In a country where discussions on sex education, pre-marital sex, safe sex, menstruation, sexual health and hygiene have hushed undertones, conversations around abortion invite mixed responses — shame, stigma and sometimes fear. The topic, however, remains controversial and is perceived mainly through the prism of religious and moral and not medical grounds or an expression of a woman’s personal choice.
Medical Termination of Pregnancy (MTP) or Medical Abortion is the ending of a pregnancy by removal of the foetus, pregnancy tissue or products of conception. When foetus is removed, it is done before it can survive outside the uterus. When the pregnancy is ended with deliberation, it is called an ‘induced abortion’ and when the abortion occurs without intervention, it is known as a ‘spontaneous abortion’ or a ‘miscarriage’. A procedure where foetus capable of surviving outside the womb is removed is called ‘termination of pregnancy’.
There are two ways to end a pregnancy i.e. abortion:
• Medical abortion by use of drugs (pills)
• Surgical abortion by operation in a clinic
Regulation of abortions
Every country has a different abortion law that permits, restricts or prohibits abortion and regulates it in a manner such. The law is governed by the socio-cultural and ethical framework of that country.
Abortion remains a divisive social and political issue. For example, in Ireland, where abortion has always been illegal, a new law introduced in 2018 allowed abortion during the first 12 weeks of pregnancy and later in cases where the pregnant woman’s life is at risk, or in cases of fatal foetal abnormalities. The archaic Irish abortion law came under intense scrutiny and criticism when in 2012, an Indian woman living in Ireland – Savita Halappanavar, died after being denied an abortion while suffering a septic miscarriage.
In India, a very progressive Medical Termination of Pregnancy (MTP) Act was enacted in 1971 that provides for the termination of certain pregnancies by registered medical practitioners until 20 weeks of pregnancy.
The union cabinet recently approved The Medical Termination of Pregnancy (Amendment) Bill, 2020 that proposes ‘to permit the termination of pregnancy up to 24 weeks from the existing 20 weeks’ and ‘aims to expand access of women to safe and legal abortion services on therapeutic, eugenic, humanitarian or social grounds’.
The increase in gestational age has been proposed mainly for rape survivors and minors and will now require consultation from two medical experts, instead of one. Minister of Women and Child Development Smriti Irani called it ‘a new step towards gender equality’.
And rightly so, as the amended law will help minor rape survivors who, in the initial months, do not even realise they are pregnant. In such cases, the parents often learn of the rape and the pregnancy much later, sometimes after 20 weeks. So, the proposed amendments mark a significant victory for reproductive rights of women.
The stigma of abortion
The stigma of abortion affects young girls and women, communities, medical practitioners, MTP providers, lawyers, activists, even grassroots workers. Largely stigmatised in urban and rural India, the taboo associated with abortion often prevents women from seeking safe and legal MTP services.
It stops them from talking about their experiences to guide other women. Out of fear and shame, women don’t even report malpractices and deficiency in services that are rampant in abortions given the ‘secrecy’ surrounding it. It is the single-most reason for the associated cost of an MTP escalating to exorbitant amounts owing to the hugely unregulated practice.
According to a study by The Lancet Global Health on the incidence of abortion and unintended pregnancy in India, an estimated 15.6 million abortions were performed in 2015. This means an abortion rate of 47 per 1,000 women aged 15–49, similar to the abortion rate in neighbouring South Asian countries.
Of these, most of the abortions (81 per cent) were achieved using pills or drugs (medical abortion) obtained either from a health facility or another source; 14 per cent were performed surgically in health facilities (surgical abortion); the remaining five per cent were performed outside health facilities i.e using unsafe methods.
The risks of unsafe abortions
Despite a good abortion law in place, many vulnerable women continue with unwanted pregnancies or undertake unsafe abortion methods. A study published in the Indian Journal of Medical Ethics revealed that 10-13 % of maternity-related deaths are directly associated with botched-up abortions.
The law in India is progressive but societal perception and the stigma associated with abortion means lack of awareness and poor implementation of the law. The newly-proposed amendments seek to grant legal abortion on humanitarian, social, as well as therapeutic grounds.
Shady banners and placards at bus stops, public toilets, in dingy lanes and in obscure corners of the city offering to perform abortions are not an uncommon sight. There are as many illegal options available as legal to perform abortions. Illegal facilities and availability of ‘unaccounted-for’ MTP pills at pharmacies pose grave threat to lives of girls and young women who, for multiple reasons, social and financial, cannot approach legitimate clinics or medical professionals.
Reproductive rights and privacy
The MTP Act gives an ‘adult’ woman complete autonomy and authority to decide if, and when, she wants to undergo abortion. It is only at the explicit will of the woman, and no other, that a doctor can perform abortion within the legally-permitted time. The Supreme Court of India in a landmark judgment had said, “A woman’s freedom of choice whether to bear a child or abort her pregnancy are areas which fall in the realm of privacy.” However, in reality, doctors ask for express consent from husbands or families or father of the child (in case of pregnancies outside wedlock) before performing the abortion.
The MTP Act clearly provides for protection of the identity of the woman. However, most government and private hospitals disregard privacy completely. The doctors and the staff are prejudiced and outright careless in terms of protecting the identity of the woman.
In most facilities, government or private even in reputed facilities, the paperwork generated as a prerequisite to any MTP procedure are easily accessed by any staff, when making inquiries or between personnel from other departments even during procedures such as conducting an ultrasound of the uterus. There are absolutely no precautions taken to uphold the patient’s privacy.
Despite provisions in the law, a woman’s reproductive rights are not recognised by the very administrators of the law.
Prejudice at every step
The entire procedure of an abortion is traumatising for a woman and has lasting effects. It becomes more difficult and trying for a woman who seeks abortion of a pregnancy outside wedlock. The prejudice that is ingrained in society surfaces through people who ‘administer’ law at every step. Hospital staff, doctors, chemists even pharmacists.
It is important to grant reproductive rights to a woman in the complete sense. Safe abortions and reproductive rights can be assured by talking about abortions, safe sex, pre-marital sex and removing the stigma associated.
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Manu Shrivastava
Manu Shrivastava is a media legal researcher with DraftCraft International, and co-convener of ‘The Woman Survivor’ initiative that documents abuse of women and children within families.
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