By Souvik Pyne:
Abortion is a word that holds the massive weight of social pressure. Many people also believe that abortion in India is illegal. However, under the Medical Termination of Pregnancy Act, 1971 (MTP), abortion services can be availed. But despite their being a law in place, it hasn’t been easy for abortion-seekers to access safe and legal abortion services due to the taboo around it.
Safe abortion to terminate an unwanted pregnancy is an important reproductive health need for individuals seeking it of all ages, educational levels, racial and ethnic groups, social and economic classes and religions. The need to make safe abortion services available has also been upheld in many international platforms and intergovernmental agreements on sexual and reproductive health and rights (SRHR).
The International Conference on Population and Development (ICPD) held in Cairo, 1994, explicitly addressed abortion in its Programme of Action paragraph 8.25, “In circumstances where abortion is not against the law, such abortion should be safe. In all cases, women should have access to quality services for the management of complications arising from abortion. Post-abortion counselling, education and family planning services should be offered promptly, which will also help to avoid repeat abortions” (Shah et al., 2014).
To aid implementation of the Programme of Action under the ICPD, some key actions were decided upon in the UN General Assembly, 1999 stating “In recognizing and implementing the above, and in circumstances where abortion is not against the law, health systems should train and equip health-service providers and should take other measures to ensure that such abortion is safe and accessible. Additional measures should be taken to safeguard women’s health” (paragraph 63iii) (Shalev, 2000).
Moreover, the UN Sustainable Development Goals (SDGs) is another framework where every country is committed to achieve goals under them. Availability of and access to safe abortion services are integral components of SRH services which ensures fulfilment of SRHR and thus indispensable in order for the SDG promise of ‘leaving no one behind’ to be fulfilled. Target 3.7 focuses on ensuring universal access to sexual and reproductive health (SRH) services, while target 5.6 focuses on ensuring universal access to SRHR as agreed in accordance with global platforms such as the Programme of Action of the ICPD and the Beijing Platform for Action and the outcome documents of their review conferences.
Since this year is the 25th anniversary of the ICPD, it’s worthwhile to reflect on the extent to which these commitments have been fulfilled.
Despite India having a relatively liberal law around abortion since 1971, the availability and access to abortion still remains a major challenge. There is a ‘prevalence paradox’ phenomenon around abortion which leads to general perception that abortion is a rare and exceptional pregnancy outcome (Kumar and Hessini, 2009).
While growing up, and even in medical colleges, we read about the reproductive system and the usual outcome of childbirth in our textbooks. However, the reality is different and abortion as an outcome is very common. According to recent estimates, in 2015, out of 48.1 million pregnancies in India, 15.6 million (33%) ended in induced abortion, that is outcome of every third pregnancy in the country ends in an abortion (Singh et al, 2018).
But are they all safe? Not quite. Even today, approximately 8% of maternal deaths in the country is due to unsafe abortions which translates into a woman dying every two hours in India and many suffering from serious morbidities due to unsafe abortion practices.
All of these are preventable.
Prevalent myths and misconceptions in the society around abortion especially around it’s legal, medical and public health aspects pose a great information access barrier. Added to that is the unavailability of services, gatekeeping at health facilities and judgmental attitudes of health providers making access even more difficult. Negative narratives and portrayal around abortion in media influences public discourse which perpetuates abortion stigma. Conflation of sex determination with abortion services has furthered the stigma.
In order to address these issues comprehensively, we need to undertake a multi-pronged approach. There needs to be initiatives undertaken by appropriate government departments and other stakeholders which actively attempts to dispel myths and misconceptions around abortion. Messaging around abortion needs to be sensitive.
There are multiple resources which lays down simple guidelines. For example, IPPF’s Abortion Messaging Guide. Health systems need to adhere to internationally accepted guidelines like theWHO’s Safe Abortion Guidance. Availability of safe abortion services needs to be expanded (at least following FOGSI’s recommendation of 1 facility per 20,000 population) and adequate popularising of the same through dedicated campaigns is essential. MMA pills (Mifepristone and Misoprostol) needs to be in the Essential Drugs List for all levels – tertiary, secondary, primary. Since none of the contraceptives are 100% efficacious, information around the provision of safe abortion needs to feature in all contraceptive related counseling.
Viewed from a human rights perspective, access to safe abortion services comes under the ambit of right to healthcare as upheld in Article 12 of International Covenant on Economic, Social and Cultural Rights. The United Nations Human Rights Council has established links between gender equality and availability of reproductive services including abortion. Thus, poor availability of and access to a certain medical service needed only by women and persons assigned gender female at birth also amounts to breach of rights of non-discrimination and equality.
Therefore, it is the duty of the State to upscale efforts to implement Comprehensive Abortion Care (CAC) services in health facilities more efficiently and destigmatize abortion. Moreover, there is a pressing need to sensitise the health providers on safe abortion from a rights and gender perspective rather than a medical service to be delivered at the whims of the health provider.
“Safe and Legal: Busting Myths and Claiming Rights Around Access to Abortion” will host a gallery of personal narratives, where crowd-sourced artwork and stories on abortion will be displayed in addition to facts around the issue. Submissions can be in the form of text, videos, audio, and pictures. If you would like to make a submission to be displayed in the gallery, please fill this form, latest by September 22, 2019. This will be a public event held in New Delhi, and the audience will be people from TYPF’s network as well as young people interested in the topic and the general public at the venue.