|
| |
 |
|
| REVIEW ARTICLE |
|
| Year : 2020 | Volume
: 17
| Issue : 3 | Page : 194-196 |
|
Contraception and MTP in COVID times
Kawita Bapat1, Sonal Palod2
1 Department of Obstetrics and Gynaecology, Bapat Hospital, Indore, Madhya Pradesh, India
2 Fellow in Vaginal Surgery Certificate Course ICOG, Junior Consultant, Bapat Hospital, Indore, Madhya Pradesh, India
| Date of Submission | 22-Jun-2020 |
| Date of Acceptance | 24-Jun-2020 |
| Date of Web Publication | 29-Jul-2020 |
Correspondence Address:
Kawita Bapat
Bapat Hospital, AHD-30 Bapat Square, Sukhliya, Indore, Madhya Pradesh
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/am.am_58_20
In this pandemic of COVID-19, women's health is disproportionately affected due to reduced access to contraceptive and safe abortion services. It has led to increased incidence of unsafe abortions, unwanted pregnancy, and quack practices. With the help of government services and policymakers, all these services should be made easily approachable to women. Basic guidelines of COVID precaution should be clearly explained to women and adolescent girls, safe contraception methods and their access should be known to patients. Telemedicine can play a huge role in covering all these aspects of women's health. Psychological counseling by doctors and health service providers reduces fear and anxiety regarding their health issues. Contraception can reduce the need for termination of pregnancy, resulting in the reduced risk of women and girls facing unsafe abortions. Recently, the United Nations Fund for Population Activities (UNFPA) data reveal that if lockdown continues for another 6 months, 47 million women in low- and middle-income countries may not be able to access contraception and that 7 million unintended pregnancies are expected to occur globally. Hence, contraception and medical termination of pregnancy services also have to be taken as prime importance among all the other gynec services to avoid upcoming population explosion.
Keywords: Contraception, COVID, pandemic, pregnancy
How to cite this article:
Bapat K, Palod S. Contraception and MTP in COVID times. Apollo Med 2020;17:194-6 |
| Background | |  |
In times of crisis, we know that women and girls are often disproportionately affected. Sexual and reproductive health care may be neglected or difficult to access, and disrupted supply chains may reduce access to contraceptives and safe abortion supplies.[1] All these factors can in turn drive more people to seek unsafe abortions. We have to ensure that pregnancy care,[1] including abortion care, remains an essential health service during the coronavirus outbreak. Abortion care is a time-sensitive service that cannot be significantly deferred without profound consequences for women and their families.
There is a global consensus on the importance of making voluntary family planning available to all women. Not only is access to family planning a human right, but also it saves lives and promotes healthier populations, more efficient systems, and stronger economies. Sexual activity does not cease even with the ongoing COVID-19 pandemic.[2] By preventing unintended pregnancies, contraception helps to protect girls and women from the negative health consequences of unintended pregnancies.[2] Contraception also reduces the need for termination of pregnancy, resulting in reduced risk of women and girls facing unsafe abortion.[3] Recent projections from the UNFPA reveal that if the lockdown continues on for a period of 6 months, 47 million women in low- and middle-income countries may not be able to access contraception and that 7 million unintended pregnancies are expected to occur globally.
What we can advise our patients
As the effect of the virus is still unknown on pregnancy and the fetus, all pregnancies should be planned keeping in view the overall situation of the COVID-19 pandemic. To ensure infection prevention and control of COVID-19, everyone, including pregnant mothers, must take the precautionary measures according to the WHO guidelines, which are to:
- Regularly clean hands with a sanitizer or[2] wash them with soap and water for at least 20 s[2]
- To keep at least 1 m (3 feet) distance between yourself and others
- Avoid going to crowded places[2]
- Avoid touching eyes, nose, and mouth[2]
- Make sure to follow good respiratory hygiene, use of mask, and cover mouth with the elbow while coughing and sneezing
- Dispose of the used tissue immediately and wash hands
- Should wear a mask when going outside of the home
- If one of the couples has any COVID-19-like symptom, they should stay home and self-isolate even with minor symptoms such as cough, headache, and mild fever, until recover[2]
- During the self-isolation period, partners should maintain physical distance and avoid any physical contact.
| Safe Methods of Contraception during Covid | | |
All modern methods of contraception are safe to use, including during the COVID-19 pandemic.[4] Based on the decision of one's family size, always prefer to use long-acting and permanent methods. Couples should continue to use contraceptive method of choice.[2] They may be able to access information and contraceptive services from a health-care provider by phone or online.[2] If it is not feasible, then opt for a method that is available without a prescription (such as condoms,[5] pills,[5] injectable, or emergency contraceptive pills)[5] from a nearby pharmacy or drug shop.[2] Patient should be informed that OCPs and emergency contraception will not disrupt an implanted pregnancy, nor will they harm a pregnancy.[6]
During the lockdown, the schedule of injectable contraceptives may have been hampered. These can be taken within 28 days of the missed schedule. Condoms, when they are used consistently and correctly, are the only method of contraception that helps to prevent unintended pregnancy and protects against sexually transmitted infections, including HIV.[7] Condoms can be used together with other methods of contraception to protect against both unintended pregnancy and sexually transmitted infections.[2] Emergency contraceptive pills can prevent up to 95% of pregnancies when taken within 5 days after any unsafe intercourse.[2] If a pregnancy is suspected, then any unapproved medicines should not be used and alternatively, the menstrual regulation at home should be tried.
| Direction for Policymakers and Service Providers | | |
- All service providers (especially obstetrics and family planning service) providing sexual and reproductive health services should increase the use of mobile phones and digital technologies to increase telephonic counseling and sharing of messages related to safe and effective use of contraceptives[2]
- Whenever possible, especially in antenatal, delivery care services and postnatal care, with a proper counseling and consent, ensure immediate postpartum contraceptive services (preferably postpartum intrauterine contraceptive device, Postpartum implant, or tubal ligation) to avoid any unwanted pregnancy.
| Telehealth Contraception in Covid Time | | |
As health-care providers are moving to telehealth visits,[1] the following guidelines and resources can help, in order to provide high-quality counseling and contraceptive methods.[1]
Contraception counseling
- Provide telephonic patient centred counselling on a range of methods and patient priorities.[8]
Contraception initiation
- Avoid delays by sending prescriptions to pharmacy, mailing, or prepacking for pickups from the providers.[8]
Assess the risk of pregnancy
- Need in-person visit for intrauterine device (IUD), implant, sterilization, and ± depomedroxyprogesterone acetate[8]
- Delay visit if COVID-19 symptoms, pending test results, or asymptomatic contact[8]
- Initiate a bridging method as needed.[8]
Contraception continuation
- Use evidence-based extended use for all methods[8]
- IUD and implants using extended durations.[8]
| Contraceptive Change or Discontinuation | | |
The IUD and implant removal is an essential reproductive health service.[8] Removal of IUD/implants can be delayed by few weeks. IUD and implant insertion or removal is a low-risk, nonaerosol-generating procedure. To minimize exposure risk during the procedures, routine surgical masks and gloves for patient interactions may reduce asymptomatic transmission. Prepare all equipment trays and materials ahead of time to reduce time in the room.
| Role of Government and Nongovernment Organizations | | |
Ensure enough supply of contraceptive methods at all service centers and shops with the service providers and supportive supervision for monitoring the service providers, especially from the seniors to check with the providers regarding the availability of commodities and the well-being of the providers too through direct or virtual communication. Governments should consider relaxing restrictions on the quantities (cycles) of short-acting contraceptives dispensed to users so as to avoid frequent repeat visits. Develop and disseminate messages with simple language through social media, radio, and television talk shows, etc.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | |
| 2. | |
| 3. | |
| 4. | Grandi G, Facchinetti F, Bitzer J. The gendered impact of coronavirus disease (COVID-19): Do estrogens play a role? Eur J Contracept Reprod Health Care 2020;25:233-4.  |
| 5. | Ferreira-Filho ES, de Melo NR, Sorpreso ICE, Bahamondes L, Simões RD, Soares-Júnior JM, et al. Contraception and reproductive planning during the COVID-19 pandemic. Expert Rev Clin Pharmacol 2020:1-7. [Online ahead of print]. |
| 6. | |
| 7. | |
| 8. | |
|
Search Pubmed for