Impact of the Covid-19 Pandemic on the Prevalence of MTP Cases and Their Clinicodemographic Profile in India: A Retrospective Multicentric Study

Richa Sharma¹ · Pratima Agarwal² · Vaishali Jain³ · Haritha Sagili⁴ · Sonali Sarkar⁵ · Anuradha Panda⁶ · Kruti Deliwala⁷ · Krupa Shah⁸

Pratima Agarwal drpratima11agrawal@gmail.com

1 Department of Obstetrics and Gynaecology, UCMC and GTB Hospital, 110095, New Delhi, India

2 JIPMER Hospital, Dhanvantari Nagar, Puducherry 605006, India

3 Department of Obstetrics and Gynaecology, Vivekanand Institute of Medical Science, B‑1/45, Sector‑J, Opp‑RBI Colony, Aliganj, Lucknow 226024, India

4 Department of Obstetrics and Gynaecology, JIPMER, Puducherry 605006, India

5 Department of Preventive and Social Medicine, JIPMER, Dhanvantari Nagar, Puducherry 605006, India

6 Obstetrics and Gynecology Department, Apollo Hospitals, Jubliee Hills, Villa 37, Aditya Empress Park. Shaikpet, Hyderabad 500008, India

7 Department of Obstetrics and Gynaecology, Narendra Modi Medical College, 14 Alpakunj Society Hiral Darshan Flats, Bhattha Paldi, Maninagar, Ahmedabad, Gujarat 380007, India

8 Obstetrics and Gynecology, Melaka Manipal Medical College, MAHE, Manipal. 88, Sai Radha Green Valley, Parampali, Udupi, Manipal, Karnataka 576104, India

Richa Sharma: Professor, MS, MNAMS, FICOG, FICMCH, CIMS, FMAS; Pratima Agarwal: Chief Medical Officer, DNB, DGO, MNAMS, FICOG; Vaishali Jain: Senior Consultant & HOD, MD, FICOG; Haritha Sagili: Professor, MD, MD, FRCOG, MFSRH; Sonali Sarkar: Professor, MD; Anuradha Panda: Senior Consultant, MD, DGO, FICOG; Kruti Deliwala: Associate Professor, MD, DGO, FICOG; Krupa Shah: Associate Professor, MD.

Background: During the Covid-19 pandemic, reproductive health of women was disproportionately affected due to difficult access to safe abortion and contraceptive services. This study aims to assess the impact of the Covid-19 pandemic on the prevalence of MTP cases and to find out the clinicodemographic profiles of women undergoing MTP during three Covid-waves in different hospitals-Government and private sectors in India.

Methods: This retrospective multicentric cohort study was conducted during three Covid-19 pandemic waves. The records were retrieved from the centers’ medical record section and the MTP register from the Department of Obstetrics and Gynaecology.

Results: On an average, 1.1 women/day underwent MTP during covid waves compared to 1.9 women/day during the pre-covid 2019. The first Covid wave’s average MTP/day was very low (0.71) compared to the third (2.88) and second wave (1.12), respectively. These differences were statistically significant (p<0.0001). The most common indication for MTP was contraceptive failure 245(50.9%), followed by eugenic/congenital anomalies 88(18.9%). A total of 244 cases (50.6%) reported for MTP ≤ seven weeks and 114(23.6%) presented between 7 and 12 weeks. More than half (54%) of the women underwent surgical methods for abortion as the unavailability of medical abortion (MA) drugs. IUCD and sterilization were severely affected during the first and second Covid waves.

Conclusion: Safe abortions are essential services for reproductive-age women. With the uncertainty of future Covid-like an emergency, we should strengthen our telemedicine network so that women can reach out early and MMA can be initiated to reduce the number of surgical abortions and unwanted pregnancies.

Keywords : Covid-19 pandemic · MTP · Medical methods of abortion (MMA) · Unsafe abortion · Contraceptive methods

During the Covid-19 pandemic, healthcare systems were globally affected. Women’s reproductive health was disproportionately affected due to difficult access to safe abortion and contraceptive services and an increased incidence of unsafe abortions, unwanted pregnancies, and quack practices (1). Women avoided visiting health facilities due to fears about Covid-19 exposure and due to lockdown restrictions.
Safe abortion and contraceptive services are essential for the healthcare of reproductive-age women. It is critical to ensure that women who seek abortion and contraceptives should not suffer from a lack of access. It is well-established that early abortions are safer for women. The Medical Termination of Pregnancy (MTP) Act 1971(2) has set up a limit of 20 weeks of gestational age for abortions, making abortion time-sensitive. A lack of MTP services may mean that women seek an abortion from unsafe providers and put themselves in a dangerous situation.

Improving maternal health is key to achieving Sustainable Development Goal (SDG)-3 good health and well-being for all. A healthy mother is the foundation of a healthy child and family. An important cause of maternal deaths is complications arising from unsafe abortion. Unsafe abortions remain a major public health issue, one of the leading causes of maternal mortality, and each year between 4.7 and 13.2% of maternal deaths can be attributed to unsafe global abortion (3). One of the most important SDG-3.1 targets is reducing the maternal mortality ratio (MMR) to less than 70 per 100 000 live births by 2030 (4).

Women die because they seek to end unwanted pregnancies and, due to a lack of knowledge, have limited access to safe abortion or MTP and contraceptive services. Therefore, safe abortion care should be provided uninterruptedly by the Government and private MTP service providers (5). This study aims to (1) assess the impact of Covid-19 on MTP cases during the first, second and third Covid-19 pandemic waves and (2) describe the total number of MTP cases and their clinicodemographic profiles among women undergoing MTP in different hospitals-Government and private sectors in India.

Conflict of interest The authors declare no conflict of interest in this manuscript.

Ethical approval Ethical approval was obtained from the Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) scientific advisory committee (JSAC) and Institutional Ethical Committee (IEC No.-JIP/IECOS/2022/303) before the commencement of the study.

Ethical standards and research involving human and animal participants The study involving human participants followed the ethical standards of the institute’s ethical and research committee and the 1964 Helsinki Declaration and its later amendments.

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