Times View

MUMBAI: While one of the Food and Drug Administration ’s (FDA) strategies to fight female feticide is to crack down on chemists illegally selling the abortion pill, the ham-handed manner in which the FDA has acted has led to an undesired effect. Chemists in the city are afraid to even legally stock the pill, making it scarce.Experts say this could lead to an unhealthy situation. “If the pill is not available or there are too many restrictions, there is a fear that abortions will go underground,” said Dr Suchitra Dalvie of the Asia Safe Abortion Partnership.The Medical Termination of Pregnancy (MTP) kit, whose sales have dropped 65% in Mumbai, is one of the safest ways to end an unwanted pregnancy. Noting the danger in its non-availability, health minister Suresh Shetty ordered action against stores not stocking the kit even as the crackdown continues on selling it without proper prescriptions and paperwork.But on Friday, a day after the Maharashtra government said it would act against retailers not stocking the pill, chemists remained reluctant to stock it. “The FDA reports us directly to the police for not keeping paperwork. Isn’t this extreme?” said a city retailer.The current scarcity can be blamed as much on the illegal use of MTP kits as on the state’s crackdown on chemists, said experts.Dalvie said there has been rampant illegal use of MTP kits, especially in sex-selective abortions. Dr Rekha Daver , who heads JJ Hospital ’s gynaecology department, said, “The pill is recommended only for pregnancies of not more than 63 days, that too on a prescription written by a gynaecologist certified to carry out abortions. But in practice, the drug was being dispensed by homoeopaths, MBBS doctors, quacks and chemists themselves.” Dalvie said that even with the availability of the pill, 45% of all abortions were not carried out by recognized MTP service providers or were performed in a place not legally approved.Doctors fear the present impasse will take women’s reproductive health back many years. Daver said it was a good measure to let the abortion pill into India.Almost 10 years ago, public health experts celebrated the entry of medical abortions. In a country where unsafe abortions accounted for 8% of all maternal deaths, the MTP kit — which actually has two pills taken 48 hours apart — was offered as the safest option for women seeking to end unwanted pregnancies. India allows the pill to be used for up to nine weeks of pregnancy.However, the pill began to be sold without prescription. Like every other medication, it can have side-effects or lead to worse dangers, like bleeding, abdominal pain and fever.In India, only one of two pills are sometimes taken in the second trimester to induce labour. This can cause incomplete abortions and septic remains of the pregnancy. Daver said, “The kit has two pills — one is expensive and the other cheaper. Off label use of this cheaper pill for second-trimester abortions is not only unethical, but unsafe.” She said her hospital has treated incomplete abortions.However, by not stocking the pill, the chemists are protesting against what they say is the government’s move to link the pill to female feticide. They say the pill can only be used during the first 63 days of pregnancy. “The sex of the unborn child is known only after 12 weeks (84 days). So, how can we be blamed for female feticide?’’ asked Dilip Mehta of the Maharashtra State Chemists & Druggists Association. He said all association members have been asked to stock the pill and sell against a proper prescription.“But abortion is a sensitive and personal matter. Most of the people who want the pill give wrong names or addresses. How do we work around this?” he asked.Something as essential to public health as abortion pills going off chemists’ shelves shows how misdirected the FDA campaign has been. Abortion pills, if dispensed legally and properly, don’t lead to female feticide; they help women escape unwanted pregnancies. Pushing women to opt for unsafe abortions is actually pushing them a generation back. More thought needs to be applied and better brains need to be engaged before embarking on campaigns as important as the present one to end female feticide.