Sadhna Gupta* discovered she was pregnant just after India imposed a crippling lockdown to curb the spread of Covid-19.

The 21-year-old from the eastern Indian city of Bhubaneswar didn’t want to be pregnant. With no public transport available, clinics closed and Bhubaneswar at a standstill, she bought an abortion pill without consulting a doctor. While what she did was not unusual, Indian law requires a prescription for the pills from a licensed medical professional.

Gupta was not prepared for what was to come. She bled for hours and was in intense pain. Panicking, she called Hidden Pockets, a reproductive health counselling helpline.

“It was a pretty scary situation,” says the helpline’s founder, Jasmine Lovely George, who talked Gupta through the termination. “It’s very scary if you’ve been bleeding for hours and nobody has counselled you. You’re in a lot of pain and you don’t know what is happening to you.”

In the past three months, calls to the hotline from women unable to access contraception, buy pregnancy tests or get an abortion have quadrupled.

The coronavirus pandemic has put huge strain on India’s health system, and women’s reproductive rights have taken a particular hit. Travel restrictions, the diversion of public healthcare towards Covid-19, the closure of private clinics and disruptions in medical supply chains have meant that women have been unable to receive timely care.

The Foundation for Reproductive Health Services India (FRHS), an affiliate of Marie Stopes International, estimates lockdown disruption could leave 25.6 million couples unable to access contraception, leading to an additional 2.3 million unintended pregnancies and 834,042 unsafe abortions.

Unsafe abortions are the third leading cause of maternal deaths in India.

When the Indian government imposed lockdown on 25 March, with only four hours warning, reproductive health was not among the essential services allowed to continue. It was only after a group of doctors and activists appealed to the health ministry that the government added it to the list on 14 April.

However, since lockdown most public hospitals have been converted into Covid-19 treatment centres, and have diverted their limited resources and staff to coping with the virus. Many private clinics had to shut down because of transport shortages and a lack of protective equipment. India’s nearly 900,000 accredited community health workers who previously focused on reproductive health and distributed contraceptives have been redeployed to Covid-19 duties.

Parivar Seva Sanstha, a reproductive health organisation, was forced to close 31 clinics that provided family planning and abortion services. Although clinics are gradually reopening, Dr Alok Banerjee, a technical adviser at the organisation, says “there was no public transportation. Most of our clients travel from rural areas and are not able to come.”

Some women who have tried to travel have been harassed by police.

“Only if someone looks seriously ill, the police lets them travel to see a doctor,” says Ajitha Suhalka, a nurse-midwife who works at a community health centre in rural Rajasthan. “If a woman looks normal and healthy, she finds it hard to explain that she wants an abortion at a police checkpoint.” On a few occasions, Suhalka’s colleagues have picked up women on their own motorcycles and brought them to the clinic.

Since lockdown has eased, rural clinics have reported an increase in the number of women coming to them with complications from taking abortion pills without medical supervision, or visiting unqualified doctors. “Women are taking abortion drugs by themselves without understanding the dosage, procedure,” says Banerjee. “Then they are coming to us with incomplete abortions, with a dead foetus inside.” About 60% of cases at Parivar Seva Sanstha’s clinics are now related to post-abortion complications.

Medical supply chains have also been hit by the ban on inter-state travel and the closure of factories producing family planning products.

The termination of a pregnancy using pills is allowed in the first seven weeks, after which a surgical procedure is recommended. Under Indian law, abortion is legal up to 20 weeks, except in cases involving rape, incest or a minor, when it can be extended to 24 weeks. After that special permission is needed from the courts. Many Indian women are unaware that abortion within 20 weeks is legal.

“There are women with unwanted pregnancies who were stuck at home, planning to visit a doctor once the lockdown eases,” says Dr Nupur Gupta, director for obstetrics and gynaecology at the Fortis Memorial Research Institute, in Gurugram, one of Delhi’s satellite cities. “Now either they have to have surgical abortions, or if they have crossed that stage they will go to a quack, or continue with an unplanned pregnancy.”

The additional precautions clinics are required to take to prevent Covid-19 are expected to increase the cost of abortion services and could impact women’s decisions to seek care. “All of these additional costs will have to be borne by the patient at a time when a lot of people are losing their livelihoods,” says Dr Suchitra Dalvie, coordinator for Asia Safe Abortion Partnership, a nonprofit that promotes reproductive rights. “Out of desperation people will definitely try unsafe methods.”

George says that in India there is “a disdain for sexual and reproductive health. The attitude is – there is a crisis happening and you want to talk about condoms?”

She adds: “Who takes the brunt of it. It’s always women.”

* Not her real name