Mumbai: Drop in sterilisation amid Covid-19 fears; doctors worry

With non-emergency and elective medical procedures being halted during the initial months of the Covid-19 pandemic, there has been a drastic drop in the number of sterilisation procedures that were carried out this year. These procedures have since resumed in city hospitals, but experts are concerned about the possible consequences of fewer tubectomies in women, vasectomies in men, and interruptions in the distribution of contraceptives.

According to data provided by the Brihanmumbai Municipal Corporation (BMC), in 2019, there were 17,680 tubectomies and 106 vasectomies carried out on women and men respectively. However, as of November this year, only 116 women underwent tubectomy and 11 vasectomies were performed.

Tubectomy, also known as tubal sterilisation, is a permanent method of birth control in which a woman’s fallopian tubes are either permanently blocked or removed to prevent fertilisation of eggs. Vasectomy is minor surgery in which by cutting and sealing the tubes that carry sperm, fertilisation is prevented.

Dr Mangla Gomare, executive health officer, BMC, said the numbers for these family planning procedures have fallen drastically this year due to the Covid-19 pandemic. “In the initial months of Covid-19, hospitals were only allowed to perform emergency services. So other non-emergency and elective procedures were halted. The number of tubectomies and vasectomies fell drastically,” she said.

With widespread fear of contracting and transmitting Covid-19, family planning service providers had to reduce their fieldwork this year. However, since the gradual relaxation of the lockdown, sterilisation procedures have resumed at many hospitals. “We are trying to increase awareness among people through different campaigns. We are hopeful that soon people will start coming forward for sterilisation,” said Dr Gomare.

Dr Gomare added that in addition to fears of contracting Covid-19, there was an anxiety among many men that getting a vasectomy will affect their masculinity in some way. ”To encourage sterilisation, we provide incentives to men. We have even started no scalpel vasectomy (NSV) technique, which is more advanced and involves the most minimal bleeding. Despite this, men get scared and always push their wives for tubectomy,” she said.

“People are always sceptical about the sterilisation process, especially men. Every year, we witness a 1:20 ratio of male-female sterilisation ratio in the city. So we have to sensitise people about their needs and safety. But now, as it has been stopped since March, NGOs [non-governmental organisations] couldn’t sensitise the public and so the procedure rate has gone down,” said Sunaina Majhi, a social worker who works with BMC’s family planning department.

The low numbers have raised concerns among health activists and doctors who worry about unwanted pregnancies during the lockdown. “Due to the pandemic, abortion services have also been impacted, so the number of live births will increase. Women may be forced to carry their unintended pregnancy to full term,” said VS Chandrashekar, chief executive officer, Foundation for Reproductive Health Services India.

Another side effect of the lockdown for women has been the that many will not have had access to contraceptives of their choices. “The distribution of condoms and oral contraceptives has taken a hit during the lockdown. So alternative birth control measures [to sterilisation procedures] have also suffered a lot in the pandemic. This will certainly push up the population of already-overcrowded Mumbai,” said activist Dr Abhijit More. “Unplanned pregnancy can also increase health complications among women,” he said.

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