Time To Let Go Of Stigma: How Far Has India Come In Accepting Abortion?

Women in India have always been at the receiving end of several social, cultural, institutional and operational challenges in all spectrums. Even after more than five decades of implementing the Maternity Termination of Pregnancy (MTP) Act in 1971, a woman's right to terminate a pregnancy, or abort her child, remains a debatable and taboo issue. More than 15.6 million abortions happen in India, and many of them are unsafe, thus putting a woman's life at risk.

Pratigya Campaign for Gender Equality and Safe Abortion highlighted that out of the 15.6 million abortions in India, about 12.7 million happen using medical methods. In contrast, only 2.2 million abortions are performed surgically.

The Foundation of Reproductive Health Services (FRHS), India, carried out a study to assess the availability of medical abortion (MA) in the local markets of six Indian states. The chosen states for the survey included Assam, Delhi, Haryana, Madhya Pradesh, Punjab and Tamil Nadu. The main objectives were to study the availability of the drugs, the understanding of chemists about the product, reasons for stocking or non-stocking the drugs, and to understand chemists' experiences/interactions with the state & district drug authorities related to sales & distribution of MA drugs in their outlet.

The results showed that four of the six states faced an overwhelming shortage of MA drugs. Very few chemists reported stocking MA drugs in Madhya Pradesh (6.5 per cent), Tamil Nadu (2 per cent) and Haryana (2 per cent). The lowest stocking was seen in Punjab at 1%, and Assam reported the highest stocking at 69.6 per cent, followed by Delhi at 34 per cent. When asked about the reasons for not stocking the drugs, about 79 per cent of the chemists mentioned d legal barriers, excessive documentation and paperwork.

A significant percentage of chemists reported having adequate knowledge about the legality of abortion in the country. Sixty-two per cent of chemists said that abortion is legal under specific conditions, while only 21 per cent of chemists reported that abortion is not legal in the country. Half of all chemists who said that abortion is legal/legal under specific conditions knew that abortion is permitted up to 20 weeks gestation.

What are the abortion laws in the country?

After the MTP Amendment Act 2021, an expecting woman requires the medical opinion of one doctor for undergoing an abortion within 20 weeks, between 20 to 24 weeks, the mother needs the opinion of two doctors. The 20 to 24 weeks category does not apply only to specific categories of women across the board. After 24 weeks, only if the foetus has anomalies that are not compatible with life, and after the medical board's opinion, can a woman go ahead and terminate the pregnancy.

Newer Issues That Impact The MTP Act

Over the last few years, new issues have emerged which are likely to pose a threat to safe abortion access, which include an increased number of women seeking judicial intervention/ authorisation for abortion, even though there is no such specification under the MTP Act, inconsistency in jurisprudence and procedural delays, inappropriate visuals and language used by the media while reporting abortion cases and the requirement on providers to mandatorily report issues of minors seeking abortion services under the POCSO Act. These factors have aggravated the apprehension and fear of increased scrutiny and engagement with law enforcement agencies among abortion providers. They have also made chemists and pharmacies reluctant to stock medical abortion drugs due to overregulation by food and drug administration officials, making abortion access difficult for women in need.

81 Per Cent Abortions Using MA Drugs

Before the amendment to the MTP Act, 1971 was passed last year, Pratigya Campaign for Gender Equality and Safe Abortion embarked on a study to assess the availability of medical abortion drugs in the markets of four Indian states - Bihar, Maharashtra, Rajasthan, and Uttar Pradesh. Their estimates suggest that medical abortion has emerged as the preferred method of abortion in the country, with 81 per cent of all abortions (15.6 million) in a year being performed using MA drugs.

While contacting the chemists, the NGO found that none of the retail chemists we spoke to in Rajasthan reported stocking and selling these drugs, while a mere 1.2 per cent in Maharashtra admitted doing so. The highest stocking was reported in Uttar Pradesh (66 per cent), while not even half of all chemists in Bihar were stocking the drugs.

While speaking to The Logical Indian about how accessible abortion is to females, Anubha Rastogi, an independent lawyer and CAG member for Pratigya Campaign, said, "Even though we are one of the few countries where the law on abortion was enacted much earlier than a considerable part of the world, it still is not a right. Till today, the law is based on the point of view of the service provider, not keeping the pregnant person at the centre of the discussion. Therefore, I opine that there is still much more that needs to be done. If in 2022, a pregnant person cannot say that she has a right to decide what happens with her body, there is a wide gap that we need to cover".

Further, Rastogi adds, "One can say that the situation of access to abortion also comes, probably because there is a lack of contraception, or there is access, but there is no negotiation. In many cases, women do not have the space to say that they want to choose contraception. There are a lot of stories that go beyond the numbers that are quoted in several surveys and studies, and for that, we still need a lot more in-depth work and research".

Way Forward

Women's ability to access safe and legal abortions is restricted in law or practice in most countries globally. Even where abortion is permitted by law, women often have limited access to safe abortion services because of a lack of proper regulation, health services, or political will.

Amongst several rights that should be provided to women to make them equal counterparts in society, the right to abortion is one of the essential rights. Improving primary healthcare facilities, especially in the rural areas, holding awareness campaigns to educate women about safer abortion options and spreading the legal framework amongst people in the lowermost rung of the society could be the start of an era where women are entitled to decide what, and what not happens to their body.

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