The saga of abortions in India

By Charu Bahri

In 2008, Arti Chauhan (me changed to protect identity), mother of a 12-year-old girl, a 9-year-old boy and a 6-year old girl, became aware that two pills — mifepristone and misoprostol — could induce an abortion, a procedure she considered when she got pregnt when her boy was just a year old.

Chauhan, 28, wife of a daily wager in Rajasthan’s Sirohi district, did not want another child so soon. “A neighbour told me about the medicine,” she said. “I bought it from the medical store for Rs 500. I aborted in 10 days. It was easy. It was much cheaper than having to pay for a surgical abortion.” Three years earlier, Chauhan had paid Rs 2,000 to a private doctor in Abu Road for a surgical abortion.

Chauhan’s story is echoed across India: Millions of women become pregnt because they lack access to contraceptive devices to limit or space their families, or are ignorant about them. More than 10 million women termite their pregncies in the privacy of their homes, reflecting the government’s failure to adequately address family planning needs, endangering mothers and keeping India more populated than it might be if women had access to, and knowledge of, contraceptives.

A family planning programme and budget skewed towards sterilisation leaves one in five women with an unmet need for contraception in India, according to District Level Household and Facility Survey 2007-08.

Elimiting all unwanted births by adequately meeting the need for contraceptives would reduce India’s total fertility rate below the replacement level — a stage where the population neither increases nor decreases — of 2.1. India’s fertility rate is currently 2.3, but if women were provided contraceptive devices and guaranteed safe abortions, the fertility rate could fall to 1.9 (the same as US, Australia and Sweden), according to a tiol Family Health Survey estimate. “If the government adequately focuses on preventing unwanted births and on empowering women to make the right decisions, India’s population could actually start falling,” said Poom Muttreja, executive director, The Population Foundation of India, an NGO working on population issues.

An estimated 2 to 5 per cent Indian women require surgical intervention to resolve an incomplete abortion, termite a continuing pregncy, or control bleeding, according to the World Health Organisation. The taking of pills to induce an abortion enters the tiol data as no more than pharmaceutical industry sales data. “Most of India’s unreported abortions are not to termite unwanted teege or single-women pregncies,” said Muttreja. “Medical abortion has become a proxy contraceptive for married women from socially and economically less privileged households.” Against 0.7 million reported annual abortions, India logged sales of 11 million units of popular abortion medicines, mifepristone and misoprostol, according to the jourl Lancet.

At present, Indians have a choice of five state-provisioned contraceptive methods — condoms, combined oral pills, intra-uterine devices, male and female sterilisation — and starting in March 2016 in Harya, the first state to implement a new government directive, an injectable contraceptive. With the Indian contraceptive prevalence rate at 52.4 per cent — meaning just over half of Indian women, or their partners, are currently using contraception — plenty of scope exists to increase the rate, which would, in turn, bode well for population control.

Surgical abortion was legalised in India with the advent of the Medical Termition of Pregncy (MTP) Act in 1971, marking a major step forward for Indian women. “Abortions by quacks were putting women at great risk,” said Suneeta Mittal, Director and Head, Obstetrics & Gyecology, Fortis Memorial Research Institute, Gurgaon.

Until the legalisation of mifepristone and misoprostol in 2002, no more than 6 per cent of primary health centres and 31 per cent of larger community health centres tionwide offered safe abortion services. Now, women can pop pills in the privacy of their home. “Medicine elimites the cost and risk surrounding hospital admission, aesthesia and surgery; and it offers more privacy than a surgical abortion,” said Mangala Ramachandra, Consultant Obstetrician and Gyecologist at the Fortis Hospitals, Bengaluru. The gap between recorded and estimated abortions based on medicine sales suggests women are aborting foetuses, primarily female. India’s gender ratio in 2011 was 940 females for 1000 males. There are concerns about the health risk to women from termiting their pregncies uided at home. (IANS)

(In arrangement with IndiaSpend.org, a data-driven, non-profit, public interest jourlism platform. Charu Bahri is a freelance writer and editor based in Mount Abu, Rajasthan. The views expressed are those of IndiaSpend. Feedback at respond@indiaspend.org)