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.
A neighbour told me about the medicine. I bought it from the medical store for Rs 500. I aborted in 10 days. It was easy. I suffered no stomach cramps. It was much cheaper than having to pay for a surgical abortion.Arti Chauhan
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.
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.Poonam Muttreja, Executive Director, The Population Foundation of India
The Dangers of Popping Pills to Induce Abortion
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.
Most of India’s unreported abortions are not to terminate unwanted teenage or single women pregnancies. Medical abortion has become a proxy contraceptive for married women from socially and economically less privileged households.Poonam Muttreja
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.
Avoiding Pregnancies Through Contraception
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.
Research estimates that every new option added to this basket of choices will increase the modern contraceptive rate by 8-12%.Poonam 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.
Reinforcing the Gender Gap
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.
Incomplete abortions have increased from around 30% to over 50% in the last five years, which shows the increase in unsuccessful home medical abortion attempts.Vinoj Manning, Executive Director, Ipas Development Foundation
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.
Should the Law Change to Allow Abortions After 20 Weeks?
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”.
Advanced prenatal diagnostics allow many deformities and other medical conditions of the foetus to be identified – such as cardiac conditions, neural tube defects, genetic malformations, microcephaly, etc. – sometimes after the pregnancy has crossed 20 weeks. So the law should be amended to allow women to end a pregnancy beyond 20 weeks if the foetus is diagnosed with any serious deformity.Suneeta Mittal, Obstetrics & Gynaecology, Fortis Memorial Research Institute
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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