The Mumbai High Court judgment disallowing the abortion of a 26-week-old foetus has sparked off a nationwide debate on abortion and a woman’s right of choice. But for a majority of Indian women, ‘medical termination of pregnancy’ (MTP, the medical term for abortions) remains largely unsafe.
Unsafe abortions are those performed illegally, by untrained practitioners with faulty equipment, leading to injuries, infections and even death.
India has the highest number of unsafe abortions in the world. According to government estimates, 8.9 per cent of maternal deaths in India every year — around 15,000 — are caused by unsafe abortions. The irony is apparent when doctors say MTP, if done right, is among the safest medical procedures.
Of the 6.4 million abortions performed in India in 2002 and 2003, 56 per cent or 3.6 million were unsafe, says the Abortion Assessment Project I, 2004. The study — one of the largest in recent times — was managed by the Mumbai-based Centre for Equity into Health and Allied Themes and Healthwatch Trust. It included qualitative and quantitative studies across various states by non-governmental organisations (NGOs), researchers and healthcare professionals.
It also pointed out problems of reach and access with public investment in abortion facilities being woefully inadequate. Only 25 per cent of abortion facilities in the organised sector are government-owned; the rest are private clinics. These are so expensive that they completely exclude the poor sections.
“There’s inadequate, inequitable distribution of facilities for safe abortions. Contraceptive usage is low in India, hence the great demand for safe abortion services,” said Dr Jaydeep Tank, chairperson of the MTP Committee at the Federation of Obstetric and Gynaecological Societies of India (FOGSI). Besides, only six per cent of India’s 23,000 primary health centres (PHCs) provide abortion services.
“Besides risk to life, unsafe abortions have serious long-term repercussions like life-long disabilities and reproductive tract infections,” said Sushanta Banerjee, senior advisor at Ipas, an NGO.
For a country with a ‘liberal’ law on abortion, Banerjee said awareness about it is extremely low even three decades after it was enacted. “In Jharkhand, for instance, we found that 82 per cent of women didn’t even know abortion was legal,” he said. In a related study by the Population Council in Rajasthan in 2002, the figure was 84 per cent and in Maharashtra at least 37 per cent of those who had had abortions thought they were illegal. This misconception leads many women to unqualified professionals. Other barriers to safe abortion are “social stigma and myths attached to MTP”, said Tank. “Awareness about abortion through drugs like Mifepristone and Misoprostol is also low, despite they being legal and easily available.”
Social barriers like spousal consent and judgmental doctors are also deterrents, though the law requires no such consent. Under the government’s Reproductive and Child Health Project, safe abortions are a key concern and some progress is being made — maternal mortality due to abortion was 11 per cent in 2001. “We need to generate awareness at the community level about contraception and safe abortion, in both rural areas and urban slums,” said Thomas Chandy, CEO, Save The Children in India. Ipas also advocates training of mid-level service providers like nurses and non-allopathic doctors in remote areas where access to trained doctors is a problem.