More than four decades after India legalised abortion, a woman dies of abortion related causes every two hours and unsafe abortions contribute to eight per cent of the total maternal mortality and lead to very high rates of morbidity.

Two-thirds of abortions in the country are still unsafe and young women and girls are disproportionately affected. Most women do not know that abortion is legal and to make the things worse, ad hoc responses to sex selection have affected women’s access to safe and legal abortion.

The challenge for Indian women seeking safe abortion services even today is significantly high ranging from ignorance to lack of accessibility and affordability. A majority of women also seek abortion primarily because of lack of access to contraception, reiterating the need for better access to safe abortion services.

Discussing these issues threadbare at a national consultation on ‘Beyond 40 Years of Legal Abortion in India’ organised by Ipas, an international non-governmental organisation working on access to safe abortion and rights of women, in collaboration with the Union Ministry of Health and Family Planning, stakeholders gave a clarion call for amending the Medical Termination of Pregnancy Act, 1971, to expand the safe abortion services by allowing midlevel healthcare workers and practitioners of indigenous systems of medicine (AYUSH) to perform the procedure.

Importantly, it was sought to sensitise implementing officials at all levels to distinctions between the Pre-Conception and Pre-Natal Diagnostic Test and the Medical Termination of Pregnancy Acts such that enforcement of one does not compromise on the other.

There was a unanimous demand to empower nurses to play an active role in abortion care in addition to strengthening pre-service and in-service training for safe abortion and certification of skills across all cadres of providers. Enabling young people to exercise their reproductive rights by integrating comprehensive sexuality education into school curricula and school based reproductive rights programmes and increasing awareness of legal abortion through a comprehensive communication strategy were other highlights of the commitment.

Emphasising on the urgent need for reviewing the legislations around access to safe abortion in India, Anuradha Gupta, Mission Director, National Rural Health Mission, said it was important to facilitate the relevant amendments to make space for task shifting to ensure utilisation of the skills of the AYUSH doctors as well as nurses to bring safe and legal abortion services available to women.

There is a need for promoting medical methods of abortion across the public and private health system as a means to strengthen women’s autonomy and decision making in choice of technology and the need for widespread awareness campaigns to increase awareness about safe and legal abortion in India, Shireen J. Jeejebhoy of Population Council said.