A Maharashtra government committee investigating deaths in Sangli district allegedly linked to illegal abortions has recommended steps that will curtail access to legal terminations of pregnancy.

The Medical Termination of Pregnancy or MTP Act allows abortions for up to 20 weeks into a pregnancy. But one of the recommendation made by the committee is to restrict access to abortion pills, so that they are not used to conduct sex-selective abortions. Maharashtra has a skewed sex ratio with 883 girls for every 1,000 boys born, according to the 2011 census.

Civil society groups have insisted that the government should focus on preventing the medical community from offering sex-determination services instead of trying to create barriers in access to abortions to pregnant women.

The seven-member investigating committee headed by the dean of the Government Medical College in Sangli has claimed that abortion pills are poison and called them a “weapon”. The committee has recommended that pills used for medical terminations of pregnancies be included in the Schedule X class of medicines under the Drugs and Cosmetics Rules. At present, these pills are listed in Schedule H, which requires a woman buying the pills to only furnish a prescription of a registered medical practitioner – a gynaecologist. However, drugs under schedule X can only be bought when two copies of the prescription are presented at a pharmacy, one of which is kept with the pharmacist as a record of the sale. Narcotic and anaesthetic drugs fall under Schedule X and are kept under lock and key at pharmacies.

The committee’s recommendations are based on the committee’s investigations, which found that the abortion pills were easily available to the doctor being investigated in the Sangli case. In early March, 25-year-old Swati Jamdade died at Dr Babasaheb Khidrapure’s clinic in Mhaisal town in Sangli, allegedly while undergoing an abortion of a female foetus. Khidrapure is not a gynaecologist but a homeopathy doctor and should not be prescribing or using abortion medication.

Swati Jamadade who died while undergoing an illegal sex-selective abortion. Photo credit: Priyanka Vora

“He [Khidrapure] was in possession of the pills though he was not a gynaecologist,” said Dr Pallavi Saple, dean of the government medical college. “We have to restrict the availability of these drugs.”

The committee’s report says, “These drugs are responsible for the deaths of 100 female children out of every 1,000 and therefore it should be considered as a poison or weapon.”

But health activists and women’s rights activists point out that restricting access to abortion pills will create pressure on women to seek out unsafe procedures to terminate their pregnancies even though the procedure is legal up to 20 weeks of development of the foetus.

“Stopping abortion is not the solution but changing mindsets is,” said Dr Suchitara Dalvie, a health activist. “Already, most public hospitals don’t provide medical termination of pregnancy pills. By further restricting its availability, the government is pushing women towards unsafe abortions.”

Reveal the gender

Among other recommendations, the committee has also provided possible three solutions to stop sex-selective abortions. At present, under the Pre-Conception Pre-Natal Diagnostic Techniques or PCPNDT Act, a doctor is not allowed to reveal the gender of a foetus to prospective parents or family members. However, the committee has suggested that the gender of foetuses should be determined in all pregnancies and the information made public.

Earlier this year, a 25-member Public Accounts Committee in Maharashtra also made the same recommendation for mandatory sex determination and tracking of women carrying female foetuses. Activists had objected to the recommendation as it restricts the women’s right to undergo abortion.

The MTP Act allows abortions up to 20 weeks of pregnancy. Activists say that committees recommending mandatory sex determination and tracking of pregnant women do not understand the provisions of the PCPNDT and MTP Acts. For instance, as Dalvie pointed out, the two laws are independent of each other but the committees are linking sex determination and access to abortion in their recommendations.

“There is no way that access to abortion leads to sex-determination,” she said.

The committee investigating the Sangli death has also recommended that trackers be installed in all sonography machines as a deterrent to doctors from determining the sex of foetuses during ultrasounds. But such trackers may also violate patients’ rights to privacy.

“At the ground level, these interventions will promote bribery and corruption,” said Ravi Duggal from Centre for Enquiry into Health and Allied Themes, suggesting that people who still want to conduct sex determination tests may still bribe health officials monitoring the data from these devices.

Punishing pregnant women

The third suggestion of the the government investigative committee is that women should compulsorily get registered with the government’s health facility within three months of pregnancy, failing which they will face punitive action. This, a committee member said, will improve maternal health as it will help Accredited Social Health Activists or ASHAs monitor pregnant women.

“It is a violation of the fundamental right of the woman,” said Duggal. “You can’t victimise women in this process.”