Close to two million women and girls have lost access to contraceptives and abortion services during the coronavirus pandemic, with experts predicting the disruption could trigger a "baby boom" in parts of the globe.
Marie Stopes International (MSI) has revealed that 1.9 million fewer women accessed their services between January and June compared to the same period last year. The organisation is one of the largest providers of reproductive health services in the world and operates across 37 countries.
The MSI report predicts that this will cause 900,000 unintended pregnancies, 1.5 million unsafe abortions and more than 3000 maternal deaths.
"Depressingly, this is not unexpected at all," Dr Clare Wenham, assistant professor in global health policy at the London School of Economics, told Britain's Telegraph. "We saw it with the Ebola outbreak, we saw it with the Zika outbreak, I think this is heavily predictable.
"And so governments could have done something to prevent this situation had they stopped to think about reproductive health issues," she added.
Stringent lockdowns, the prioritisation of coronavirus care, contraception supply chain disruptions and fears of picking up an infection at a health clinic have all contributed to reductions in access to reproductive and sexual healthcare.
According to MSI, India is currently the worst hit - with 1.3 million fewer women accessing services provided by the organisation. An Ipsos Mori survey found that almost a third of respondents in India seeking an abortion said the clinic in their area was closed and nine per cent reported a wait-time of more than five weeks.
The country, which adopted one of the most extreme lockdowns in the world, is predicted to see an additional million unsafe abortions, 650,000 unintended pregnancies and 2600 maternal deaths due to lack of access to MSI services alone.
The report adds to a growing body of evidence suggesting that "women are bearing the brunt of this global calamity", said Dr Rashmi Ardey, director of clinical services at MSI's India programme.
She added that sexual and reproductive health was "already under prioritised", but with healthcare services under enormous strain across the globe this has only worsened - especially as many nations, especially in Asia, did not categorise reproductive health as "essential" during the pandemic, meaning care was suspended.
Earlier this month the World Health Organisation said that two-thirds of 103 countries surveyed between mid-May and early July reported that sexual and reproductive health services had been disrupted. The UN Population Fund (UNFPA) has predicted that the world could see as many as seven million unintended pregnancies as a result.
Many experts are predicting that this will trigger a pandemic "baby boom" as women cannot access vital services, while domestic violence and child marriage rates are on the rise.
"Humanitarian crises often lead to an increase in fertility rates," Dr Wenham said. "Often among displaced migrants or refugees affected by war there is an increase in pregnancies as services are disrupted."
Diana Moreka, a coordinator of the MAMA Network that connects women and girls to care across 16 African countries, has suggested that the level of disruption she has witnessed has been comparable to countries at war.
"The pandemic ... has taken us many years backwards" in family planning services, she told the Associated Press, adding that she predicts many regions will see a baby boom in the coming months.
But Dr Wenham cautioned that it is too soon to identify a surge in pregnancies - although the coronavirus was first identified in China almost eight months ago, it reached many countries much later.
The UK, for instance, has so far reported a decline in pregnancies and that there is unlikely to be a clear global trend - some nations may report a baby boom, while others will see a decline in births.
Dr Wenham also cautioned that, in the current setting, a rise in pregnancies is likely to correspond to a spike in maternal and neonatal mortality as fewer women are able to give birth safely in hospital. A recent study in Nepal found this dropped by half due disruptions to health services and fears of picking up Covid-19 in a healthcare setting.
In Kenya, a surge in teen pregnancies has been reported - with Kate Maina-Vorley, country director at UK based NGO Plan International, describing the unfolding situation as a "shadow pandemic".
"We now have a rise in teenage pregnancies, a rise in sexual and gender based violence and we are seeing an increase in FGM [female genital mutilation] as a precursor to child marriage," she said.
Diana Kihima, from the Women Promotion Center, told Associated Press that some young women in Nairobi's Kibera slum resorted to using broken glass, sticks and pens to try to abort pregnancies. Two are known to have died of their injuries, while some can no longer conceive.
Meanwhile in parts of West Africa, the provision of some contraceptives fell by nearly 50 per cent compared to the same period last year, according to the International Planned Parenthood Federation (IPPF).
Many women's health providers have scrambled to find solutions such as telemedicine, home deliveries of contraceptives and home-based medical abortions.
For instance in Uganda, MSI has partnered with the UNFPA to deliver services via a ride-hailing app similar to Uber, while the UK made it possible to take abortion pills at home after a telephone consultation.
But Dr Wenham added that some more conservative governments have made adapting to coronavirus restrictions difficult for sexual and reproductive health providers.
"Just look at the US. A number of states - Texas, Utah, Idaho, Alabama - deemed abortion not to be an essential medical service, therefore they cannot be accessed during the coronavirus pandemic. It's used as an excuse for restrictive policies," she added.