With abortion pills being sold over the counter, City Express takes a look at the rising trend of self-medication among the youth:
Unplanned pregnancy can be a nightmare for many young women who do not wish to step into motherhood at an early age. Thanks to medical science making rapid progress, abortion pills have proven to be a big boon for all women regardless of status or stature in our country today. However, in the contemporary age and with the advent of the Internet, self medication which in some cases can be fatal has gained popularity especially among youth. For 18-year-old Manyata Sharma (name changed), her world came crashing down when she found out that she was pregnant. With the fear of humiliation lurking in her mind, she decided to confide in none and took the drastic step of self-abortion. “I was scared and lonely. I didn’t know what to do. My mind had gone through this over and over again. My boyfriend left me the moment I told him. Coming from a conservative family, I couldn’t seek help from any of my family members. I read about abortion pills on the Internet. Gathering all remnants of courage I had left in me, I decided to drop by a drug store one day. I picked up the abortion pills and was given clear cut instructions by the pharmacist on how to use them. All I had to do was pay Rs 499,” she said with tears in her eyes.
Like Manyata, there are millions of girls in India who take these medications without consulting a doctor.“It is illegal to sell these drugs over the counters. Most of the pharmacies do not ask for any prescription. It is quite dangerous. Earlier, people would consult a doctor before taking any decision but today things have changed. Without proper medical supervision, consuming abortion pills could lead to death. In our country, there is absolutely no control over the sale of drugs in pharmacies. Abortion pills are a big boon to us. I think it is a huge step in medical science. These pills are cheap and accessible. For just Rs 499, one can head to the pharmacy and get these pills. No questions asked. However, people cannot play doctor,” said Dr Indu Kala, senior consultant at a multi-speciality hospital.
Home pregnancy tests, contraceptive pills and abortion pills have revolutionised the pharmaceutical industry today. Though many doctors applaud the progress medical science has made today, there are several others who fear the rising trend in self-medication. According to Dr Indu Kala, administering a drug during unplanned pregnancy or otherwise must not be done without clinical examination and appropriate investigation. “Most of the abortion cases we receive are a result of pre-marital sex. It is alright if one wishes to use a home-pregnancy test to find out if they are pregnant or not. However, in cases of abortion, a doctor’s consultation is extremely important. After careful examination, an ultrasound needs to be done in order to confirm that the pregnancy has not occurred in the fallopian tube as consuming ‘pills’ may lead to tubal rupture. Besides, the time period is also important. I had an emergency case recently where a woman suffered from tube burst and went into hemorrhagic shock. A laproscopy was done and she was put on anti-biotics immediately,” said Dr Indu.
In some cases, consuming the pill may lead to excessive bleeding and incomplete abortions. Apart from developing infections, the mother is also at the risk of causing permanent damage to her uterus. Accentuating on the importance of awareness and responsible medication, Dr Vinaya, a gynaecologist at a leading hospital in J P Nagar, said that the government needs to regularise the sale of medication in our country. “It is appalling that medicines are being sold over the counters without any supervision. This is illegal and needs to be stopped immediately. I have seen several cases where young women, after watching an advertisement on TV, decide to consume pills and deal with their abortion on their own. Fear and humiliation are just mental blocks. It is times like these that one requires all the support they can from family and friends. In some cases, women also develop post abortion depression which needs to treated with great care,” Dr Vinaya added.
What does the law state?
Enacted by the Indian Parliament in 1971, the Medical Termination of Pregnancy (MTP) Act was implemented a year later. Although it is one of the most liberal MTP Acts in the world, majority of the estimated 6.7 million abortions done annually are still performed by illegal providers. These illegal and unsafe abortions are major determinants of the continued high level of maternal morbidity and mortality in India. The risk of death following unsafe abortion procedures is several times higher than that of an abortion performed under safe conditions. Despite the documented safety of the procedure, many women have limited access to abortion services because of logistical and social obstacles.
It is surprising that even after 41 years of MTP being legalised, its availability in rural areas is limited and in primary health centres (PHCs) where provisions for MTP services are made, no information is available about its actual utilisation & efficient functioning. A major reason for this unsatisfactory situation is the interpretation and implementation of the MTP Act, which differs from state to state.
The first important thing to know is when pregnancies can be terminated by registered medical practitioners. Notwithstanding anything contained in the Indian penal Code, a registered medical practitioner is not considered guilty of any offence under that Code or under any other law for the time being in force, if he terminates any pregnancy in accordance with the provisions of this Act. A pregnancy can be terminated by a registered medical practitioner if the length of the pregnancy does not exceed 12 weeks. However, for this, the practitioner should be of the opinion that the continuance of the pregnancy would involve a risk to the life of the pregnant woman or of grave injury to her physical or mental health: or there is substantial risk that if the child were born, it would suffer from such physical or mental abnormalities as to be seriously handicapped. The same applies if the pregnancy has exceeded 20 weeks.
The medical method of MTP is recognised as one of the methods under the MTP Act. Therefore, all the issues related to administration, privacy, etc, are applicable to this method of MTP. However, these medications can only be used by a registered medical practitioner under the Act and can be administered in a clinic or consulting room. The owner should display a certificate of affiliation with a recognised MTP centre.
The practice of using OTC abortion pills (mifepristone) for abortion is on the rise. It is one of the most misused medicaments by doctors, especially those belonging to the other pathies like pharmacists. The Federation of Obstetric & Gynaecological Societies of India (FOGSI) recognises the universal evidence on the effectiveness and safety of mifepristone and misoprostol administration for inducing the medical termination of pregnancy up to 49 days from the LMP, as approved for use by the Drug Controller General of India. It needs to be stressed that under the existing laws, these methods can only be administered by gynaecologists and RMPs recognised for performing MTPs by the MTP Act of 1971.