Every day 13 women die in India due to unsafe abortion-related causes. Nearly 6.4 million pregnancies are terminated every year in India. Unsafe abortion, the third leading cause of maternal deaths in the country, contributes eight per cent of all such deaths annually.

Thousands of deaths are reported from unsafe abortions due to lack of trained abortion providers, lack of knowledge about the legality of abortion and availability of safe services, compounded by the social stigma surrounding abortion.

Research shows more than 80 per cent of women do not know that abortion is legal in India and this contributes to women seeking terminations from backstreet providers.

WHY THE QUACKS RULE

While close to 70 per cent of facilities in the public sector in many states offer comprehensive abortion-care services, only 30 per cent of primary health-care centres -- which are the first place that village women visit -- offer services.

In Bihar and Jharkhand, studies show that 20 per cent of residents know that abortion is legal, whereas in Madhya Pradesh only 12 per cent are aware of the legality of the abortion. In addition, a recent study in Madhya Pradesh revealed that a woman has to travel an average distance of 20 km to reach an abortion provider.

Stigma and attitudes toward women -- particularly young, unmarried women -- seeking abortion also contribute to the number of unsafe abortions. Some providers refuse to perform abortions on young women or demand that they bring their parents to the health centre. This forces many women to turn to clandestine and unsafe abortions. While the law requires the consent of only the woman if she is over the age of 18 years, in practice, many providers also ask for consent from the spouse or another relative.

A girl stands on posters during a rally against abortion in the southern Indian city of Hyderabad. (Photo: Reuters)

Despite the liberal law -- Medical Termination of Pregnancy Act (MTP Act) -- that governs abortions in India, non-availability of trained providers, and detailed documentation coupled with poor knowledge about the legality of abortions contribute to abortion-related deaths.

Estimates indicate that two to four per cent of all abortions in the country are son selective abortions. In India, 80-90 per cent of reported abortions take place in the first trimester, while the sex selection is largely an issue in the second trimester.

Poor, young and unmarried women are more likely to delay abortion because they are often poorly informed on many fronts: they may not understand the signs of pregnancy, possibility or legality of obtaining the abortion and the location of safe services.

Accredited Social Health Activist (ASHA) workers serve as the first source of help for rural women when it comes to abortion. (Photo source: American India Foundation)

SOLUTION

To bring down the overall maternal mortality rate, it is imperative that access to safe abortion is made available.

Strengthen access to safe abortion services in the current context: Dissemination and implementation of the comprehensive abortion care training and service delivery guidelines are imperative. It needs to be ensured that providers are trained and equipment and drugs are available at all level of facilities.

Expand the base of legal abortion providers: India basically has a 'physician only' abortion law. The number of providers could be significantly increased by amending the law to authorise medical practitioners with a bachelor's degree in unani, Ayurveda or homoeopathy to provide abortion care.

Increase the upper gestational limit for abortion: In cases where there is a diagnosis of substantial foetal abnormalities, the MTP Act should be amended to allow for later terminations, i.e. beyond 20 weeks of gestation.

Make the MTP Act comprehensive and clear: It needs to be clearly communicated that only the consent of women is required for the MTP procedure. This would address the common practice of providers insisting that a woman's husband also consent to the abortion.

Simplify access to legal abortion services: As per the law currently, women must obtain the opinion of one doctor for a first-trimester abortion and the opinion of two doctors for a second-trimester abortion. Amending the MTP Act to simplify and reduce the requirement for a provider's opinion for both first and second-trimester abortions would greatly increase women's access.

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