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Abortions: 61 lakh in five years, but issues remain

45352241 - court legal concept of abortion law, Copyright: kagenmi / 123RF Stock Photo. Several cases are provoking debate around India's abortion law - and whether it's time for changeIndia recorded 61 lakh abortions in the five years since the 2014-15 period, Minister of State for Health and Family Welfare Ashwini Choubey informed lawmakers last week. 

Giving a written reply to a question posed in the Lok Sabha, Choubey said that the Government was taking steps to ensure access to safe abortions in the country through the Centre’s programme concerning reproductive maternal, newborn, child and adolescent health and nutrition. In addition, he informed that states and union territories are provided with support to provide comprehensive abortion care under the National Health Mission, including certifying facilities operated by the private sector and non-government organisations where safe and comprehensive abortion care is provided. 

Unsafe abortion is a major issue in India. As many as 56 percent of such procedures carried out in the country are considered to be unsafe, with unsafe abortions responsible for the deaths of thirteen women every day in India. 

As previously reported by Health Issues India, a number of barriers to accessing safe abortion services exist in India despite the practice being legal per the Medical Termination of Pregnancy Act. A lack of infrastructure and societal stigma are among the factors making it a challenge for women to avail this necessary reproductive health service. 

Some have argued that India’s abortion law itself is too restrictive. Abortion is presently permitted in the first twenty weeks of pregnancy, if there is a risk to the mental and/or physical health of the mother or if there is sufficient probability that the child would be born with severe physical and/or mental disability.

The agreement of two medical practitioners is needed after the twelfth week of gestation, before which one practitioner must agree. After the twenty-week mark, abortion can be allowed but only with judicial authorisation, wherein a procedure can only be carried out with the assent of a court and a district-level medical board unless failing to immediately terminate the pregnancy poses a danger to the life of the woman. 

“A vast majority of Indian women and girls lack financial and legal resources to seek judicial authorisation and will be forced to carry an unwanted pregnancy to term or risk their lives through unsafe abortion,” argues the Centre for Reproductive Rights. They argue that “judicial and medical board authorisation requirements endanger women’s and girls’ reproductive rights by leading to delays, denials, public scrutiny and trauma, and a chilling effect on access to abortion even at earlier stages of pregnancy.”

35001464 - filthy and unsafe surgical instruments, Copyright: realchemyst / 123RF Stock Photo
Thirteen women die in India every day due to unsafe abortions. Some suggest making abortions more accessible will stop people from seeking out unsafe abortions.

The Centre told the Supreme Court earlier this year that it would not seek to extend the timeframe for abortion, stating “petitioners on their right to reproductive autonomy does not outweigh the interest of the state in protecting the life of [the] foetus in the womb, especially from the point of viability (i.e from the period of 20 weeks onwards). It is a settled law that personal freedom of choice of an individual cannot curtail the freedom or choice of other individuals, [especially] the most vulnerable and persons who are defenseless.” 

This has been critiqued by practitioners. “The limit definitely needs to be extended to 24 weeks, because medical advancements have ensured that it is perfectly safe and ethically sound to terminate pregnancies at that stage,” argues Dr Jaideep Tank, secretary-general of the Federation of Obstetric and Gynaecological Societies of India. 

However, some argue that the twenty-week mark is too restrictive as some foetal abnormalities and other complications may not be detected until late in the pregnancy. As the Centre for Reproductive Rights argues, women in these cases may be compelled to carry their pregnancy to term or seek an unsafe procedure, if they lack the resources to pursue judicial authorisation. Some women may look for an unsafe abortion because they are not aware that the procedure is legal in India: this is a concern that has been expressed by practitioners for a number of years. The conflation of illegal sex-selective abortion with exercising one’s reproductive rights as provided for by law is another consideration. 

“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,” Dr Rita Bakshi commented earlier this year. “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.”

The true scope of abortions in India is unlikely to be captured by government data. The figures presented by Choubey to the Lok Sabha are unreflective of illegally performed abortions, which account for a significant proportion of the number of the procedures carried out in India. Indeed, of figures presented pertaining to abortions in Delhi (which said 49,000 and 56,000 abortions were performed between 2013 and 2018), gynaecologist Dr Pundeet Bati said “this doesn’t even come close to the actual figures that are rarely disclosed and kept extremely confidential.” The same is likely to be true at the national level. 

While it is good news that the Government is providing resources for abortion, it is clear that more needs to be done to ensure women can avail their rights. From exploring relaxing the timeframe to raising awareness of the legality of abortion, the challenges are manifold and an effort is required by policymakers and other stakeholders to ensure that the number of women killed by unsafe abortions no longer stands at thirteen a day, but rather at zero.

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