In 2008, Arti Chauhan (name 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, taken with a day’s gap between them – could induce an abortion, a procedure she considered when she got pregnant when her boy was just a year old.
Chauhan, 28, wife of a daily wager employed in a fabrication workshop in Mt Abu in southwest Rajasthan’s Sirohi district, did not want another child so soon.
Three years earlier, Chauhan had paid Rs 2,000 to a private doctor in the neighbouring town of Abu Road for a surgical abortion. “I had a baby daughter at the time, I wanted another child – a boy – but after a couple of years,” she said.
Chauhan’s story is echoed across India: Millions of women become pregnant because they lack access to contraceptive devices to limit or space their families, or are fearful of using them, or, like Chauhan, are ignorant about contraceptive devices. More than 10 million women terminate their pregnancies 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 the District Level Household and Facility Survey 2007-08.
After the birth of her third child – a girl she did not want – the Chauhans wanted a second boy. A neighbour suggested contraception. “Then I started using Mala-D,” she said.
Chauhan has been able to source Mala-D, a government-distributed oral contraceptive pill, from the local government health facility, without break over the last six years. Otherwise, she would be repeatedly popping pills to terminate unwanted pregnancies, in doing so facing the prospect of complications such as severe abdominal or back pain, heavy bleeding with clotting, cramps, fever, vomiting, nausea, foul-smelling discharge, perforation and injury. An estimated 2 to 5% of Indian women require surgical intervention to resolve an incomplete abortion, terminate a continuing pregnancy, or control bleeding, according to the World Health Organization.
Against 0.7 million reported annual abortions, India logged sales of 11 million units of popular abortion medicines, mifepristone and misoprostol, according to this June 2016 report in Lancet, a global medical journal.
A greater focus on spacing and limiting methods by making more contraception options available would help avoid unwanted pregnancies in the first place and reduce reliance on abortion pills, said Muttreja.
With the Indian contraceptive prevalence rate at 52.4% – meaning a little more than half of Indian women, or their partner, are currently using at least one method of contraception – plenty of scope exists to increase the rate, which would, in turn, bode well for population control.
Hard-to-get contraceptive devices leave women heavily dependent on surgical or medical abortion to eliminate unwanted pregnancies.
Surgical abortion was legalised in India with the advent of the Medical Termination of Pregnancy (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 & Gynaecology, Fortis Memorial Research Institute, Gurgaon.
Unhygienic, unsafe invasive procedures using sticks and concoctions, violent abdominal massages: Women in India have suffered all of this and more.
Until the legalisation of mifepristone and misoprostol in 2002, no more than 6% of primary health centres 31% of larger community health centres nationwide offered safe abortion services. Now, women could pop pills in the privacy of their homes.
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 1,000 males.
Another concern is the health risk to women from terminating their pregnancies unaided at home.
When a home abortion attempt goes wrong, many women suffer and spend money needlessly because they approach providers who are not qualified to help: 95% of the women of the Madhya Pradesh study first sought care from one or more private doctors and chemists – only later did they go to a district hospital or medical college hospital equipped to take care of them.
Under the Act, abortions can be done up to 20 weeks, if “the continuance of the pregnancy would involve a risk to the life of the pregnant woman or [risk of] grave injury to her physical or mental health”.
Abortion is also allowed if substantial risk exists “that if the child born, would suffer from such physical or mental abnormalities as to be seriously handicapped or incapable of survival”.
Abortion is a better option than giving birth to a seriously handicapped child, she said, or facing the prospect of early neonatal death, even when the pregnancy was planned.
(This piece has been edited for length. For the full story, go to IndiaSpend.com. Bahri is a freelance writer and editor based in Mount Abu, Rajasthan.)
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