Access to Safe Abortion

The Medical Termination of Pregnancy (MTP) Act, 1971 aims to provide safe and accessible abortion services for women seeking to terminate an unintended pregnancy up to 20 weeks gestation. This can be done only with the opinion of a registered medical practitioner in case where the pregnancy hampers the physical and mental health of a woman or the fetus or pregnancy has been caused by rape or contraceptive failure. In 2002, an amendment was made in the MTP Act resulting in approval of medical abortion with Mifepristone and Misoprostol medicines for termination up to 7 weeks gestation.

Despite India’s commitment to recognizing abortion as a legal right of women, the incidence of unsafe abortion remains quite high in India. Unsafe abortions generally take place outside medical facilities and are carried out by unregistered medical practitioners, traditional and local health providers without any medical training and women themselves, by taking wrong pills or incorrect dosage of the drugs. Such practices can lead to severe complications such as sepsis, hemorrhage, infection and genital trauma in the long term.

As per a Lancet Report on the incidence of abortion in India, there were about 15.6 million abortions in the year 2015, of which 0.8 million took place in unsafe circumstances outside registered health facilities or without the appropriate medication. According to the report, unintended pregnancies occurred at a rate of 70.1 per 1000 women in the age 15-49 years in 2015, accounting for about half of all pregnancies (144.7 pregnancies per 1000 women aged 15- 49 years). The high number of unintended pregnancies could be attributed to high incidence of unmet need for contraceptive among women, resulting in women opting for abortion.

Most women in India seek abortion services as a means to limit their family size. According to a study by International Centre for Research on Women (2003) in Madhya Pradesh, 59% of women surveyed had an abortion because they did not want any more children and 22% revealed having an abortion as means of spacing between two children. Socio-cultural factors such as Stigma related with abortion and less control of women over their reproductive choices due to patriarchal mindset of partners are some other factors which contribute to restricted access to safe abortion services in India.

To improve access to safe abortion services, a draft amendment bill to the MTP Act, 2014 has been proposed by Ministry of Health and Family Welfare which allows abortion between 20 and 24 weeks if the pregnancy involves risk to the mother and/or child or has been caused by rape. While increasing the time limit is in line with the technological advancements and would give the couple adequate time to decide in case of fetal abnormalities, it can also lead to an increase in the sex selective abortions in the country.

The provision of safe abortion services is a key commitment of the National Population Policy 2000. The Government must ensure that steps taken to address sex selection should not restrain women’s access to safe abortion care provided under the MTP Act. Additionally, the government must invest in behavior change communication and advocacy strategies which should aim at empowering the women to seek safe health care services.