Need to save lives by making abortions safe

Not many in India are aware that last week, on September 28, the world celebrated the “Day of action for access to safe abortions.”

It is slowly picking up and becoming international in nature, though its origin is in Latin America where women’s groups have been mobilising around this day since the last two decades to demand that their governments provide access to safe and affordable abortion services and to put an end to stigma and discrimination towards women who choose to have an abortion.

This movement continues up to this day by growing in force and commitment on the part of women’s rights activists in the region and globally as well. The date – Sept 28 – was chosen in commemoration of the abolition of slavery in Brazil which is now remembered as the day of the ‘free womb’ demanding for safe and legal abortion for all women.

Seeking safe abortions is of great relevance in the Indian context. Unsafe abortions are a major public health problem in this country. Shockingly, India recorded 6.5 million abortions in 2008 of which 66 per cent or two-thirds were deemed unsafe. The major reason behind these disturbing figures is the fact that though abortion is legal in India, for numerous reasons, women are not able to access proper medical facilities. Unfortunately, they are getting abortions done in unsafe clinics and that is why a good measure of abortions in India end up in complications and death.

Crucial steps

Unsafe abortion is defined by the WHO as a procedure for terminating a pregnancy that is performed by an individual lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both. Measures to reduce the incidence of unintended pregnancy and unsafe abortion, including investments in family planning services and safe abortion care, are crucial steps towards saving women’s lives.

The Medical Termination of Pregnancy (MTP) Act, which was enacted by Indian Parliament in 1971 is a progressive law with regard to safe abortions. It has undergone several changes since then. The Act allows women to undergo abortion for certain specific conditions only. It was amended in 2003 so that women can gain better access to the services. Again in 2010 the Central government set up an expert committee to suggest recommendations for amendments to the Act.  Still they have not been put in place.

In spite of all these amendments and the law having been in existence for more than four decades, unsafe abortions continue and unfortunately, they outnumber safe and legal abortions. This is directly a consequence of the failure on the part of the health programmers of government who have not given due attention and promotion that this issue needs. Just compare this with the promotion that the family planning programme had got earlier or the current huge publicity for iodised salt. This Act needs much more intense awareness programme so that women will have the choice to access safe abortion.  
It is also falsely feared by policy makers that expanding the base of providers for abortion will lead to more sex-selective abortions. However, 80-90 per cent abortions in the country take place in the first trimester whereas sex determination takes place in the second trimester.

The 2011 Census reported alarming figures of child sex ratio. It is likely that the policy makers might have been influenced by this gender biased sex selection trends and thus took a harsh decision to curtail the availability of medicines that can be used for inducing abortion. Few states took this issue intensely and thus the chemists were compelled to stop storing these medicines.

This created an artificial scarcity of these useful medicines. Making available these medicines at the right time for the right person should be the goal of our policies. World Health Organisation recommends the use of mifepristone and misoprostol safely for up to 12 weeks.

Let us not be carried away by the thought that by tinkering with a few policies and providing few medicines to women in India they will be free from abortions that are threatening their lives. We need to create a society that respects economic, social, cultural, civil and political rights, in which all people, especially women, have access to, and control over, power and resources, enabling them to make decisions that contribute to optimal health and quality of life.

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