Morbidity and Mortality
resulting from Unsafe Abortions
The election fever had gripped the nation, with each of us
trying to make sure that issues which matter to us are reflected in the
political manifestos. It is the right time, to make the law makers and the
political parties aspiring to determine the course of the country’s future in
the next five years to give their commitment to these issues which are often
neglected in public debate. Media is also doing its bit to draw the attention
of the political parties and people to issues related, particularly, to women’s
safety and wellbeing. This is one election where women are emerging as an
important vote bank.
One issue which continues to remain neglected is the loss of
maternal lives owing to lack of access to safe abortion services. Despite a
liberal law governing abortion in India (Medical Termination of Pregnancy Act
1972), every two hours one woman dies in India due to complications arising
out of unsafe abortion practices. Research documents that, every year 6.4
million abortions take place in India, of which nearly 56% are unsafe.
These startling figures reflect a number of issues related to
abortion in India, the most significant being the non-availability of trained
providers apart from ignorance about legality of abortions among people.
Coupled with social stigma attached to abortion in the Indian social context, women
with unintended pregnancies are often forced to turn to unsafe methods or to
untrained providers to end their pregnancy, resulting in a high rate of
avoidable maternal morbidity and mortality.
Yet
another factor influencing abortion services is the misplaced attempt by the
government to restrict abortions to control sex selective abortions, which are
resulting in the fall of sex ratios across the nation. Data shows that, 80 to
90 percent of reported abortions in India take place in the first trimester
when the sex of the baby cannot be determined. Sex selection can be done only
in the second trimester of the pregnancy. Yet, every woman availing an abortion
service is viewed with suspicion of indulging in pre-birth sex selection. The
PCPNDT Act (Pre-Conception and Pre-Natal Diagnostic Techniques Act) focuses on
sex determination alone. It is important to recognize pre-birth sex selection
as a medical malpractice that is promoting the deep seated gender biases and
son preference in the society. Whereas, safe abortion services are a legitimate
entitlement of women with unwanted pregnancies resulting from contraceptive
failure or rape and for women for whom the pregnancy is likely to result is
physical or mental trauma or the survival or quality of life of the child is
compromised due to congenital defects.
India is currently in the cusp of
change where there is increase in young people engaging in sex at much earlier
ages but at the same time the system dithering in providing them appropriate
sex education and easy to access contraceptive services. Even today many health
providers believe that there is no need to talk about condoms to girls. While
the knowledge about contraceptive methods is almost universal, access to
contraceptives is limited in many parts of the country. It is estimated that even if all the eligible
couples practice contraception, there would still be a need for abortion due to
the 2-3% incident of contraceptive failure. It is in this context that one
needs to focus on safe abortion services to the women.
The political parties need to be sensitive towards the issue
of access to safe abortion within the ambit of women’s reproductive rights,
this is particularly important in the context of the rising concern and
pressure on the government to act to save the girl child. None of the political
parties has ever specifically addressed the morbidity and mortality arising out
of unsafe abortion practices in its manifesto, though maternal and child health
issues are discussed. In the din of the rising concern for the safety of women
in homes, on roads and workplaces, let’s not forget the safety of women when
they are most vulnerable i.e during pregnancy and child birth. India still has
the dubious distinction of a maternal mortality rate of 212 (SRS 2011) which is far above
the natural incidence of 5 deaths per 1 lac live births. Eight percent of this
mortality is due to unsafe abortions. It is time for the political parties to
recognize and promote access to safe abortion services under the reproductive
health rights of women.
India basically has a “physicians only” abortion law. The
Medical Termination of Pregnancy (MTP) Act currently allows only gynecologists
and MBBS doctors who have undergone specific training to provide abortion
services. However, the latest developments in medical abortion, (where abortion
is induced through drugs without having to undergo any intrusive surgical
procedure) makes it safe even for the non-allopathic doctors and para medics to
provide services, of course when
adequately trained to identify the complications arising out of it and refer
the women to the appropriate institutions in case of complications. Data shows
that a women has to travel on an average 20 Kms to access a abortion service provider and that there
are only one service facility for 25000 women requiring the service. The number
of providers could be significantly increased by amending the law to
authorize medical practitioners with bachelor’s degrees in Unani, Ayurveda or
Homeopathy to provide abortion care to provide medical abortion services.
Currently, as per
the law, women must obtain the opinion of one doctor for a first-trimester
abortion and the opinion of two doctors for a second-trimester abortion. This
is especially difficult for women living in rural areas, where there are far
fewer physicians. Simplifying and reducing the requirement for a provider’s
opinion for both first and second trimester abortions would greatly increase
women’s access. Further, keeping the
changing sexual behavior of young people in view, extending the condition of
contraceptive failure for unmarried women as well would also help reduce number
of women seeking unsafe abortions.
Yet another issue
which needs to be resolved is the need for abortion in later gestational period
in certain exceptional conditions where substantial fetal abnormalities
are observed much later into the pregnancy, there is a need to increase the
upper gestational limit beyond the 20 weeks of gestation allowed as of now in
the act. Technological and medical advancements in recent years have made late
abortions safer than ever before.
Considering the
widespread ignorance of the legality and availability of abortion services it
is imperative that government simultaneously invests in creating awareness
about the same. The challenge is to create that awareness without moralizing or
stigmatizing abortion further.
At the
implementation level there is an urgent need to implement the comprehensive
abortion care training and service delivery guidelines to ensure that providers
are trained and available at all levels of facilities and that they have access
to required equipment and drugs to provide quality abortion services.
It is also
absolutely important to establish district level committees for certification
of private facilities for safe abortion services as mandated by the MTP Act.
Restricting
access to safe abortion services for women has not only long term health
consequences, but is also a violation of their reproductive as well as human rights.
It’s time that it becomes as important an issue of women’s safety as other
issues of violence against women.
