Safe And Legal Abortion: Conceive Choice, Terminate Myths

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.

The YP Foundation, in its effort to promote access to stigma-free information around SRHR for young people, is hosting an event to commemorate International Safe Abortion Day on September 28.

“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.

Featured image for representative purpose only.
Featured image source: REUTERS/Anindito Mukherjee.
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An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

Read more about his campaign.

Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

Read more about her campaign.

MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Read more about her campaign. 

A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Find out more about the campaign here.

A native of Bhagalpur district – Bihar, Shalini Jha believes in equal rights for all genders and wants to work for a gender-equal and just society. In the past she’s had a year-long association as a community leader with Haiyya: Organise for Action’s Health Over Stigma campaign. She’s pursuing a Master’s in Literature with Ambedkar University, Delhi and as an MHM Fellow with YKA, recently launched ‘Project अल्हड़ (Alharh)’.

She says, “Bihar is ranked the lowest in India’s SDG Index 2019 for India. Hygienic and comfortable menstruation is a basic human right and sustainable development cannot be ensured if menstruators are deprived of their basic rights.” Project अल्हड़ (Alharh) aims to create a robust sensitised community in Bhagalpur to collectively spread awareness, break the taboo, debunk myths and initiate fearless conversations around menstruation. The campaign aims to reach at least 6000 adolescent girls from government and private schools in Baghalpur district in 2020.

Read more about the campaign here.

A psychologist and co-founder of a mental health NGO called Customize Cognition, Ritika forayed into the space of menstrual health and hygiene, sexual and reproductive healthcare and rights and gender equality as an MHM Fellow with YKA. She says, “The experience of working on MHM/SRHR and gender equality has been an enriching and eye-opening experience. I have learned what’s beneath the surface of the issue, be it awareness, lack of resources or disregard for trans men, who also menstruate.”

The Transmen-ses campaign aims to tackle the issue of silence and disregard for trans men’s menstruation needs, by mobilising gender sensitive health professionals and gender neutral restrooms in Lucknow.

Read more about the campaign here.

A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

A Gender Rights Activist working with the tribal and marginalized communities in india, Srilekha is a PhD scholar working on understanding body and sexuality among tribal girls, to fill the gaps in research around indigenous women and their stories. Srilekha has worked extensively at the grassroots level with community based organisations, through several advocacy initiatives around Gender, Mental Health, Menstrual Hygiene and Sexual and Reproductive Health Rights (SRHR) for the indigenous in Jharkhand, over the last 6 years.

Srilekha has also contributed to sustainable livelihood projects and legal aid programs for survivors of sex trafficking. She has been conducting research based programs on maternal health, mental health, gender based violence, sex and sexuality. Her interest lies in conducting workshops for young people on life skills, feminism, gender and sexuality, trauma, resilience and interpersonal relationships.

A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform Change.org, demanding that the Government of Assam install
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on Change.org has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in Change.org’s flagship program ‘She Creates Change’ having run successful online advocacy
campaigns, which were widely recognised. Through the #BleedwithDignity campaign; she organised and celebrated World Menstrual Hygiene Day, 2019 in Guwahati, Assam by hosting a wall mural by collaborating with local organisations. The initiative was widely covered by national and local media, and the mural was later inaugurated by the event’s chief guest Commissioner of Guwahati Municipal Corporation (GMC) Debeswar Malakar, IAS.

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