Many mothers, even in urban India, resort to unsafe methods of termination of pregnancy which at times prove fatal, say doctors

Only one in 10 abortions in Delhi are reported, say gynaecologists, with the official figures on termination of pregnancies hovering between 49,000 and 56,000 in the last five years (2013 to December 2018), as disclosed by the Delhi Health Department in an RTI reply.

“This doesn’t even come close to the actual figures that are rarely disclosed and kept extremely confidential,” said gynaecologist Dr. Puneet Bedi.

While the official figures itself, according to doctors, are just an indication of the trend in the sector, what is more worrying is the fact that only 42 maternal deaths related to abortions have been reported and recorded between 2013 and 2018, all of them in government hospitals expect two.

The missing data

“There is no data available from private hospitals about maternal deaths related to abortions except two in 2016-17. The data clearly hides more than it reveals,” said RTI activist Rajhans Bansal who sought the figures on abortions and related maternal deaths.

“Abortion in India is legalised and governed under the ambit of Medical Termination of Pregnancy Act, wherein a woman can opt to medically terminate her pregnancy with the approval of one or two registered medical practitioners up to 20 weeks of gestation,” said Dr. Rita Bakshi, gynaecologist-obstetrician and chairperson, International Fertility Centre.

She said it is unfortunate that till date a large majority of women, even in urban India, are unaware of their rights regarding abortion and continue to resort to unsafe and medically non-substantiated methods of abortions which at times prove fatal.

“As a matter of fact, unsafe abortions currently account for one of the leading causes of maternal mortality in our country,” said the doctor.

Induced abortions

Dr. Archana Dhawan Bajaj, gynaecologist and IVF expert, Nurture IVF Centre, said an induced abortion is always a planned action which mostly takes place in a situation when the continuation of pregnancy carries risk to the life of the expecting woman or it can bring upon serious threat to her physical or mental health. Also in cases where the child is upon a substantial risk of being born seriously handicapped with physical or mental abnormalities, induced abortion is an option.

“Often unexpected pregnancy due to failure of contraceptives also leads to induced abortion,” she added.

“Earlier a significant number of abortions were carried out based on the gender of the baby [female foeticide], but in recent years people are opting for induced abortions mostly due to health concerns. The most common age group to go for abortions is also changing gradually from teenage girls to women in their late 30s and 40s.”

Miscarriage risk

Women over the age of 35 are at high risk of suffering miscarriages. According to doctors, miscarriage in early pregnancy (less than eight weeks) is most commonly because of genetic abnormalities in the embryo, hormonal imbalance or some other medical problems with the mother. Miscarriage in later pregnancy is because of uterine abnormalities and autoimmune diseases in the mother.

Dr. Sonia Naik, head of unit, obstetrics and gynaecology, Max Super Speciality Hospital, said: “Abortions are commonly seen in pregnant women who are 35 years and above because of increased genetic abnormalities in the embryo.”

She added that termination of pregnancy related to female unborn child happens in the early second trimester.

“These are women who come asking for termination of pregnancy or take pills sold over the counter [easily available in our country] for abortion,” she added.

In metro cities like Delhi, women of reproductive age may seek abortions due to various reasons such as failure of contraceptives leading to unplanned pregnancies, medical complications that are likely to cause harm to the mother and the unborn baby, and being worried about various socio-financial implications (many couples do not wish to have a second child or feel that having a baby may interfere with their professional careers).

For unmarried girls or married women below 21 years of age, abortions are sometimes seen as a way out to shove off age-inappropriate, untimely responsibilities.

Dr. Rita Bakshi said that even though gender detection of feotus is illegal in India, sex-selective abortions continue to be a persistent problem, especially in rural towns and suburbs.

“However, it is important to mention that only less than one-tenth of the total abortions happening in India are estimated to be sex-selective, while a vast majority of abortions take place during the first trimester [when it is practically impossible to determine the gender of the baby]. Female foeticide is a major social issue and a sensitive topic which needs to be seen and handled from a wider lens instead of only blaming abortions for it, which usually contribute to a very minor proportion of this large social problem,” said Dr. Bakshi.