Over-regulation of drugs to curb gender-biased sex selection such as through government programmes like ‘Beti Bachao, Beti Padhao’ has hindered access to safe, legal and cost-effective abortion, according to a survey across six States which found an “overwhelming shortage” of abortion pills or medical abortion drugs.
A study conducted among 1,500 chemists in six States by Foundation for Reproductive Health Services India (FRHSI) indicated a severe shortage of medical abortion (MA) drugs in five out of the six States surveyed, with abysmal stocking in Madhya Pradesh (6.5%), Punjab (1%), Tamil Nadu (2%), Haryana (2%) and Delhi (34%). The only State that seemed to be better was Assam (69.6%).
The findings show that State-wise regulatory and legal barriers are the key reasons why 79% of the chemists surveyed refrained from stocking these drugs. As many as 54.8% of chemists also reported that medical abortion drugs were over-regulated as compared to other prescription drugs.
“The regulatory hurdles are due to a misunderstanding that easy availability of medical abortion drugs will be misused for sex selection. But this drug is approved for use only up to nine weeks, whereas an ultrasound can detect a foetus only at around 13-14 weeks. Moreover, these abortions are allowed under the Medical Termination Act. The law on abortions allows termination of pregnancy in the first nine weeks and in some cases even in the second trimester, such as in sexual assault cases as well as due to foetal anomalies,” Mr. V.S. Chandrashekar, chief executive officer, FRHSI and Pratigya Campaign Advisory Group member told The Hindu in a telephonic interview.
Abortion pills are different from emergency contraceptive pills. The latter are taken 72 hours after unprotected sex to prevent an unintended pregnancy. Whereas abortion pills or MA drugs are abortafacients which terminate a pregnancy by expelling an embryo or foetus.
Mr. Chandrashekar adds that the regulatory crackdown has resulted in abortion services on the whole becoming inaccessible, especially those during the second trimester, but there is little ground for restricting MA drugs.
The lack of availability of MA drugs forces many women to seek a surgical abortion from a facility, reducing her choice. It will also reduce access to safe abortion and force them to seek services from unsafe providers as there are only 16,296 approved abortion facilities in the private sector in the country, whereas MA drugs can be provided by an obstetrician or a gynaecologist, who are estimated to number about 60,000-70,000, the study highlights.
A Lancet study on the incidence of abortion and pregnancy in 2015 estimated that 81% of abortions annually are medical abortions and nearly 90% of abortions are sought in the first trimester.
Moreover, MA drugs are also cost-effective. The cost of first trimester surgical abortion varies from ₹2,000-5,000 in Tier 2 and Tier 3 towns and smaller nursing homes or clinics. In these towns, the cost of abortion pills plus the consultation fee is in the range of ₹700-1,000.
During COVID-19, the lack of access to abortion services is likely to have worsened as not only travelling to a surgical facility is challenging, but the cost of such a procedure may have gone up as clinics charge for PPE (personal protection equipment) and require a mandatory COVID-19 test.