Sexual and Reproductive Health: Challenges and opportunities during COVID-19 – An Indian Perspective

Introduction Sexual and Reproductive Health Rights (SRHR) protect and improve the living conditions of the underprivileged and the marginalized by increasing access and awareness to sexual and healthcare services. It is imperative that these rights are actively protected and improved upon but the pandemic has seriously challenged the efforts and progress of SRHR with respect […]


Sexual and Reproductive Health Rights (SRHR) protect and improve the living conditions of the underprivileged and the marginalized by increasing access and awareness to sexual and healthcare services. It is imperative that these rights are actively protected and improved upon but the pandemic has seriously challenged the efforts and progress of SRHR with respect to SDG, globally and in the Indian subcontinent. To put this into perspective, about a 10% drop in the efforts made for SRHR care will result in 49 million more women losing access to contraceptives, 15 million women being subjected to unplanned pregnancies, 168,000 newborn deaths, 28,000 maternal deaths, and 3 million unsafe abortions [1].

Indian Perspective to SRHR with regard to COVID-19

The pandemic has disrupted access to healthcare, education, transportation, and other essential facilities during the period, with women being the worst affected and data has indicated that abuse, discrimination, and exploitation aimed at women towards has worryingly worsened with effects already visible on women’s reproductive and mental health.  

The most common method of contraception in India is female sterilization which although is invasive and irreversible is adopted by 36% of women while male vasectomies are adopted by a mere 0.3%. Despite the progressive stance on SRHR, data has evidently shown the conservative nature and the lack of autonomy found in societies across the country. The hierarchy of caste/class prevents equal distribution of healthcare resources across the country. A woman from a marginalized community might not have access to the same healthcare services as a woman from a class/caste privileged background. Added to that, despite the existence of legal provisions the normalized binary nature of gender is highly non-inclusive of trans persons, often subjecting the community to violence, discrimination and suffering. 

Policies during the Pandemic – Opportunities and Challenges

India reported almost twice the number of cases related to sexual and gender-based violence; 116 cases during the first week of March 2020, which doubled to 257 cases by the last week of the same month, prompting the National Commission for Women (NCW) to launch a WhatsApp number to aid the process of reporting [2, 3]. The Indian Government launched a national helpline crisis called ‘Kiran’ which provides free mental health rehabilitation services via phone and redirects people to access resources. Although measures and policies are actively being adopted,

the prioritization of resources towards emergency responses to the pandemic has severely affected other essential non-COVID-19 health services. Family planning and reproductive health services were severely disrupted, leaving an estimated 25 million couples in the country without access to contraceptives. In fact, India is likely to witness the highest number of forecast births at 20.1 million [4]. According to Ipas, 1.85 million women in India will be unable to access abortion services due to the impact of the pandemic. 

Despite the strong presence of a cadre of women frontline workers, dogmas and misconceptions on reproductive health and justice have hindered the pace of progressive conversations and actions. For example, only 27% of unmarried but sexually active women in rural India use methods of conception [5]. Policies and measures focused on infant and maternal health, such as the Janani Suraksha Yojana 2021 have been introduced to decrease the number of maternal and neonatal deaths and improve overall access to healthcare and nutrition. However, with decreased accessibility to hospitals and effects of the pandemic, the efficacy of these schemes has reduced over time [6]

Going forward, there is a lot of work to be done towards ensuring and safeguarding women’s reproductive health and rights with a strong emphasis on the infrastructural needs and requirements in rural areas. Technological solutions in abortion services and telemedicine services for consultations on family planning can be a critical step towards reaching the last mile. The post-pandemic era should be perceived as an unique opportunity for radical reforms to India’s public health system [7]

Legal Issues and Measures during the Pandemic

Gender Equality is yet to be achieved in India, and sexuality is viewed through a heteronormative lens. The deep cultural heritage has a strong influence on jurisprudence, and conversations that diverge from conventional norms are considered sacrilegious.  


Despite immense progress, abortion in India remains a stigmatized issue even within the medical fraternity. The pandemic in combination with cultural stigmas and lack of resources has thwarted years of progress [8]. During the period over two million women were unable to access safe abortion practices [9]

Abortion laws have been amended and liberalized in India as recent as in 2021 yet the law still does not recognize abortion as a woman’s choice that can be sought on-demand as is the practice in 73 other countries. The law does not grant women complete control over reproductive choices.

Key points from the Medical Termination of Pregnancy (MTP Amendment) Act, 2021 [10]:

  • 1. The gestation limit for abortion has been raised from 20 to 24 weeks for special categories such as rape or incest survivors, provided there is approval of two registered doctors.
  • 2. Pregnancies up to 20 weeks require one doctor’s approval whereas before one doctor’s approval was required for pregnancies up to 12 weeks, and two doctors’ approval for pregnancies between 12 and 20 weeks. 
  • 3. Women can now terminate unwanted pregnancies caused by contraceptive failure regardless of marital status while the earlier version extended only to ‘a married women and her husband’. 
  • 4. No upper gestation limit for abortion in case of fetal disability if so, decided by a medical board of specialist doctors.  

However, the chronic shortage of doctors in India combined with the widespread impact of the pandemic, women have found it extremely difficult to access and seek expert opinion from doctors and medical boards, often throwing the future of the mother and the fetus at the mercy of the courts. Between the months of May and August 2020, 112 cases of abortion were heard in 14 courts across the country as compared to the 175 cases that were heard over a 35-month span from June 2016 to April 2019. 

The entirety of the language used in the law is non inclusive of trans persons and as mentioned earlier, the consideration fails to go beyond gender binary and rather remains gender-blind. Having received medical training based on a binary sex-gender system, doctors have limited knowledge on treating trans bodies [11]. Despite policy level advances, the de facto experience of a trans person’s encounter with the health system poses a severe barrier to accessing and ensuring equal and quality healthcare to all [12]. Moreover, the medical field is also highly inexperienced in dealing with the reproductive health of intersex people. 

Rape, Marital Rape, and Assault

According to the National Crime Records Bureau’s 2013 Annual Report, 24,923 rape cases were reported across India in 2012, of which 24,470 were committed by a known member such as a relative or a neighbor, making rape the fourth most common crime against women [13]. The Courts, taking cognizance of the situation have passed strong comments and judgements, some of which are as follows:

  • 1. The Supreme Court of India dismissed the notion that the testimony of a prosecutrix with disability be considered inferior and rather added that such a testimony met the criteria for inspiring judicial confidence [14].
  • 2. The High Court of Himachal Pradesh while dismissing the bail petition of a person accused of rape observed that neither the absence of resistance nor the unwilling submission implies consent in any language [15].
  • 3. The Delhi High Court taking cognizance of the victim’s family background awarded 6 lakh INR as interim compensation to a six-year-old victim of sexual assault, observing that though the system cannot undo the offence, it can provide security with monetary help besides prosecuting the offender [16].

On the other hand, there have been a few instances where comments and judgments have been hurtful and this extends beyond the issue of rape alone. 

  • 1. The Delhi High Court while granting bail to a man alleged of sexually exploiting and raping a two-year-old girl questioned the complainant about the delay in the registration of FIR, especially when a crime of heinous nature had taken place [17].
  • 2. A recent plea to declare marital rape as a ground for divorce was dismissed by the Delhi High Court [18]. 

While rape is strictly condoned, the legal framework on marital rape and abuse is ambiguous and discriminatory, echoing the growing need for debate, reformation, and progress in issues that are beyond the conventional [19]. 

Sexuality and same-sex marriage

Although Section 377 of the Indian Penal Court has been decriminalized, there is no fundamental right to same-sex marriage in India. The Government of India has added that recognizing same-sex marriages would be in violation of existing codified and personal laws as the current legislative scheme talks about a biological woman as the wife and a man as the husband [20]

Here are a few judgements concerning the LGBTQIA+ community:

  • 1. The Allahabad High Court while directing the Home Guard Quarters in Uttar Pradesh to reinstate a staff member from queer community whose appointment was cancelled, asserted that it was wrong to discriminate based on sexual orientation, as it interferes with the right to privacy [21].
  • 2. The Kerala High Court questioned the National Cade Corps decision to exclude a transgender student and suggested the government make amends to the NCC Act to make provision for transgender persons [22].
  • 3. The Orissa High Court advised implementing stringent penalties to crimes of sex trafficking, and suggested other courts to take into account the definition of trafficking as laid out in the UN Protocol [23].
  • 4. The Kerala High Court directed concerned authorities to ensure rations cards, free supply of medicines, and provide other welfare measures to transgender persons in the state during the COVID-19 pandemic [24].
  • 5. The Supreme Court of India issued a notice to the Union Ministry of Health as the current blood donation guidelines prohibit transgender people, men who have sex with other men, and female sex workers as they are considered high-risk category for HIV/Aids infection, although all blood units collected are tested for infectious diseases [25]. 

Impact of availability and accessibility of SRHR products and services

While reproductive rights are actively ensured, in marginalized and underserved communities, lack of access to essential information and knowledge on sexual/reproductive health and associated human rights leave women vulnerable to a host of issues. Moreover, cultural stigmas and disproportionate allocation of resources across the country have pushed women towards unsafe abortions carried out by unregistered medical practitioners that have inadequate training. According to a 2015 Lancet study, 15.6 million abortions occurred in India in 2015, of which 73% were through medical abortion drugs accessed outside of facilities and 5% through traditional unsafe methods [26]. The pandemic has also triggered a sanitary pad crisis owing to a lack of raw materials, and availability of other resources [27].

While the pandemic negatively impacted the situation, measures were taken up by some state governments to quickly address the effects. 

  • 1. The Tamil Nadu government apart from adding more Protection Officers also classified them as essential workers ensuring free movement during the pandemic.
  • 2. The Uttar Pradesh government launched a special helpline for survivors of domestic violence. 
  • 3. The Jammu and Kashmir High Court while taking suo moto cognizance of rising domestic violence cases during the pandemic issued interim directions such as dedicated funding, increased access to legal/call-in services, and designated safe spaces for women. 

While the Courts have taken a proactive approach on the various issues evolving due to the pandemic, the budget allocated for Mission for Protection and Empowerment of Women has been cut to INR 48 crore in 2021 from INR 901 crore from the previous year [28] owing to the uncertainty and stretched utilization of resources caused by the ongoing pandemic. Also, the Nirbhaya fund remains largely unused despite the urgent and desperate need for deployment of new resources [29]. Diversion of resources and facilities to handle COVID-19 patients has discontinued shelters, threatened protection to survivors, and obstructed the delivery of critical aids. 


In India, significant improvement to SRHR is being made but bearing in mind the existing challenges and the uncertainty of the pandemic, the pace at which action is implemented needs to increase multifold for the country to reach the SDG goal by 2030. Still, there are several areas that need to be improved, including but not limited to

  • 1. Educational reforms to promote awareness on sexual and reproductive health from a young age and emphasizing the difference between good and bad touch.
  • 2. Eliminating stigma and providing space environments for children to communicate, discuss, and report matters. 
  • 3. Expanding the SRHR budget to better train personnel and implement standard operating procedures that include robust safety protocols. 
  • 4. Providing mental and sexual health support to victims of GBV free of cost or at a nominal price. 
  • 5. Making Sexual Harassment training mandatory for all employees in both private and public sectors. 
  • 6. Ensuring a thorough and timely investigation of cases (like, GBV) by the executive and the judiciary. 
  • 7. Adopting new laws and policies to tackle evolving issues (like, marital rape) at a timely manner to safeguard the rights of individuals, especially, the underprivileged and marginalized.

Prepared by Ram

Research And Analysis 

              Hibiscus Foundation


1. Riley T et al., Estimates of the potential impact of the COVID-19 pandemic on sexual and reproductive health in low- and middle-income countries, International Perspectives on Sexual and Reproductive Health, 2020, 46:73-76.


3. India – COVID-19 Rise in Domestic Violence – National Commission for Women Concerns on Police Apathy

4. Coronavirus: Health system overload threatens pregnant women and newborns

5. National Family Health Survey (NFHS-4)

6. Maternity Nutrition Scheme launched for Pregnant Women in Jaipur & 3 other districts of Rajasthan



9. Why 243 Women Had To Ask A Court For Permission To Abort

10. India’s amended abortion law still gives doctors, not women, the final say in terminating pregnancy

11. Banerjee, Aparna. 2017. Interview for NHRC Study on Sexual Health and Well-being. In person. New Delhi

False marriage promise wrong, but if couple living together, can intercourse be termed rape, asks CJI

13. Crime in India: 2013 Statistics — page 195 // table 

14. IN THE SUPREME COURT OF INDIA CRIMINAL APPELLATE JURISDICTION Criminal Appeal No 452 of 2021 (Arising out of SLP(Crl) No 1795 of

15. Himachal HC Denies Bail To Rape Accused, Says ‘No Means No’

16. Delhi High Court awards 6 lakh as interim compensation to victim, system can’t undo the offence – India News

17. Delhi HC cites 8-hour delay in filing FIR, grants bail to rape accused

18. Plea seeking to declare marital rape a ground for divorce dismissed by Delhi High CourtPlea seeking to declare marital rape a ground for divorce dismissed by Delhi High Court.

19. Plea seeking to declare marital rape a ground for divorce dismissed by Delhi High Court

20. Same sex marriages cannot be given legal sanction: Government

21. Allahabad High Court orders home guard sacked for being gay reinstated | India News

22. Kerala HC issues directive to amend NCC Act and enrol transgenders

23. Trafficking for prostitution is more heinous than drug trafficking: Orissa High Court

24. No reason to deny any basic human right to the Transgender community: Kerala HC issues directions on provision of ration cards, medicines

25. SC notice to Centre on plea against guidelines excluding transgenders from being blood donors

26. Glasier A, Gülmezoglu AM, Schmid GP, Moreno CG, Van Look PF. Sexual and reproductive health: a matter of life and death. Lancet. 2006 Nov 4;368(9547):1595-607. doi: 10.1016/S0140-6736(06)69478-6. PMID: 17084760.

27. The coronavirus pandemic has triggered a ‘sanitary pad crisis’

28. How Has The Govt Dealt With Domestic Violence Post COVID-19?

29. Nirbhaya Fund underused, slotted for services that don’t help women directly — Oxfam report