Despite its liberal law on abortion, unsafe abortion practice is the third largest cause of maternal mortality in India, says Ipas CEO
India needs to be applauded for its liberal law on abortion, one of the oldest among the developing countries, but there are barriers of affordability, accessibility and information which need to be removed, says Liz Maguire, president and CEO, Ipas, an international organisation working for safe abortions.
The Medical Termination of Pregnancy Act, 1971, allows safe abortion care to be made available in the public sector if two gynaecologists certify the requirement or there is a contraceptive failure. “However, only laws are not enough. These need to be backed up by affordable and accessible services,” Ms. Maguire told The Hindu during her visit to India to celebrate 40 years of Ipas in India.
Pointing out that a woman died in India every two hours due to unsafe abortion, she said it was unfortunate that despite the law, such deaths were happening. She said that the trend suggested that there was a need to educate people that abortion was legal in India and also a need to create a cadre for mid-level healthcare service providers trained in conducting abortions and giving contraception advice.
Citing the example of Nepal, Ms. Maguire said it legalised abortion just a decade ago and had managed to cut down maternal mortality by 50 per cent in such a short time span. Nepal has safe abortion care facilities in every district and the programme is being successfully implemented by trained community healthcare workers who educate people on the importance of safe abortion and the choice of contraceptive methods.
On the link between a liberal abortion regime and sex selective abortion, Ms. Maguire claimed only two to four per cent women indulged in sex selective abortions — though it still meant a huge number — and enforcing stringent anti-abortion programmes meant the rest of the women who needed or genuinely wanted such facilities were being deprived of them. “Poor and disadvantaged women are the doubly jeopardised women who cannot afford safe abortion in the private sector. Sex selection needs to be addressed and one needs to find a fine balance between the two,” she explained.
Importantly, Ms. Maguire said both men and women need to know that abortion in India is legal and they should know where to access it, if they need such facilities. “All forms of mass media and communications should be used to create awareness about the issue which will also help in eliminating stigma around abortion.”
Of the 40 million abortions across the world every year, 21 million are said to be unsafe accounting for the death of 47,000 women and between eight to ten million suffer lifelong injuries. India alone reports over six million abortions annually. While there is no data on the number of unsafe abortions but it is the third largest cause of maternal mortality.
Studies done by Ipas-India in Madhya Pradesh suggest that only 12 per cent of the people knew that abortion was legal in India and only two per cent were aware it could be done up to 20 weeks. In Jharkhand, only one per cent of youth (both men and women) knew abortion was legal.
Suggesting inclusion of safe abortions in the millennium development goals (MDGs), Ms. Maguire said, “We want to see a world where women have availability of safe abortion. Women should have a right to decide in case of an unwanted pregnancy.”
Ipas is an international non-profit organisation with a mission to reduce maternal deaths and injuries due to unsafe abortion and to increase women’s ability to exercise their sexual and reproductive rights with a special focus on the right to safe abortion. It works in 25 countries across the world.