Every time 19-year-old Basanti and her 22-year-old boyfriend would run out of condoms, they would travel all the way from Dudhauli in Sindhuli district to Bardibas in Mahottari by bus to get hold of contraceptives from the health post there.

It is not that they don’t have health posts in Dudhauli. But since premarital sex is still considered taboo in Nepali society, Basanti and her boyfriend do not dare purchase condoms in their village.

“Everyone knows everyone in the village,” said Basanti, whom the Post is only identifying by her first name in the interest of privacy. “If they find out that I am sexually active prior to my marriage, my family will disown me.”

But ever since the lockdown was instituted on March 24, there is no public transportation, which means Basanti and her boyfriend have no access to contraceptives, as they can’t walk 17 kilometres to Bardibas.

Basanti and her boyfriend live very close to each other and are able to meet each other despite the lockdown. And when they meet, things eventually take a turn for the physical. Now, the only thing Basanti fears is getting pregnant.

“We once had unprotected sex a few days ago and I’m afraid of getting pregnant,” she said. “If I get pregnant, I might as well kill myself.”

For many men and women, mostly in Nepal’s rural areas, the lockdown has disrupted all access to contraceptives. And it is not just young people like Basanti and her boyfriend but also older, married couples who might want to use protection to prevent pregnancies or for family planning, as couples sheltering in one place are likely to have more sex.

A 2019 report by the World Health Organization has already warned that the impacts of an epidemic on sexual and reproductive health can often go unrecognised, as the effects are not the direct result of the infection, but “the indirect consequences of strained health care systems, disruptions in care and redirected resources,”

A new report, released by the United Nations Population Fund in response to the Covid-19 pandemic, further predicts that over 47 million women and girls across the globe may no longer be able to access contraception due to service disruption. A lockdown for six months could result in 7 million unplanned pregnancies, says the report.

Even before the pandemic, Nepal was struggling to increase the national contraceptive prevalence rate, despite the government and many non-governmental organisations providing family planning services free of cost. The contraceptive prevalence rate is the percentage of women of reproductive age who are using (or whose partner is using) a contraceptive method at a particular point in time, almost always reported for women married or in sexual union.

According to the 2016 Nepal Demographic and Health Survey, there is a 24 percent unmet need for family planning in Nepal, resulting in high rates of unwanted pregnancies, unplanned deliveries, unsafe abortions, and high maternal mortality.

Many women in Nepal still don’t use contraceptives due to fear of side effects, inconvenience and religious prohibitions. Research has also shown that men are often reluctant to use contraception, especially with the easy availability of abortion pills. In such conditions, health officials say that the lockdown has only created additional barriers in accessing contraception.

According to Tila Kumari Thapa, a midwife based in Langur Khola, Sindhuli, the lockdown has halted many outreach and awareness programmes regarding the use of contraception in family planning and preventing disease.

“Since many villages are far from the health post, many women cannot get immediate access to family planning services,” said Thapa, who works for Marie Stopes Nepal, an international organisation that provides family planning services across the country. “To make health services more accessible, we used to reach out to them ourselves but due to the lockdown, we’ve been asking the people to visit our health post instead.”

However, Thapa reported that only one to two people show up at their healthpost every day, although she believes that there are many women who require both contraception services and family planning counselling.

“A majority prefer intrauterine devices (IUDs), contraceptive injections, condoms and birth control pills as barrier methods for birth control and they rely on us to get information as well as access to these facilities,” she said. “However, due to the lockdown, neither of us are able to pay a visit to one another.”

Outside of the Kathmandu Valley and urban centres, contraceptives are often hard to come by. Most people in rural areas have to visit health posts to purchase even simple methods of birth control, like condoms. These areas are where the effects of the lockdown have been most acute.

In Udayapur, Banke and Parsa districts, health officials say that they have seen a decline in the number of people seeking family planning services.

“Although we have a stock of contraceptives and nurses to provide services, not many are visiting health posts. It might be because they fear contracting Covid-19,” said Muna Shrestha, president of the Nepal Family Planning Association of Banke district.

Even in the Kathmandu Valley, where most pharmacies sell contraceptives and are open despite the lockdown, a lack of public transportation and the government’s order to remain indoors has meant that fewer individuals are venturing out, according to Hima Mishra, helpline manager at the Marie Stopes’ Meri Saathi Contact Centre.

“There have been many calls from people who say that they were questioned by the police while going for check-ups related to reproductive health at the hospital,” said Mishra.

According to Mishra, the Marie Stopes helpline receives more than 100 calls a day from women with different queries related to reproductive and sexual health. The helpline operates from 7 in the morning till 12 midnight every day.

The lockdown has not just prevented people from seeking sexual and reproductive health services, but has also affected the supply of contraceptives.

Government officials said that they are aware of the problems in accessing contraceptives and sexual and reproductive health services due to the lockdown. According to Bhim Singh Tinkari, director of the Family Welfare Division at the Health Ministry, the government has declared sexual and reproductive healthcare as an essential service but contraceptives are being treated as secondary amid the Covid-19 pandemic.

But as families and couples continue to remain indoors, there is a greater likelihood that Nepal will be seeing a baby boom once the pandemic has run its course.

“Due to the lockdown and a lack of work, many couples are spending the majority of their time together, which means they are engaging in sexual activities more,” said Mishra of Marie Stopes Nepal. “In such a situation, a lack of access to contraception puts women at high risk of unplanned pregnancies, which can further lead to unsafe abortions.”

Marie Stopes toll-free helplines: 16600119756 (NTC); 9801119756 (Ncell)