and girls. Frontline health workers were recruited to help with the COVID-19 response putting women and girls in a precarious position as it cut off access to their primary source of sexual and reproductive health information and services. Despite this disruption, the need for family planning increased as many migrant men who had moved towards major cities in search of viable job opportunities, returned home after losing their jobs and incomes due to lockdown measures. For women, access to family planning is critical and part of basic healthcare. Without these services, women and girls run the risk of losing the ability to decide when they wish to become pregnant. It is anticipated that this could lead to 7 million unintended pregnancies in low- and middle-income countries.
Further, considering the many men returning home and the ongoing economic crisis, we can expect a shift in household dynamics. Early evidence suggests that the stress from the pandemic and its ripple effects could lead to an increase in gender-based violence, women dropping out of the workforce to manage the increased burden of unpaid care work , and the possibility of an increase in school dropouts and a potential rise in early marriages. The norms around fertility, childbearing and use of contraception will be further entrenched, weakening women’s reproductive agency. The International Center for Research on Women (ICRW) conducted a study to unpack how the pandemic is affecting couples’ daily lives, their dynamics, and family planning needs.
Findings from ICRW’s qualitative research, where we interacted with several stakeholders in the community (40 interviews), suggest that the frequency of sex has increased, but this was not a linear increase. During the initial period of the pandemic and lockdown, the fear of the virus was high and there was a perception that the virus could spread during sex, which led to abstinence between couples. But gradually, as more information was available and several myths were cleared, sexual activities resumed. The men we interviewed, especially migrants and those newly married, spoke of how they found it difficult to abstain from sexual activity while at home with their wives. Lockdown measures resulted in an increase in the time spent at home, which could be recognized as a reason for the increase in sexual activity. Indeed, many men have been at home due to the lack of employment opportunities — either they are unemployed or engage in erratic work. With the ongoing economic crisis, men are finding ways to distract themselves and/or exert control to compensate for not being able to play the role of provider. A male respondent stated, “…sex is a way of distracting ourselves from the stress, we cannot keep thinking of the crisis 24/7.” According to the interview responses, sexual activity is on the rise due to COVID-19 and lockdown measures, leading to a likely increase in the demand for contraceptives.
At our research sites, Begusarai (Bihar) and Kanpur Dehat (Uttar Pradesh), frontline health workers are the primary source of information for women on family planning and other reproductive health services. Health workers’ role also extends to being advocates for women to consider modern contraceptives. A health worker from our study remarked, “it’s her responsibility to ensure women understand and use precaution because they don’t speak up but ultimately, they suffer since it’s a women’s burden.” However, the pandemic led to frontline health workers being recruited to help with COVID-19 patients and a disruption in the global supply chain of contraceptives. In addition, there was a lack of clarity around access and provision of family planning services during lockdown. Women were the most affected by this disruption of sexual and reproductive health services.
During the initial lockdown, women who wanted to access facilities for long-term contraceptives were not able to get their preferred birth control method since these services were completely unavailable. However, even after lockdown restrictions were eased, fear of the virus impacted the demand for these services. Consequently, many women relied on traditional methods of birth control like eating sour or acidic foods. At the same time, we noticed an increase in men speaking about the use of condoms over the past few months. Men listed pharmacists as the primary source for their family planning needs. As in the case of women, men also lacked access to health workers who could advise them on family planning and thus men often turned to pharmacists for guidance. During our interviews, the pharmacists in both Begusarai and Kanpur Dehat observed an increase in the sale of condoms.
The disruption of the global contraceptive supply chain and the increased demand for family planning combined with the fear of COVID-19, leading many to avoid health facilities, have resulted in some men taking on a greater share of the family planning responsibility. The norms around family planning being the same, this change in how men view family planning is anticipated to be temporary.
The lack of family planning services is going to have far-reaching implications on women, particularly in countries such as India where family planning services were already scarce. There is a need to reassess the health system’s priorities and capacities. While there is a need to focus on the response to COVID-19, other health needs cannot be ignored. Lack of access to sexual and reproductive health can have long-term consequences on people’s wellbeing and healthcare. We need to prioritize access to family planning and safe abortion, especially as the economic crisis worsens thus increasing the pressure on already marginalized women.
 The authors acknowledge the extensive efforts of Amrita Nandy (Independent), Falak Raza (ICRW Asia), Rai Ganguly (Independent), Tarini Gupta (Independent), Ripudaman and Sunil (Gram Praudyogic Vikas Sansthan, Begusarai), and Rakesh and Amitabh (Shramik Bharti, Kanpur)
 These findings are part of an ongoing ICRW study, Couple Engage. As part of the larger study, we conducted a nested study on Family Planning in the Times of COVID-19 Rapid Research to Assess the Effects on Young Men and Couples.
Please note that blog posts are not peer-reviewed and do not necessarily reflect the views of SRHM as an organisation.