India is already mired by controversial abortion laws. Add to it, the lack of knowledge and skills required for the procedure, indicating not just a staggering infrastructure, but also the need for reformation in the existing ones. Ironically, abortions are legal in the land for the past 46 years, but almost 60% of the procedures are unsafe. Incidentally, the figure is closer to the countries where abortion is illegal.
In the latest study published in the international medical journal Lancet, the soaring numbers are stated to be because of lack of access to hospital facilities, awareness and stigma around abortion.
The study conducted by WHO, in coordination with Guttmacher Institute, shows that 62 countries with highly restrictive abortion policies have 75% unsafe abortions as compared to 13% in 57 countries that have relaxed abortion regulations.
For instance, in a research paper published by the NCBI, medical abortions in rural Tamil Nadu are mired with doubt and uncertainty as the doctors who perform the procedure have been found to be non receptive of the usage of drugs mifepristone and misoprostol. In fact, many of the doctors did not have a clear idea of what normal bleeding in case of abortions was. While women in rural Tamil Nadu are adaptive to the procedures, it is necessary that the healthcare system providing them the facilities are upgraded with trained doctors.
In a separate report by The Hindu in the year 2011, it was said that close to 20,000 women die annually in India owing to unsafe abortions. This fact was discovered by the then Social Welfare Minister Poongothai Aladi Aruna in Chennai. She had cited, "The two major causes of women dying during pregnancy in India are postpartum haemorrhage and unsafe abortions." She had further pointed out that the maternal mortality rate in India, amounting to 300 deaths in 1 lakh deliveries, was the highest in the world. Tamil Nadu's maternal mortality rates was 40 in 1 lakh.
Unsafe abortions killing a woman every 2 hours
In another report published by The Hindu in 2016, IPAS estimated that unsafe abortions are killing a woman every two hours in the country. The main reasons, as cited by the research institutes, behind the increasing number of unsafe abortions, are illegal practices of sex determination and late detection of anomalies. Lack of amendments in the MTP Act (Medical Termination of Pregnancy (MTP)) is also considered to be one of the reasons why there is a spike in unsafe abortions in the country, especially in the Southern region of India.
It is said that in the absence of safe legal options, women opt for backroom procedures which is fatal in most of the case. Despite the Centre's intervention with proposed changes in the MTP Act, as recommended by an expert group constituted in 2010, little seems to have been done in implementing them.
Unsafe abortions more in developing nations
Medical experts believe that unsafe abortions could be avoided by training healthcare workers, midwives and Ayush doctors. Ipas Development Foundation executive director Vinoj Manning, speaking to the Times of India, said, "To reverse this, India must take major policy and programmatic action. The government needs to urgently take forward the proposed amendments to the MTP Act." He further added, "Without the expansion of provider base proposed in the amendments, safe abortion will never be a reality for women in rural remote areas of the country."
According to Sushila Singh of Guttmacher Institute, who is also a part of the research, the average unsafe abortions in the south central Asia region, including Pakistan, Bangladesh, Sri Lanka, Nepal and India, was as high as 58%. However, Singh shows a ray of hope as she says, "Though the situation in India has improved in the last few years, the percentage of unsafe abortions continues to be very high in India. Currently, we do not have India-specific abortion estimates but we are conducting a study especially to determine the magnitude of unsafe abortions in the country and its impact on maternal health."
(IPAS is an international NGO working on increasing access to safe abortion services)