After morning-after pills virtually disappeared from pharmacies in Tamil Nadu 10 years ago, women have taken to abortion pills without medical scrutiny , leading to a surge in unhealthy, life-threatening abortions. “We see cases of septic abortions that make blood transfusion and surgery essential,” said obstetrician-gynaecologist Dr Nazira Sadique, assistant professor, Sri Ramachandra Medical University.At her hospital, which works as a referral centre, 40% of women who underwent abortions came with complications after taking abortion pills without prescription. These women were then taken for emergency treatment that included surgical abortion.A study by a postgraduate student found that these women had bought prescription pills over the counter for anything between Rs 500 and 700 from medical stores. After talking to the women, the study found that some of them did not know that their pregnancy was ectopic (outside the uterus) and some had taken the pills too late. A few women popped them in the wrong order or at inadequate intervals.For 10 years, Tamil Nadu has enforced restrictions that made morningafter pills virtually unavailable, forcing women to take recourse to abortion pills without prescription or medical advice.This, doctors say , leads to complications and death. Doctors at Sri Ramachandra Medical University have taken seriously a study by a student which found many women had ended up with complications after they took prescription pills over the counter.Doctors in other hospitals said they did not have statistics because most women don’t reveal that they had taken abortion pills, and report complications as part of spontaneous abortion. “It’s tough to find out if women have taken these pills. We have no time to waste on that either,” said gynaecologist Dr Uma Ram of Seethapathy Nursing Home.Several doctors’ bodies such as the Federation of Obstetric and Gynaecological Societies of India and the state chapter of Indian Medical Association have urged the state to tighten sale of abortion pills and relax the rules on morning-after pills. In the absence of contraceptives, doctors say that morning-after pills are the best alternative for a woman to avoid the strain of an abortion.The drug was pulled out of the state by several manufacturers as they felt it was virtually impossible to abide by the restrictions in the state. “So some women wait till they get pregnant. When they do, they get the abortion pills from their local drug store,” says senior obstetrician Dr Jayashree Gajaraj.The abortion pill, unlike the morning-after pill, is a schedule H drug that should be administered only under medical supervision. Doctors say there is a reason. Though doctors put medical termination (pills) as the first choice for abortion, they warn that not all women can take them. It cannot be given to women who have pregnancy outside the uterus (ectopic). It is most effective when given to women who are under six weeks of pregnancy. At the end of the course, doctors do a scan to ensure the uterus is empty.In fact, doctors at the government hospitals say that the protocol is so cumbersome that they prefer surgical abortion. In 2015, some 30,000 of the 46,000 abortions done in government hospitals were surgical abortions where doctors use vacuum to aspirate the foetus. “We are concerned that women won't come for a follow-up scan. Instead of risking an unsupervised medical termination, we prefer a surgery ,” said gynaecologist Dr Usha Rani at the Government Women and Children Hospital, Egmore.Some private doctors, however, say it is all in the counselling. Dr Nazira Sadique, who sees patients from different economic backgrounds, asks women to take every pill under medical supervision. “We give them the first pill and ask them to come back for the second dose. We send them only after we know they don’t have severe bleeding or other side effects. Every patient is followed up with a scan,” she said.In states like Kerala, abortion pills are sold only to patients who hold double prescription. The pharmacist should hold a copy of the prescription and submit an account of the purchase and sale of every drug to the state drugs control directorate. In the absence of any such rules, the local drug stores sell the pills as over the counter like any prescription drugs, including antibiotics. Officials at the directorate of drug control said they haven’t received complaints about the sale of these drugs. “We have never received a complaint from a doctor or medical body so far,” he said.