Miscarriage of rights

On his first day in office, US President Donald Trump signed an executive order repealing federal aid to NGOs that either performed or facilitated abortions in any form around the world. After eight years of progressive reproductive legislation reforms under the Barack Obama administration, this new order hits the developing world hard. Ronald Reagan had first put in place the controversial ‘Mexico City policy’ in 1984 and it was only in 2009 that Obama rescinded it. While there was no direct funding for abortions even during the Obama years, it did take care of access to contraceptives and post-abortive care. Trump’s decision effectively cuts off reproductive healthcare services to developing countries, including India and its neighbours, which receive a good part of the aid. The Netherlands has stepped in and promised $10 million to fill the federal funding hole, but this still leaves a shortage of $600 million for the next four years.

Globally nearly 20 million, or about 50 per cent of abortions remain unsafe, according to data from the US government body National Centre for Biotechnology Information, and is the leading factor — at 13 per cent — for maternal mortality. According to the World Health Organisation, in developing nations a woman dies every eight minutes due to unsafe abortions. Several studies point out that banning access to abortion has in the past led to more unsafe abortions, rather than reducing the number of abortions. India not only has insufficient centres offering abortion services, they are unevenly distributed too. Bihar accounts for 10 per cent of the population, but has only 1.6 per cent of the approved abortion centres countrywide. Maharashtra, with nine per cent population, has 23 per cent of the centres.

The figures are disappointing in India due to various reasons, but mainly the outdated Medical Termination of Pregnancy Act (MTPA). According to a 2013 report by the NGO Ipas, a woman dies every two hours from an unsafe abortion in India.

Still, it is a fact that the MTPA, when it was introduced in 1971, was a significant improvement over the then prevailing laws. Until 1971, abortions were governed by the draconian section 312 of the Indian Penal Code, making them illegal and punishable under all circumstances, except when saving the woman’s life. Under MTPA, on the other hand, abortions are allowed in good faith with the permission of one medical practitioner within 12 weeks of the pregnancy, and two practitioners within 12-20 weeks in the case of rape, or if the woman is not in a mental or physical condition to have the child, or if her economic circumstances prevent her from doing so.

However, Dr Puneet Bedi, obstetrics and gynaecology consultant at Apollo Indraprastha Hospital in Delhi, believes the MTPA wasn’t introduced with a liberal, pro-choice agenda. “The MTPA was introduced as they needed a government hospital to conduct abortions en masse. The MTPA’s biggest flaw is that the decision to abort or not rests with the doctor, not the woman who has conceived a child. So while married women are covered under the Act, single, divorced or widowed women are not protected, and it isn’t legal for them to have an abortion in India, unless they state that they were coerced by their partner, or the doctor decides that they’re incapable of having a child in their present physical or mental state.”

Married or not

The Ministry of Health and Family Welfare has proposed amendments to MTPA, keeping in mind the fact that the law covers only married women, and that too only in the absence of sex determination. Failure of contraceptive is proposed to be introduced as a valid reason for an abortion, to protect the rights of single women, who are otherwise at the mercy of doctors, as the law does not extend to them.

Ravisha Mall, who once lived in Delhi and is currently a communications consultant in Liberia, spoke about the ease with which single women, especially in the 15-19 age group, are swindled when seeking an abortion. “Back in college in Delhi about five years ago, I accompanied my friend, who was pregnant with her then boyfriend’s child, for an abortion at a well-known local hospital. Since we were students, it was really difficult to arrange the money for it. To make matters worse, the first attempt proved unsuccessful.” After undergoing the recommended D&C (dilation and curettage) procedure, the friend emerged feeling unwell.

“She was asked to come back the next day for an ultrasound, which showed that the plastic tip of the surgical instrument had broken off inside her. The doctor said she would need another surgery, and aggressively denied it was her fault.”

Mall’s friend then hired a lawyer, who threatened to sue the doctor for negligence if she failed to perform the second operation for free. This too left the patient physically ill for two weeks, and mentally and emotionally traumatised for months after that.

Mall worries that her friend may have suffered further consequences too. “There could have been long-term effects, impacting her ability to conceive and have a healthy pregnancy.”

Poverty and added stigma

Mall’s mother, Rita has accompanied several women in such circumstances and feels that the worst brunt is borne by those who are poor. With limited access to healthcare services and contraceptives, they are especially vulnerable in such situations. “Add to it the social stigma aspect and there is a very real risk to their life and health.”

A study conducted by Centre for Operations Research and Training, Vadodara, found the gap between reported MTP cases in government centres and private ones to be enormous; only 10 per cent of all abortion cases are reported and performed in government MTP institutions. To resolve this difficulty, another proposed amendment to the MTPA involves authorising AYUSH-certified physicians to perform abortions, thereby increasing not only healthcare access but also the number of practitioners available for the operations. But this proposal met with a lot of opposition, as currently only certified hospitals and medical practitioners can offer abortion services.

Unsafe hands

Neha Gupta*, a professional living in Delhi, was accompanied by her partner when she visited a clinic for an abortion in 2016.

“We found the gynaecologist online, since we had decided not to share this information with anybody. I went to her fairly early, eight weeks to be precise. This doctor’s profile on Practo, an online platform for public reviews of medical practitioners, mentioned that she had been practising for 30 years. However, she not only gave me a wrong dosage of pills that resulted in a botched-up abortion, she also showed me a clip of the unborn foetus. It was a tough decision to make as it was, without the doctor’s emotional blackmail adding to it. We were really distraught, and she wrapped up the pills in a paper napkin, saying I wouldn’t be able to buy them over the counter, and overcharged for them.” (Incidentally, MTP pills are available over the counter in India, and are often taken without medical supervision.)

What followed was days of excruciating agony for Gupta. “The abortion was painful, and unsuccessful... I kept bleeding for the next three weeks, after which I went to another doctor to get it checked. The second doctor was very helpful, and prescribed a vacuum abortion to scoop out the remaining dead tissue in the womb. She recommended acting immediate to avert further damage to my system, as there was a high risk of infection from the dead tissue inside my body. The operation set me back by quite an amount, and included a day’s admission at the hospital. Consent forms were signed by my partner; they did not require my signature.”

The whole experience left Gupta deeply traumatised. “Perhaps the most debilitating of all was the feeling of loss of control over my own body, a sense of disconnect, which was exacerbated by my experience with the first gynaecologist. Her carelessness had put my life at risk, and caused me unnecessary trouble.”

Nishtha Singh’s* horror story unfolded when she underwent an abortion for the first time at a hospital in Gurgaon, NCR.

“The first attempt failed and it involved a chemical procedure. The terms were simple, I was asked to take two pills and told I’d feel some discomfort, the foetus would pass through like a clot during periods, and it would hurt. She did a terrible job of it, obviously, because I realised after a few weeks that I was still pregnant. The baby was still growing, but most of its organs were not, because of the pill. So the second time around, it was a D&E, because the baby had bones by then. The second doctor agreed to do it because there were ‘problems with the pregnancy’, not because I wanted it done.”

Clearly, the MTPA is inadequate in guaranteeing a woman’s right over her body. While, on the surface, abortions are not illegal in India, viewed under the lens of family planning, the law’s protection is unavailable to single women and those who do not have access to proper sex education or healthcare. Unless the recommendations are brought into force, millions of women in this country are potentially putting their lives at risk every year.

(*Names changed to protect privacy)

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