There is a significant decrease in access to abortion drugs since the middle of 2012 following the 2011 Census results that created a nationwide alarm by revealing the worst-ever child sex ratio.
Unsafe abortion is the third leading cause of maternal deaths in India, contributing to eight per cent of all maternal deaths annually — morbidity attributable to unsafe abortions is much more.
Experts believe the Census results seem to have put pressure on policymakers and implementing authorities to address the problem of gender biased sex selection by curtailing availability of abortion services, particularly in the second trimester when the sex of the foetus can be known. Some State and district authorities have intensified enforcement and regulation of abortion providers and chemists, resulting in shortage of drugs and services which has adversely impacted women who need an abortion.
Medical experts and health activists say there is a need to reverse this trend and make these drugs available to access to safe and legal abortion services for women who need them, and also to prevent them from resorting to illegal and life-threatening sources of abortion.
“Our ability to offer safe abortion drugs has been severely compromised due to difficulty in procuring medical abortion drugs, both as an institutional buyer and women not being able to purchase the drugs even with prescriptions,” according to Kalpana Apte, assistant secretary general (Programmes), Family Planning Association of India (FPAI).
The FPAI has over 40 clinics across the country providing safe abortion services. “The problem is made more acute because most government facilities across States are not offering medical abortion services because procurement process for medical abortion drugs are not in place despite funds allocated for the same in the annual plans under the National Rural Health Mission,” Dr. Apte told The Hindu.
It is estimated that 6.4 million abortions take place in India each year. Half of these are unsafe — performed in unhygienic conditions by untrained providers. More than 80 per cent of women in the country still do not know that abortion is legal and available. The latest World Health Organisation guidelines on “Safe abortion: technical and policy guidance for health systems” recommend the use of mifepristone and misoprostol safely for up to 12 weeks.
In a survey done in Maharashtra by the India chapter of Ipas, an international non-profit organisation working for safe abortions, Mifepristone and misoprostol were available in only 10 per cent of the chemist shops in Maharashtra while none of the chemists in Mumbai stocked the drugs. Selling abortion drugs requires a chemist to keep the details of the woman seeking such drugs along with a copy of the prescription. The process is cumbersome and even a minor error may make them liable for prosecution and harassment from enforcement agencies. Thirty two per cent of the chemist shops reported never stocking these drugs and 58 per cent of the chemists interviewed reported that they had stopped stocking medical abortion drugs in the recent past. Most said that increased burden of documentation for dispensing these drugs (91 per cent) and threats from drug inspectors or some authority (56 per cent) against stocking was the reason behind their decision not to keep these drugs.
A multi-city study was conducted across 238 chemist shops in eight cities of Maharashtra exactly a year ago. Data was collected by an independent agency to assess retail stock of selected schedule-H drugs, mainly mifepristone and misoprostol. Chemist shops were chosen using cluster sampling with a focus on those located near hospitals, and nursing homes.
“The alarming trend of chemists having stopped stocking abortion drugs found in the Ipas study is not an isolated phenomenon. We are hearing reports of medical abortions drugs unavailability in other States like Madhya Pradesh and Rajasthan also where the drug enforcement specifically targeted to medical abortion drugs has been at a heightened level post the 2011 Census,” Ipas country director Vinoj Manning said.
