Safe abortion procedures put the woman’s safety first

March 30, 2020
India, AbortionNo Comments

Abortion in Bangalore, India is legal and permissible by law under certain circumstances. In events where medical terminations of pregnancy are to be carried out, the utilization of safe abortion methods is essential.

Until 20 weeks of gestation, abortion is permissible for multiple reasons since the risk to the woman’s health is least. But, beyond 24 weeks, the scope of abortion in India gets tapered. The tapering has been done keeping the woman’s health as the prime concern.

Safe abortion in Bangalore:

When abortion is carried out by trained, licensed medical professionals employing World Health Organization (WHO) prescribed methods, abortion is considered safe.

An approved and certified Medical Termination of Pregnancy (MTP) center with experienced gynaecologists ensures the safety of a woman as its priority, while conducting legal and safe abortion procedures.

Safe abortions are ensured by following the guidelines about equipment, medications and related facilities.

The legal scope of abortion in Bangalore, India:

The legal framework for providing Comprehensive Abortion Care (CAC) services in India is guided by the Medical Termination of Pregnancy (MTP) Act, 1971.  Until 20 weeks of pregnancy, an abortion is permissible if:

  • Pregnancy continuation can pose threat to a pregnant woman’s life and can injure her physical and/or mental well-being.
  • The fetus will be born as a child with any physical and/or mental abnormalities.
  • The pregnancy is a result of rape or unwanted sexual intercourse.
  • The pregnancy is unwanted as the result of the failure of contraceptives.

Considering the safety of women as a priority, the act also specifies:

  • The professionals who can terminate the pregnancy; A registered medical practitioner (RMP) having recognized medical qualification and name entered in the State Medical Register can do the procedure. Sufficient training and experience in gynaecology and obstetrics are also required for carrying out safe abortions.
  • The duration till when any pregnancy can be terminated safely.
  • The centres where a pregnancy can be terminated.
  • Consent of the woman is necessary before carrying out the abortion procedure. However, if the pregnant woman is minor or mentally ill, guardian consent is sought.

The MTP Act has been amended time and again for better implementation and increased access of women to CAC. First, in 2002, the MTP Act was amended and in 2003, specific rules for the same were framed.

Looking into the challenges faced by women in receiving CAC, certain amendments were proposed in 2014.  CAC guidelines were also revised thereafter.

Safe abortion methods:

Comprehensive Abortion Care (CAC) recommends women’s health as the major concern throughout the period from conception to post-abortion care.

Unsafe abortions are the third largest cause of maternal mortality in India.1 “Ten women reportedly die due to unsafe abortions every day in India.”2 This is what rang a bell for CAC implementation.  It reflects how alarming the situation is and the importance of safe abortion methods. Women’s access to CAC recommended safe abortion methods in approved MTP centres is crucial to their health.

An abortion method is considered safe if it intends to promote and protect:

  • Health of women
  • Human rights of women
  • Non-discrimination of any kind
  • Autonomy in decision-making
  • Confidentiality

As recommended by the World Health Organization (WHO), three methods can be categorized as safe abortion methods. These are briefed here for your reference. Following your medical condition, your gynaecologist will prescribe the safest method for you.

  1. Medical Abortion (MA)
  2. Vacuum aspiration (VA)
  3. Dilatation and Evacuation (D & E)

Medical Abortion:

Medical abortion refers to the usage of safe abortion pills rather than an invasive method as the abortion procedure. They are also referred to as Medical Methods of Abortion (MMA). This method of abortion can be approved up to 6 weeks of gestation. In India, there are two drugs approved for the purpose, Mifepristone and Misoprostol.

  • Mifepristone is an anti-progestin drug that ceases the growth of the fetus. Progesterone is the hormone necessary for the growth of the fetus and Mifepristone blocks its action. So, it is given to initiate the medical abortion procedure.
  • Misoprostol is used to expel the products of gestation. It works by softening the cervix and bringing about the contraction of the uterine muscles.

Advantages:

  • Non-invasive procedure
  • Abortion process is easy, and the use of safe abortion pills makes the procedure spontaneous and convenient.

Disadvantages:

  • Many times, the abortion procedure is not complete and there can remain pending products of gestation.
  • Side-effects such as nausea and vomiting may prevail even with the use of safe abortion pills.
  • Vaginal bleeding may last from a few days up to a few weeks.

Vacuum aspiration (VA):

The aspiration of gestational products done by using suction created by a vacuum pump is known as Vacuum aspiration. It can be done manually using a hand-held plastic aspirator to be called as manual vacuum aspiration (MVA). Or the suction can be created by an electric pump and the procedure is termed as electric vacuum aspiration (EVA).

This method of abortion is recommended as a safe abortion procedure for the termination of early pregnancies. It is mostly prescribed for abortions up to 14 weeks of gestation.

Advantages:

  • Reduced need for anaesthetic products while carrying out the procedure. Local anaesthetic can be used.
  • The short duration of the procedure (3 to 10 minutes).
  • Shorter stay at the hospital. Many women feel it convenient to get discharged in less than an hour after the procedure.
  • Less blood loss since most of the contents are evacuated by the aspirator.

Dilatation and Evacuation (D & E):

Dilatation and evacuation is a safe abortion procedure that requires well trained and experienced gynecologists to carry out the termination of pregnancy. It is generally prescribed for safe abortions to be carried out during and after second trimester or 14 weeks of gestation.

Advantages:

  • The key advantage is that the procedure withdraws all the unwanted uterine contents. So, there are very minor chances of any remainder gestation products.
  • In cases where abortion is prescribed owing to a potential abnormality in the fetus, abortion can be done safely.
  • The procedure takes less than 30 minutes for completion.

Disadvantages:

  • It is an invasive procedure.
  • Anaesthesia is required.
  • Risk of haemorrhage and uterine infections are comparatively more if not carried out as prescribed in Standard Operating Procedures by experienced medical professionals.

Only well-equipped and certified MTP centres are permissible to carry out safe abortions to protect and promote patient health.

Reasons for unsafe abortions:

Due to inadequate access to quality abortion facilities and trained professionals throughout the country many women tend to have unsafe abortions. Social, economic, financial and logistical barriers result in hesitation in women to have abortions at certified centres. In India, pregnancy can be terminated in events of failure of contraceptives.  However, lack of access to information also prevents many women from accessing safe and legal abortion procedures.

In other instances where pregnancy termination is not permissible legally, such as in late stage pregnancies, women under pressure get the abortion done at uncertified centres. Not having valid facilities, untrained professionals and unhygienic conditions for abortion procedures expose women health to considerable risk.

Awareness about legal aspects for abortions is required to help women undergo safe abortion procedures. These concerns have been recognized to make CAC accessible to every woman and the amendment bill has been proposed.

Safe abortion care in Bangalore:

At American Hospital Bangalore, safety concerns for women undergoing abortion are significant at all stages, before, during and after abortion. All abortions are done following guidelines mentioned for Safe abortions in WHO’s, “Clinical practice handbook for safe abortion care.”

Pre-abortion care:

  • Gestational age is the most critical deciding factor for selecting the safe abortion method. During the early stages, bimanual examination, abdominal examination, laboratory findings and ultrasound imaging is done before carrying out an abortion.
  • It is essential to check the age of the pregnancy and also confirm that the gestation is intrauterine. Ectopic pregnancies need immediate medical attention. And any risk of any kind of abortion though being safe increases with increase in gestational age.
  • In events of surgical abortions, using prophylactic antibiotics during the abortion procedure reduces the risk of infection.
  • It is ascertained that there is no reproductive tract infection at the time of the abortion. Any infection can increase the risk of post-surgical reproductive tract infections. In such events, it becomes necessary to administer antibiotics. Also, strict observation of disinfection procedures is taken into consideration.
  • Providing the woman knowledge as what to expect during the procedure reduces her anxiety. Besides, it also prepares her mentally for abortion. Equipping her about the safety concerns for her health with accurate and easy-to-understand format is given. Proper counselling of the woman is done before the procedure.

Selection of safe abortion method:

Every woman is a unique individual and individual concerns are considerable. But our chief concerns while selecting the safest procedure for every individual woman are her health and safety.  All the procedures are carried out by a team of well-trained and competent certified health care professionals and gynecologists.

Following CAC guidelines, selection of abortion method for it to be safe for the woman needs the following considerations:

  • For termination of pregnancies with gestational age between 12 – 14 weeks, vacuum aspiration may be recommended.
  • The medical method of abortion utilizing an oral dose of mifepristone followed by a single dose of misoprostol is prescribed for age up to 6 weeks of gestation. The MA is also done with a single dose of Mifepristone and repeated doses of Misoprostol.
  • D & E is typically recommended when gestational age is between 12 – 14 weeks. Properly cleaned and sterilized hygienic vacuum aspiration and forceps are used.
  • Considering the risk of cervical injury and uterine perforation, cervical preparation is recommended for surgical abortion.
  • Pain management is offered both in medical as well as surgical abortions. Analgesics and local anaesthetics as may be required are provided without any delay. Need for pain management increases with increase in gestational age.
  • Local anaesthesia is used when mechanical cervical dilatation is required to ease the woman’s discomfort.
  • Precautions for infection control to eliminate the risk of transmission of bloodborne infections are exercised.

Post-abortion care:

  • Before discharge after any kind of abortion, all vitals of the woman are checked to ensure she can go home.
  • A follow-up phone consultant or visit may be scheduled after 7-14 days of the procedure. At the follow-up session, all vitals are checked along with the symptoms of vaginal bleeding if it persists.
  • During the follow-up session, women are provided with complete safety measures for conception or contraception according to their choice. Sufficient information for future events is provided. Hormonal changes are also tracked to check the regularity of the menstrual cycle.
  • All the instructions and necessary precautions are provided with both verbally as well as in prescribed written form.
  • All the information as to what to expect after the procedure up to a month is provided to the woman. This includes up till when to expect vaginal bleeding, how to recognize potential complications and when to make a visit.
  • Contact number for queries is given where she can express her concerns and seek help from the hospital health care providers.

Deaths and disabilities in women as a consequence of unsafe abortions can be prevented by using safe abortion procedures. American Hospital, Bangalore is a premier medical centre that is accredited to carry out safe abortions in Bangalore.

As per MTP Rules and Regulations, 2003, American Hospital, Bangalore is equipped with the necessary training and certifications required to be a qualified MTP medical centre.

Feel free to ask any query relating to termination of pregnancy in the comment section below. Your health is crucial for your family and also for us.  With our latest equipment and caring professionals, your safety will be our priority.

References:

  1. “Illegal abortions cause of many maternal deaths – Times of India”. The Times of India. Retrieved 2 July 2018.
  2. “Unsafe Abortions Kill 10 Women Daily in India”. Deccan Chronicle. Retrieved 2 July 2018