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.
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