Despite a liberal abortion law, countless poor rural women continue to die because of unsafe practices and doctors who choose to interpret the law differently.
The tragic death of the 31-year-old dentist Savita Halappanavar in a hospital in Galway, Ireland, on October 28 has brought the issue of women’s right to safe and legal abortion to the forefront yet again. Savita died in her first pregnancy even though she was within reach of a hospital with modern facilities and trained medical personnel. Yet, the doctors chose not to intervene because of their interpretation of the law that makes abortion illegal.
There are literally lakhs of Savitas in India who die during pregnancy either because they have no access to modern medical facilities or because doctors choose not to intervene because of the way they interpret the law. And this happens in a country where abortion has been legalised since 1971, under the Medical Termination of Pregnancy (MTP) Act. Yet even here, although it is the right of any woman facing the kind of complications Savita did to go to a government facility and ask for an abortion, there is simply no guarantee that she will get it. Because the ultimate decision is left in the hands of doctors who can choose to interpret even this liberal law in different ways.
According to a recent study by the World Health Organisation and the New York-based Guttmacher Institute, India has the highest number of unsafe abortions in South and Central Asia. Of the 10.5 million abortions in the region, an estimated 6.5 million abortions take place in India (2008). And of these, two thirds are “unsafe abortions”, that is abortions that expose the woman to infection that could even lead to death. Although official figures cite that only 8 per cent of maternal deaths are caused by unsafe abortions, this is likely to be a gross underestimation as the link between an unsafe abortion and a maternal death is unlikely to be established in cases where health complications occur over a period of time after the abortion.
These complications include blood loss, infection and septic shock. Think of a woman in rural India who becomes pregnant but has to seek an abortion for various reasons. She is most likely to be sent to a quack for an abortion. If she then develops complications, chances of her getting to a medical facility in time are low. Even if she makes it to a primary health centre, whether she will get the treatment she needs in time is a question. But in the event of her death, it is highly improbable that the cause will be linked to the earlier episode of an abortion under unsafe conditions.
That apart, several studies in the last two decades have brought out several important aspects of women’s access to safe abortion facilities in India. For one, a substantial number of rural women are unaware that abortion is legal in India and that they can go to a government facility within 12 to 20 weeks of their pregnancy. Secondly, even if aware, they would not find such facilities as most are clustered in or around urban areas. As a result, most rural women are left with no choice but to turn to private untrained practitioners, thereby risking their lives.
Even where women can access government hospitals, they have complained of long waits, humiliation at the hands of doctors and nurses, insistence on approval of husbands even though this is not mandatory, and in the case of married women considerable pressure to undergo sterilisation after the abortion. For unmarried women, the treatment is much worse and usually results in the young woman running away and seeking some other facility.
This year, the central government appears to have woken up to this reality in India where, despite the law, women are dying from complications arising out of unsafe or incomplete abortions. It has identified 20,000 model health facilities that will provide abortion services round the clock and has prepared “Comprehensive Abortion Care” guidelines. This is a baby step in a country as large as India but it is a step forward.
The bottom line is that pregnancy is not a life-threatening condition or a disease. Women, who have the exclusive responsibility of childbirth, should not be exposed to risks that result in permanent health complications or even death. At a time when advances in science have increased longevity of the human race, it is unacceptable that millions of women in India continue to die during the course of their pregnancy or during childbirth.
Savita’s premature death should act as a wake-up call to our government too. There is no point having a liberal law if you cannot extend its reach to the women who need it; if you cannot train your doctors to understand and interpret the law keeping in mind the urgent need of the woman in front of them; if your facilities cannot provide the necessary safe and aseptic conditions that are essential; and if you fail to inform women that access to all this is their right and not a favour that a government doctor bestows on them.