At a quiz conducted recently for state-level health communicators in Bihar, it was found that some were not aware that abortions were legal in India while some others thought a woman required the consent of her husband or father for aborting her foetus. In fact, some of them were not even aware of the difference between emergency contraception and abortion drugs. This was significant given the fact that Bihar with 1.25 million abortions annually accounted for a sizeable chunk of the 15.6 million abortions annually estimated in the country by Lancet, an international health journal. Neighbouring Uttar Pradesh reported 3.15 million abortions.
As per the national statistics, only 22 per cent abortions are carried out in health facilities while 73 per cent are medication-based. The national average of unsafe abortions stood at 5 per cent, meaning thereby that about 10 women lose their lives daily because of unsafe abortions.
Studies by voluntary health organisations such as IPAS Development Foundation and Sanjha Prayas working in states such as UP and Bihar suggest that the high mortality rate due to unsafe abortions is attributable to very low awareness about the legality of abortion and availability of services. In the absence of awareness about their rights, a stigma has come to be attached with abortions in the rural and backward areas of the country.
In fact, much like the health communicators themselves, it has been found that frontline health workers themselves such as ASHA have certain misconceptions around abortion. Moreover, there is lack of Comprehensive Abortion Care service availability in lower level public health facilities.The research findings also suggest that women and even their families prefer private hospitals over public health facilities, owing to more privacy, better services and availability of female doctors.
However, the most common option appeared to be medical abortion drugs, mostly because they are cost-effective and easily available. Though they are categorised as Schedule H Drugs, they are easily available over the counter and generally recommended by pharmacists rather than doctors. In fact, in most cases, it’s husbands who play a key role as they mainly go to purchase these drugs from the counter.
As per the Medical Termination of Pregnancy Act, 1971, pregnancy can be terminated only by a Registered Medical Practitioner, who has a recognised medical qualification under the Indian Medical Council Act, whose name is entered in the State Medical Register and who has such experience or training in gynaecology and obstetrics as per the MTP Rules. Yet, in the absence of their availability in many of the rural areas, women are constrained to approach other doctors or even quacks or compounders and in the process often end up developing complications, which otherwise could have been avoided given the right kind of advice.
The MTP Act allows women to legally opt for safe abortion services within 20 weeks of gestation period. Termination of pregnancy is allowed only if the pregnancy is posing a life threat to the woman; when it may result in serious damage to her physical and mental health; if it is caused due to rape; in case it is suspected that the child, if born, will be mentally or physically disabled or when pregnancy is caused due to failure of contraception used by a married couple.
There are allegations by activist groups that some of the provisions are misused by some people to abort female foetuses in a country obsessed with the male child while many wonder how failure of contraception can be proved. There is also a section which believes that men too should have a say in abortions as against the current provisions which have given the choice in the matter to women alone, and nurses rather than doctors should be allowed to terminate pregnancies like in some countries.
While these aspects remain debatable, the fact remains that due to the stigma attached, even today majority of the people do not visit government hospitals for sexual health problems, including abortions. The respondents in the aforementioned study raised apprehensions that if they were seen visiting public health facilities for their sexual problems, they could become victims of rumour-mongering regarding their virility and fertility.
While the easy availability of abortion drugs has significantly made a difference in women being able to take a decision with regard to unwanted pregnancies, the usage of drugs without proper guidance is also leading to complications. The need of the hour, therefore, is a proactive approach by IEC officials of the state and Central health and family welfare ministries and frontline health workers to create awareness on a massive scale about the rights of women and provisions of the MTP Act.
Equally important is the need to enhance Comprehensive Abortion Care facilities in terms of infrastructure and staff, including lady doctors, at the primary level, especially in the rural, tribal and urban slum areas to instill a sense of confidence among the general public about public healthcare facilities. Media too should highlight issues related to abortion and not confine the subject to crime reportage related to rape or dowry death and thereby contribute to reducing the number of unsafe abortions in the country, whose prevalence along with issues such as malnutrition stigmatises an emerging nation no end.
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