Abortion data in India is a curious case. Even as the Central Health Management and Information System of the National Rural Health Mission (NRHM) recorded 11.06 lakh abortions in India in 2008-09, there is no official data available on unsafe abortions in the country. This, when the Registrar General of India — Sample Registration System (RGI-SRS) — estimates that 8 per cent of maternal deaths in India are attributed to abortions — a majority of these to unsafe procedures.
An analysis of the official data on abortions suggests that the quality of data on comprehensive abortion care for most States is poor, with incomplete reporting on most indicators.
The utilisation of services in both certified public and private sector facilities is very low, with second trimester service delivery being abysmal.
While the District Level Committees (DLCs) — to be established for certification of private and NGO sector facilities to provide quality services, following amendments in the Medical Termination of Pregnancy (MTP) Act in 2002 — have been constituted in many States, they are ineffective. The result is the lack of certified public and private facilities that pushes women into seeking unsafe procedures performed by untrained personnel.
Andaman and Nicobar, Dadra and Nagar Haveli, Himachal Pradesh, Jammu and Kashmir, and Sikkim are yet to constitute DLCs — well over a decade after the MTP Act was amended.
Uttar Pradesh has established 75 committees, Madhya Pradesh 48, Bihar 38, and Rajasthan 34, but most remain defunct.
Even where data is provided as per the amended law, it just gives numbers of terminations and not the reason behind them or any complications associated with them.
A look at the government facilities offering MTP services suggests Andaman and Nicobar Islands do not have abortion facilities for a 20-week-old foetus, though 27 public facilities provide abortion facilities for up to 12-week-old foetus. Similarly, Andhra Pradesh has no public health facilities where a 20-week-old foetus can be aborted; whereas, in comparison, Maharashtra has 634 such facilities, with only 211 providing abortion facilities for a 12-week-old foetus. Maharashtra and Madhya Pradesh are the only two States where second trimester facilities are more than those for the first trimester.
Again, Maharashtra has the largest number of certified private facilities offering MTP services, followed by Gujarat, Uttar Pradesh and Karnataka. Very few claim to offer MTP for a 20-week-old foetus, which is often associated with sex-selective abortion.
Admitting that there was lack of awareness among the people about the legal status of abortion in India, Anuradha Gupta, Mission Director, NRHM, says India has one of the most progressive abortion laws in the world which permit the termination of pregnancy even in the case of a failed contraceptive. “But most people believe abortion is illegal and do not approach public health facilities for the procedure.
Our awareness programme has been relatively weak in this sector but we are now ready with a strategy to educate people on the need for approaching a certified health facility for quality services as it involved woman’s health,” she explains. The Ministry will shortly launch an information, education and communication campaign on abortion.
As of now, the government supplies pregnancy testing kits free of cost to women through Accredited Social Health Activists under the NRHM and even contraceptives for accidental pregnancies.
Health activists and gynaecologists have been demanding more amendments to the MTP Act to permit trained non-MBBS graduates and mid-level healthcare providers like Auxiliary Nurse Midwives (ANMs) and nurses to perform abortions so that these facilities are accessible and confidentiality is maintained.
“Our estimation based on the sale of drugs suggests over 10 million abortions are performed in India annually. These are reported cases, but the number of procedures performed outside of certified facilities is much more,” says Nozier Sheriar, secretary general of the Federation of Obstetric and Gynaecological Societies of India.
“There may not be any mala fide intention for non-reporting but the registration system is so complicated and difficult. Even the DLCs which were constituted to simplify the procedure are highly bureaucratic,” Dr. Sheriar told The Hindu .
Appreciating the government for including abortion under the NRHM umbrella, Dr. Sheriar says that unfortunately the States have not followed it up properly during the implementation process. “It remains an unfinished business.”
Claiming that only 15 per cent of women actually misuse the law for sex-selective abortions, Dr. Sheriar says stringent laws to prevent selective abortions were depriving 85 per cent of women, including unmarried women and adolescents, who actually need this facility .
“We need to give a woman a choice to plan her family and if she is unable to prevent a pregnancy, she needs to be given a second choice by way of safe abortion,” Dr. Sheriar says.