There is a glaring shortage of abortion pills across retail market as chemists refuse to stock them.
A cross-sectional study of 1008 chemists - ‘Availability of Medical Abortion Drugs in the markets of four Indian States,’ conducted by 'Pratigya Campaign for Gender Equality and Safe Abortion,' revealed that in Rajasthan, no chemist stores stocked Mifepristone and Misoprostol, two drugs that are required to abort a pregnancy used in first trimester.
In Maharashtra, a negligible 1.2 per cent of chemists were stocking the drugs, in Bihar close to 37.8 per cent and in Uttar Pradesh up to 66 per cent were stocking those drugs. “In Maharashtra, only three retail chemists said they are selling the drugs while not even a single chemist in Rajasthan admitted to stocking and selling them. Among those who were not selling the drugs, 11.6 per cent revealed that they used to at some point but stopped stocking them eventually,” stated the study.
“This could result in women being forced to seek services from informal and unsafe providers, risking their lives and health,” said VS Chandrashekhar, Pratigya Campaign Advisory Group Member and CEO, Foundation for Reproductive Health Services India.
Drug Controller General of India’s (DCGI) crackdown on sex-selective abortions has intimidated chemists who are asked to keep copies of prescriptions, or maintain registers with names of clients to whom they have sold MA drugs. “This is in direct violation of Clause 3 of Regulation 5 and 6 of the Medical Termination of Pregnancy (MTP) Act which says that the name of client seeking abortion cannot be revealed unless ordered by judiciary,” the study stated.
“Legal and regulatory issues emerged as a common reason for not dispensing the drugs among 69.4 per cent of retail chemists across the four States,” the study said further.
Misconceptions among chemists
The study observed that current maximum retail price of a combipack is more affordable than a surgical abortion in private facilities which costs between ₹ 2000 to ₹ 3400. Pharmaceutical companies like Mankind, Macleods, Aristo and Cadila are leading players. While Mankind Unwanted Kit is priced at ₹ 390, Cadila-Mifegest Kit is priced at ₹408, but availability is a major hurdle.
While pushing for better availability of drugs, FRHSI is also appealing to the Ministry of Health to bring about parity in different acts and rules governing medical abortion. “For example, MTP Act of 2003 says that pill-based abortion can be carried out up to seven weeks, but DCGI in 2008 approved pharmaceutical companies to write on combipacks that the same can be carried out up to nine weeks, while the World Health Organization (WHO) has put the safe upper limit up to 12 weeks,” said Chandrashekhar.
Amendments to the MTP Act were since made in 2014 but have been lying in cold storage for close to five years now. One of the impediments is experts say that according to the provisions of the MTP Act, contraceptive failure is the only condition that applies to married women. “The proposal for amendment includes making contraceptive failure applicable for all women and their partners as with other reasons for termination of pregnancy under the MTP Act has not seen the light of the day in terms of debate and discussion in the parliament,” said Chandrashekhar.
The study also revealed misconceptions among chemists with more than half of all the chemists responded these drugs have increased the number of abortions.“More retail chemists hold such a perception in Uttar Pradesh as compared to other states. About 71 per cent of chemists with MA drugs available stated that the drugs have increased the number of abortions,” said the study.
Chemists were also found probing women who came to buy pills, unwarranted questions about the number of living children, place of residence and reasons for undergoing abortion.