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Abortion in India is legal, but very difficult

The Times of India logo The Times of India 26-06-2022 Ketaki Desai
© Provided by The Times of India

The story was first published on May 21, 2021

One night, Jasmine, who runs a chatline focused on sexual and reproductive health, found her phone pinging with frantic messages from a young woman who had taken over the counter medication to induce an abortion. She had started bleeding and was convinced she was going to die. The young woman began to send her photos. “This is all happening in real-time. Even for our counsellors who have received extensive training, looking at those kinds of pictures can be very challenging,” says Jasmine. “Luckily, she ended up okay.”

Abortion rights have hit the headlines with the US Supreme Court reportedly ready to strike down Roe v Wade. India’s abortion law, the Medical Termination of Pregnancy (MTP) Act, 1971, is quite progressive in comparison but that doesn’t mean access to abortions is easy, say those like Jasmine who work in the sector.

Many women think it’s illegalOne of the major roadblocks is that women are not aware of the law.

Alka Barua, a public health expert who handles the safe abortion theme at CommonHealth, an organisation working on abortion advocacy, says that they have seen over and over again that women think abortions are illegal.

DIY route difficultThough many women prefer medical abortions (MA), the pills can be hard to access. A 2020 Foundation for Reproductive Health Services study looking into the availability of these drugs in six states found that only 20% of chemists store MA drugs. In Punjab, only 1% of stores had them while Tamil Nadu and Haryana were only marginally better. The reasons for this include the heavy documentation requirements and supply issues.

Debanjana Choudhuri, gender specialist and safe abortion advocate, says many pharmacists sell these drugs at exorbitant prices over the counter, despite them being Schedule H (available at chemists with prescriptions). “Sales have gone underground and the price has skyrocketed from Rs 200 to as high as Rs 1,000 or 2,000,” says Choudhuri.

Shortage of OB-GYNSThere simply are not enough doctors in the country to perform abortions. There is a 70% shortfall of ob-gyns in rural India, according to the Rural Health Statistics data from 2019-2020. Legally, only ob-gyns and those who have received specific training under ob-gyns are allowed to perform the procedure, says Barua.

Plus, Jasmine, who runs the chatline startup called Vipasyin as well as the non-profit Hidden Pockets Collective which focuses on educating people about abortions and their rights in smaller towns, says many doctors are unwilling to perform abortions. “We see this problem a lot in the northeast because it is heavily Christian. In Jammu as well, barely any doctors are willing to perform abortions,” she says. Because of this, many young women turn to quacks.

The Covid of it allThe pandemic has only worsened abortion access, says Barua of CommonHealth, which conducted a study to understand the extent of the problem. An ASHA worker in Punjab told them, “During the initial two-three months of lockdown, women were going to chemists, quacks or trying some home remedies. They tried to approach ASHA and ANM but we could not help much as we were doing other duties.” Reena (name changed) had to travel 45 km to access abortion services at the FRHS clinic in Bareilly. A mother of three, her socio-economic condition did not allow for another pregnancy. “Owing to the lockdown nothing was available, private clinics were also closed. As soon as we were informed of FRHS India clinic, my husband and I drove to Bareilly on a two-wheeler.” FRHS saw several cases of women travelling long distances, one even travelled 250km, to access an abortion.

Legal roadblocksSneha Mukherjee, an advocate with the Human Rights Law Network who has worked on several abortion-related cases, says the 2021 amendment may seem more progressive — it increased access to people who are 24 weeks pregnant and added a confidentiality clause — but it actually adds more roadblocks.

“They have instituted a medical board which decides if a woman should be allowed to get MTP after 20 weeks. There is already a shortage of doctors, and the government now has to set up medical boards at the tertiary level. In Delhi, the only medical board is in AIIMS. So, you can imagine the situation in states like UP and MP, where people will have to travel long distances to access a medical board,” she says.

“And what if they are not given permission? Members of the board will have the same societal biases as everyone else,” she adds.

She gives the example of a recent case she worked on, which was referred to her by AIIMS. The woman was from a lower-middle class family and was 26 weeks pregnant. The medical board’s report found that the foetus had a cardiac abnormality, yet did not allow the abortion.

“The report said the child would require multiple surgeries from infancy to adulthood, and if those are successful, it would have a 80% chance of a normal life with regular check-ups,” she says. Even though the child’s life was contingent on successful surgeries, which are also very expensive, the abortion was disallowed. Eventually, they went to court and the judge allowed the abortion. “But how many people can afford to go to court?”

Plus, the law doesn’t use gender-neutral language, which becomes just another hurdle for pregnant people who are not women – trans men and non-binary people, for instance. “If there are 10 barriers for a woman, there are at least 15 for trans people,” says Choudhuri.

Additionally, the relationship between MTP and other laws complicates matters even further. Choudhuri says, “POCSO is a great law, but it mandates mandatory reporting when anyone under 18 comes for an abortion.” This only reduces the likelihood of adolescents going for safe abortions, she points out.

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