Why do women in India tend to have an unsafe abortion even when it is legal?

The healthcare system in India offers legal abortion options to the women seeking it or if prescribed. The provision was legalized in 1971 with the introduction of the Medical Termination of Pregnancy Act, 1971 (MTP Act, 1971). To address the needs of situations concerning women safety and health, many amendments have also been introduced, the latest being MTP Act, 2020.

An abortion procedure in India is considered safe when carried out by trained, licensed medical professionals under prescribed guidelines. The World Health Organization (WHO) has laid down the fundamentals for safe abortion procedures.

As of today, women consider an abortion unsafe not only on medical grounds but also on the ethical grounds. If the privacy and confidentiality of their abortion are not safe, abortion is deemed to be counted as unsafe in personal opinion.

For any certified and accredited Medical Termination of Pregnancy (MTP) centre, woman’s safety is the priority. But several considerations are looked as above in the priority queue for abortion in India, even when it is legal.

Why take risk with an unsafe abortion?

Abortion can either be prescribed for health concerns or the termination decision can be an outcome for an unwanted pregnancy. In either case, the procedure is to be carried out at a facility equipped with the necessary resources. But are resources the only deciding factor to choose an MTP centre?

There are many facilities across the country but not all are certified and not all are safe. Still, many women tend to seek an unsafe abortion despite the risks involved.

Let us have a look at the factors that lead many women into the slipstream of an unsafe abortion.

• Lack of knowledge: Unsafe abortion can be linked directly to literacy rates. Awareness grows with education. Uneducated women are inclined to have abortions at facilities that fall out of the formal healthcare system. Even educated women may lack the knowledge of laws and regulations governing an abortion. Many women either don’t know or are made to believe that abortion is illegal.
• Social stigma: Though legal, abortion is still at times condemned in society. Unmarried women and rape victims often resort to secret abortions instead of asking for it openly at a legal centre. This can be directly associated with societal stigmas. Without realizing the associated health risks, the maximum numbers of unsafe abortions in India are due to social stigma.
• Confidentiality: Women either due to society or due to personal reasons want the abortion to be kept confidential. Centres ask pertinent patient information before abortion which women are reluctant to reveal. Their biggest fear is that abortion data can be retrieved anytime in future which may pose difficulty in their future lives.

Either they are unaware that MTP certified centres are required by law to respect the privacy of the patient. Or they ignore the fact that a non-disclosure agreement is entered into between the patient and the facility, so all of the patient’s information needs to be kept fully confidential. Do you know this?

Even women who know this fact are unable to keep up their faith in the institution for keeping up their privacy.

• Gestational age: In India, abortion was legal up to 20 weeks of gestation. But now the duration has been increased up to 24 weeks as per the new MTP Act, 2020.

Women seeking an abortion after 20 weeks often receive refusal for it being illegal at the certified centres. Hence, if abortion is sought after the gestational age of 20 weeks period, due to the fear of facing denial, women seek unsafe abortion. Women who know this fact go directly for unsafe abortion. Others who face denial through the legal procedure turn up at the unauthorized facility.

• Fear: Apart from the fear of privacy, many women fear the treatment they would receive as a patient from healthcare providers. They fear being judged by the doctors and the staff and they assume disrespectful behaviour from them.
• Income-settings: Many women and the family consider that having an abortion done at a certified centre will be expensive. But what comes out as a result of unsafe abortion costs heavy on health. People refrain even from the inquiry. If they inquire before arriving at any decision, they’ll have all doubts cleared.

Do you think all these factors outrank irreparable damage to the woman’s health?

Feel free to share your views.

Abortion statistics in India:

Approximately half of the abortions occurring globally are considered unsafe. Unsafe abortions often lead to maternal morbidity and mortality.¹ As per the abortion statistics in India, unsafe abortions are the third largest cause of maternal mortality in India.² “Ten women reportedly die due to unsafe abortions every day in India.”³

Complications of an unsafe abortion:

All the approved MTP centres carry out the pregnancy terminations as per the guidelines issued for the same. However, when unsafe abortions are conducted without following these guidelines, various complications may arise. These guidelines have been drafted to avoid these complications and to keep a woman’s safety as a priority.

Some of the complications that can arise with unsafe abortions are:

• Incomplete abortion: If the medical method of abortion is adopted after the recommended period of 6 weeks of gestation, there are ample chances of incomplete abortion. An incomplete abortion will lead to abdominal cramps, continuous vaginal bleeding from scanty to heavy for weeks. Even a surgical abortion may be incomplete.

An incomplete abortion may also lead to hematometra, the post-abortion syndrome. It results in endometrium being distended with blood. Since the contraction in the uterine muscles is decreased, vaginal bleeding gets reduced or completely diminished.

And ultimately, surgical intervention will be needed to remove all the remaining products of gestation.

• Haemorrhage: Haemorrhage during a surgical abortion can result if proper care is not taken due to rupture of a blood vessel. Haemorrhagic shock may also result in if the uterine perforation leads to injury to major blood vessels.
• Trauma to internal organs:Improper uterine perforation may lead to injury to blood vessels, bowel, bladder, uterine lining, fallopian tube and other organs. If proper techniques and measures are not taken during the procedure, it can also lead to infertility.
• Infections: There is little or no care for hygiene at centres offering unsafe abortions. Unhygienic procedures offer result in infections presented by fever, abdominal pain, chills, vaginal bleeding.

Most of the damage caused is irreversible and can sometimes also be fatal.

Most of the times, women undergoing unsafe abortion are aware of the medical complications they may have to face. Still, they resort to these illegal means of abortion for other factors outweigh their health concerns.

Do you think it is wise to play with your health and life?

Most of the facilities which are not accredited and do not comply with the standards laid down for being recognized as an approved MTP centre also lack the facilities and the competence to handle these complications. In such cases, women are required to visit a verified centre to receive medical aid. Is it not better to reach out for safe abortion in the first place to avoid these multiple complications?

Preventing unsafe abortions:

Identifying and recognizing the causes and finding apt solutions in the light of protecting physical, mental and social health of women is the only method of preventing unsafe abortions. A comprehensive understanding is required to identify the thought process and the considerations that go into the decision-making for choosing an MTP centre.

Are you are looking forward to terminating an ongoing pregnancy? What are the factors that you would consider while choosing an MTP centre?

Some of the factors that may be responsible for a woman’s decision to have an abortion, safe or unsafe are:

• Reason for termination of the pregnancy: As a presumption, if the termination is sought to avoid medical complications arising from the pregnancy, the reason is genuine. For these abortions, women prefer the legal route.

But the pregnancies like the ones being carried by unmarried women or by rape victims or the ones resulting as failure of contraceptives are sometimes seen as criteria for judgement.  These women tend to adopt unsafe abortions for the reasons discussed earlier in the post. Hence families of such women resort to unsafe abortions at uncertified centres.

It is essential to understand that every legally permissible reason is genuine and worthy of respect. A good MTP centre in India is non-judgemental about the patient’s decision and the reason.

Some women may want to end their pregnancies due to the unwanted sex of the child, generally female fetus. Prenatal sex determination is not permissible legally and a punishable offense as per Pre-Natal Diagnostic Techniques Act, 1994 (PNDT Act, 1994). Hence, such women consider an unsafe abortion.  It is important to note that sex selective abortion is not legal or permissible in India under any circumstance.

• The decision for abortion: Decision to abort an ongoing pregnancy is not an easy one to make. Generally, any woman first realizes that she is pregnant only after 4-5 weeks of her last menstrual period. For some, it may come as a blessing while for others a fury.

Decision for abortion cannot be made instantly. She has 15 weeks to make an early decision and then to visit the healthcare centre. The decision depends on medical, emotional, social, financial and physical factors. Every woman is a unique individual and the factors vary from one another.

• MTP provider options: Once the decision for abortion is made, the right provider has to be chosen. Out of the available providers, filtering is done based on all the concerns which are responsible for wanting an abortion.

For some women, their safety and health concerns outweigh over all other factors and they seek the best available medical facility for abortion. Other women might want or are forced to opt for visiting uncertified facilities to seek an abortion.

• Available methods of abortion: Some healthcare providers can provide only medical abortion at their facilities. Others might be able to provide both medical abortion as well as surgical methods of abortion. According to the gestational age at the time of abortion, the method adopted varies. This can have an impact on the woman’s choice of the MTP centre.
• Post-abortion care: After an abortion, a woman’s body undergoes plenty of changes. It is important to follow-up with the doctor to keep regular monitoring and seek help if needed.

Whatever be the adopted method of abortion, post-abortion care is equally important. It is essential that the woman’s health is restored and she gets back to normal functioning post-abortion. This is yet another feature that can be availed only with approved MTP centres.

• Influencers: Though abortion can be a personal decision or a requisite, many women tend to search for methods and centres through various channels. They can be influenced by their peer group where they might openly discuss their concerns and seek solutions. This may sometimes help them identify the importance of getting a safe abortion at a proper certified MTP centre.

For many women, social networking groups play a vital role in decision-making processes, even as personal as getting an abortion. They have the ability to mold a person’s decision. If you too have queries that you expect to be met with by your social groups, be sure to pick the wiser choice. For medical queries, it is always best to seek advice from a healthcare professional.

Safe abortion in Bangalore:

American Hospital Bangalore (AHB) provides safe abortions not only via its highly technical, well-educated and professional staff, but we also address the concerns about the social and mental well-being of our patients.

We believe every woman has a right to access a highly safe, sterile and secure hospital environment which we can ensure at American Hospital Bangalore. It is MTP Certified and complies with CAC (Comprehensive Abortion Care) and WHO standards. Work is managed by the powerhouse medical team of AHB including the top US and internationally trained gynaecologists, doctors, nurses and assisting staff.

For us, women’s safety is the utmost priority not just in health but also in mental and emotional capacities. We respect your privacy and concerns and strive to keep them undisclosed. We strive to fill the gap that keeps women aloof from safe abortion even when facilities are available. We intend to protect women from unsafe abortions and provide them with safe options within the legal framework.

From pre-abortion counselling to the post-abortion care, you can expect to receive our best services and words of comfort. For a safe, legal and confidential abortion hospital in India, feel free to call or WhatsApp us and make an appointment.

References:

1. Termination of Pregnancy and unsafe abortion, Best Practice & Research Clinical Obstetrics & Gynaecology; Volume 28, Issue 6, August 2014, Pages 859-869
2. “Illegal abortions cause of many maternal deaths – Times of India”. The Times of India. Retrieved 2 July 2018.
3. “Unsafe Abortions Kill 10 Women Daily in India”. Deccan Chronicle. Retrieved 2 July 2018