MUMBAI: A total of 15.6 million (1.56 crore) abortions took place across India in 2015, against the 7 lakh figure the Centre has been putting out every year for the last 15 years, according to a research paper published in The Lancet Global Health medical journal on Monday.

Not only do a lot more Indian women than previously thought undergo abortions every year, an overwhelming number — 81% — take medicines at home instead of going to hospitals, the study has said.

“The government figure talked of surgical abortions carried out in its own hospitals. The private sector was not counted, nor were medical abortions,” said the main author, Dr Chandra Shekhar of International Institute of Population Sciences in Mumbai.

Overall, 12.7 million (81%) abortions were medication abortions, 2.2 million (14%) were surgical, and 0.8 million (5%) were through other methods, probably unsafe. Medical abortions using mifepristone and mifepristone-misoprostol combipacks need a doctor’s prescription.

Doctors whom TOI spoke to said the revised number of abortions caried out in India wasn’t asurprise. “Smaller studies done previously in Mumbai and Chennai indicated abortions were higher than thought,” said a doctor with a government hospital. “Sale of medicines for abortion also gave us an indication,” said gynecologist Dr Nozer Sheriar, who was a part of the study.

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The new study also estimated that half of the total 48.1 million pregnancies in India in 2015 were unintended. “Abortions accounted for one-third of all pregnancies, and nearly half of pregnancies were unintended,” said the study, adding that India’s abortion rate is 47 per 1,000 women of reproductive age, which is similar to rates in Pakistan (50), Nepal (42) and Bangladesh (39). Dr Shekhar said the unintended pregnancies pointed to the need for better contraception and family planning programmes.

Around 53% Indians use modern contraception, but the expert said studies have shown that half the couples surveyed didn’t know how to use the condom correctly. The study — conducted jointly by IIPS, the Delhi-based Population Council and the New York–based Guttmacher Institute — compiled national sales and distribution data of medical abortion pills and conducted surveys of various public and private health facilities in six Indian states.

It estimated that close to three in four abortions are achieved using drugs from chemists and informal vendors. WHO says abortion medicines are safe and effective when used correctly and within a nineweek gestational limit.

Unfortunately, only a quarter of the abortions occur in the public sector, which is the main source of healthcare for the poor. Dr Sheriar said abortions are the third leading cause for maternal mortality in India. “The use of medicines for abortions has brought down this number from 12% to 8% in recent years, but it is still huge,” he said, underlining the need to make access to abortion easier for women. The results show abortions don’t need to take place in hospitals, nor do they need highly trained doctors. The study proposed recommended permitting nurses, AYUSH doctors (practitioners of indigenous medicine) and auxiliary nurse midwives to provide abortion medicines. This would expand the number of providers—and facilities—qualified to offer safe abortion services.

