Last week, a 29-year-old woman walked into the State-run J.J. Hospital in Mumbai with severe bleeding. A medical examination revealed the cause to be an incomplete abortion that had led to a severe infection. The housewife from Byculla had had a combination of two abortion drugs, mifepristone and misoprostol. Though these are the common drugs used in a medical termination of pregnancy (MTP), they ought to be had only with an authorised prescription.
The woman had accessed them from a chemist or a quack who had failed to gauge her accurate gestational age and the complications that could arise thereafter. “Due to the higher gestational age, and despite consuming the drugs, she had had an incomplete abortion. The remains in her uterus caused severe infection and had to be removed through a suction-evacuation procedure,” said gynaecologist Dr. Ashok Anand.
The patient required two units of blood, was put on a high antibiotic dosage and discharged after her condition improved three days later. But when the doctors asked her about the source of the pills, she refused to say a word. “This is not uncommon at all. We get many such patients with complications arising after consuming MTP pills without consulting a qualified doctor,” Dr. Anand added.
Data on terminations
A research paper recently published in The Lancet Global Health said that a total of 15.6 million abortions were carried out in India in 2015. Of these, 11.5 million abortions were medication abortions done outside of health facilities.
While the Medical Termination Of Pregnancy Act, 1971 makes prescriptions mandatory for medication abortions, the ground reality may present a different picture. “Access to safe, legal abortion services has lagged, so women now commonly obtain medication abortion from pharmacists, chemists, and informal vendors, and the information they receive on how to use the drugs and on recommended gestational limits is often inaccurate or absent,” the paper states. While the paper does not provide estimates of women who could have accessed MTP pills illegally, it states that “many abortions are happening without prescriptions and outside of facilities via chemists and informal vendors, which suggests the need to improve facility-based services”.
A qualified doctor will carry out a sonography to understand the gestational age and whether the pregnancy is ectopic. “In ectopic pregnancies, wherein the foetus grows outside the uterus in a tube, there is always a risk of the tube rupturing and causing a haemorrhage due to the MTP pill,” said Dr. Anand who has seen many patients with such complications.
But Dr. Suchitra Dalvie, coordinator for the Asia Safe Abortion Partnership, said that it is a good thing that more number of women are undergoing a non-invasive form of abortion. “The abortion pills are safe. The problem arises when taking drugs with inadequate information. It is a reflection of the failure of the system,” she said, adding that while the pills are not dangerous, a lack of information is. “Women are accessing what they think is effective and easy. The onus is on the public health system to offer facilities women find accessible and easy,” she added.
Unintended pregnancies
An evident, unmet need of contraception is the key reason for unintended pregnancies, many of which result in abortions. The Lancet paper stated that half of the 48.1 million pregnancies of 2015 were unintended. “Unintended pregnancies are a strong indicator of the need for improvements in contraceptive services,” the paper stated, adding that the unmet need for contraception among married women in India was 13%. An additional 6% of married women used traditional methods of contraception with relatively high failure rates. Other factors that might contribute to both an unintended pregnancy and abortion include contraceptive failure from incorrect and inconsistent use, sexual activity among unmarried women, and, a woman’s and couples strength of resolve to have small families.
“One cannot ignore the fact that the burden of family planning continues to be on women. Unless this mindset changes, the figure of abortions will continue to remain high,” said Mumbai-based gynaecologist, Dr. Sudhir Naik.
In Mumbai, for example, 20,745 tubectomy procedures were carried out in 2016-17. Tubectomy is a surgical form of female sterilisation procedure. On the other hand, there were merely 736 NSV or non scalpel vasectomies (male sterilisation procedure) carried out during the same period, even though NSV is a simple suture-less procedure. “We are a long way from reaching the masses and generating the kind of awareness required on the ground level,” added Dr. Naik.
jyoti.s@thehindu.co.in
