Indian Government declared abortion as an essential health service on April 14, 2020. The country was under lockdown during this period. It bought relief to a few women who were in urgent need of the facilities. But one can only wish things were this simple. IPAS development foundation is a Non-Profit Organization working to manage unwanted pregnancies in India. It’s report suggests that 73% of abortions that take place in India annually are done via medical abortion (MA) drugs.
The access is then outside of facilities. Private health facilities deal with 16 percent of the cases. Whereas, another 6 percent gets covered by public health facilities. The traditional methods of the usage of sticks, roots, and herbal medicines are further considered unsafe.
These methods are still put up for the remaining 5 percent of abortions. The current pandemic is choking India’s health system. Report also suggests that many several private health facilities have temporarily shut down. Either due to unavailability of staff or proper protective equipment or both. This had led to derailing of supply chains of MA drugs.
There is a restriction on access of public transport due to the lockdown. These aspects coupled with the stigma around abortion one realizes that on-ground reality is different.
The Impact of Covid-19
The above mentioned report also indicated that access to 1.85 million abortions may have been further compromised. These are results of the above mentioned problems only from March to June. These are almost 50 percent of the number of abortions that would have taken place in this period otherwise. The consequences may result in a large number of unwanted pregnancies. Unsafe abortions that can also result in maternal deaths.
An extra 834,042 unsafe abortions and 1,743 maternal deaths are in estimation by the pandemic according to report by Foundation for Reproductive Health Services India. The price of abortion services at private facilities is to shoot up. Reasons not only include higher demand but also costs of additional protective gears. This makes it more difficult for economically underprivileged women.
There are higher chances that women will now have to undergo surgical procedure instead of drug induced MA. Since drug induced MA are permissible only up to nine weeks of pregnancy. Few will have to undergo for second trimester abortions (12 weeks onward). These are difficult to execute as the law mandates that two doctors, as opposed to one, sign their approval for the procedure.
The Law on Abortion
Abortion has been legal in India since 1971. It was with the introduction of Medical Termination of Pregnancy Act. According to the law, a pregnancy termination in the notice of registration medical practitioner (RMP) is important, if continuance of the same would cause grave injury to the physical or mental health of the woman. Termination by RMP is possible if there is great risk that the child would be born with severe physical or mental abnormalities.
The authorization of one doctor is enough when the pregnancy is up to 12 weeks. But when it is between 12-20 weeks two doctors are to grant authorization. The amendment bill reads a termination of pregnancy within 20 weeks with the approval of one doctor. And abortions between 20-24 weeks will need two doctors to sanction the procedure. This would have made abortions of pregnancies up to six months legal for specific categories of women. By replacing “married woman or her husband” with “woman or her partner” the bill expands the provision to unmarried couples.
India’s Laws on Abortion
In India there can be no discussion on this aspect of abortion without seeing it along with female infanticide. India has the Pre-Conception and Pre-Natal Diagnostic Techniques Act (PC&PNDT Act). It bans the use of sex-selection techniques before or after conception. All ultrasound scanning machines as well as laboratories received regulations. Registration of Genetic clinics is a need and doctors are to further report all prenatal tests. On April 2020, considering the Covid-19 emergency, a central government order relaxed some strict reporting provisions under the Act.
The same is applicable until June 30, 2020. While record needs maintenance the submission is, of the same, relaxed. A petition was filed challenging the government’s order notification that suspended Rule 8.9 (8) and 18A (6) of the PNDT Act, 1994. The petitioner contended that relaxation of rules may lead to free use of sex selection tests.
But, on June 15, the Court refused to intervene and adjourned the case until the third week of July. If the notification extends beyond June 30 the petitioner can return to the Court. The Medical Termination of Pregnancy (Amendment) Bill, 2020, was going to change it. The Parliament looked into it this March. Unfortunately, coronavirus interrupted parliamentary affairs too.
Way Forward
MA drugs are the need of the hour. State drug controllers should ensure their availability at pharmacies, as suggested in FRHS India’s report. Abortion facilities are further located in the urban parts of India. Hence, it becomes important for the government and health facilities need to ensure that accurate information about available services reaches every woman who may need access to same. It becomes especially vital for women residing in rural areas so she can make decisions and receive medical care on time.
France, Ireland and the United Kingdom relaxed the laws to permit abortions at home via telemedicine. It refers to medication obtained through a prescription and medical guidance from a doctor over the phone or online. On switching to regular routine the health system needs to be further prepared for increase in demand. Especially for second trimester abortions.
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