A study reveals that the main reasons for the more than 50 abortions being performed daily in Delhi’s Government hospitals are — enough children, unplanned pregnancy, contraceptive failure and previous child being very young. SANGEETA YADAV speaks with doctors and activists who say that lack of awareness regarding contraceptives, poor sex education among teenagers, under-age marriages, rape and sex-selective abortions are leading to the rise in India’s abortion rate
- RTI activist Rajhans Bansal’s report says that more than 50 abortions are performed in Delhi’s Government hospitals daily. Around 88,188 abortions were performed in Government hospitals over the last four years. As many as 40,238 foetuses were aborted in Delhi’s hospitals from 2008 to 2009, but that number dropped drastically the following year to 13,850. By 2011-2012, it rose to 19,000. Nationally, India has been reporting over six lakh abortions every year for the past 12 years.
- In Mumbai, a shocking report by the Bombay Municipal Corporation revealed that out of 30,000 women who underwent abortions in 2013-14, more than 100 were younger than 15 years. Another 900 women were in the 16 to 19 age-group. From 2012-13, 4,167 abortions happened before 12 weeks and 237 after 12 weeks in Government hospitals whereas 20,970 abortions happened in private clinics.
- A study reviewing the demographic profile and assessing the concurrent contraceptive acceptance in women seeking medical termination of pregnancy, published in the Indian Journal of Public Health in 2009, revealed that 15,726 women came for induced abortion between1995 and 2007 at AIIMS alone out of which 63 per cent were between 25-29 years, 99.1 per cent were married and 72 per cent were with three or more living children.
- A majority of married (92.5 per cent) and 12 per cent unmarried women reported in the first trimester of pregnancy. Nearly 40 per cent were not using any contraception at the time of conception and only 4.2 per cent used oral pills or intrauterine contraceptive devices. The main reasons for seeking abortion were, enough children (56 per cent), unplanned pregnancy (14 per cent), contraceptive failure (10 per cent), previous child very young (7.5 per cent) and others (12.5 per cent).
Fifty legal abortions daily in Delhi’s Government hospitals might sound like an alarmingly high figure. But for Dr Jaydeep Tank, programme director and board member of ProFert IVF Fertility Clinic, this rise in abortion rates is not surprising as it was legalised way back in 1971 and took an amendment in 2002.
What, he feels, is really surprising and also alarming is the fact that “one of the biggest reasons for abortions in our country is failure of contraceptives and their unmet need in rural India”.
In metros, where men and women are educated, safeguarding against various sexual related diseases, not wanting a baby yet (in case the couple is married) and being sexually active means that use of pills and condoms is pretty common. But these are not foolproof. Cases of being ‘knocked up’ because the condom burst or the pill didn’t work are a dime a dozen. In such a situation, abortion becomes the recourse.
“Contraceptives pills and condoms have high risk of failure. There are many woman who have contraceptive pills and feel tension free about not getting pregnant. But at times, it fails and turns into a nightmare. Defective condoms also lead to unwanted pregnancies. In such cases, women have no option but to opt for a medical termination of pregnancy within the 20 weeks of conceiving. No contraceptive guarantees pregnancy prevention and you can’t completely rely on them. They are the main culprits triggering unwanted pregnancies and rising abortion rates,” Vinoj Manning, country head, Ipas, tells you.
As per statistics, as many as three million contraceptive users worldwide experience accidental pregnancy annually due to a failed device, says World Health Organisation’s Safe Abortion Report of 2012. The global data collected by WHO in 2007 says that out of 37,806 women who opt for the periodic abstinence birth control method which is avoiding sexual intercourse from days 10 to 17 of the menstrual cycle (the most fertile phase), around 9,452 had accidental pregnancy. This method records a 25 per cent failure rate whereas barrier method of birth control is the second most failed method recording a 20 per cent failure chance. Out of the 2,291 users of this method, 458 ended up with accidental pregnancy that year.
In India, the more modern birth control measures like copper-T Intra Uterine Devices (IUD) technology find few takers. According to the recent Mumbai’s Family Welfare Bureau report, even though the IUD procedures have jumped by 12.29 per cent and reached an all-time high of 4.1 lakh cases this year, a large number of population still opts for pills and condoms which don’t come with 100 per cent guarantee.
Though the awareness about the use of contraceptives among the urban population and its availability in cities is well organised, in rural areas, the situation is quite the opposite. It’s the lack of awareness about contraceptives and their unmet needs in the region which is giving rise to unplanned pregnancy and hence abortions. Around 30 per cent of the women have no access to contraceptives, to avoid unwanted pregnancy.
Apart from the contraceptive failure and its unmet need in the rural areas, there are other reason that contributes to the rising number of abortions in India.
“I have seen cases where the couple coming from a financially low background is not ready to have another child. Some give the reason that they already have too many children or want a gap in the between the two child. A woman experiencing health problems during pregnancy; old age pregnancy, extra marital conception or rape pregnancies are all conditions leading to unwanted pregnancies,” Dr Tank says.
A common reason for abortions in rural India is under-age marriage and early pregnancy.
“Under-age marriage and early pregnancy are very prevalent in rural India. The girls have no option but to conceive which not only adds to the rising population but also contributes to several abortions. Moreover, women are not aware about contraceptives,” Dr Suneeta Mittal, director and HOD of obstetrics and gynaecology at the Fortis Memorial Research Institute in New Delhi, tells you. She adds that in such a situation, unsafe abortions can’t be ruled out.
“The abortion mortality rate is high. Before the MTP Act of 1971 came in, a lot of dangerous tools were used by doctors in abortions procedures — sticks, harmful chemicals etc. In 2002, out of the total mortality rate only 12 per cent mortality happened due to abortions through surgeries. With the 2002 amendment in the MTP Act, the medical abortion (termination of pregnancy through pills) and other advanced techniques were introduced for the first time in India which reduced complications and brought in a fall in the mortality rate. In 2008, the abortion mortality rate came down to 8 per cent. But we still need more legal hospitals in rural areas to keep a check on illegal sex selection abortions and ensure safe abortions,” Dr Mittal says.
While under-age marriages are a major contributor to abortions in rural India, it is teenage pregnancies that are stalking cities and adding to the rising number of abortions. Pregnancy due to sexual violence is another big reason for termination of unwanted pregnancy.
“In rape cases, if the girl gets pregnant and if she is a minor, she has to seek permission from court for an abortion as it becomes a legal case. First, she has to face the trauma of being raped and then the test which is been done by doctors. Moreover, if no immediate preventive medication for abortion is given, then the risk becomes higher. It’s extremely important that girls who want to terminate pregnancy seek it as soon as possible. The more they delay, the higher the risk and complications would be,” Mittal says.
When it comes to teenage pregnancies, sex education plays an important role but in India, many parents and teachers is still hesitant to hold talk session on this topic with the child.
“Lack of proper guidance and poor sex education is another reason for rise in abortion rates in India among teenagers. Though sex education has become mandatory in all Government, public and private schools, it has not been well taught to the children. The teenage pregnancy rate have come down from last year but still it’s extremely important to teach children at an early age, before they suffer for the lifetime. We want TV talk shows and Government awareness programmes through the newspapers and advertisements to tackle this problem. Also State Government should keep a check on illegal abortions happening in clinics,” Chetan Kothari, a Mumbai-based RTI activist says.
But then, a major issue with teenage abortions is the conflict of MTP Act with the Protection of Children from Sexual Offences Act (POCSO) Act.
“If a teenage girl gets pregnant due to consensual sex with her boyfriend or because she has been raped, the MTP Act has a special provision to allow the abortion but only in the presence of her guardian, not necessarily her parents. The MTP Act also assures confidentiality to the patient. But here, the MTP Act contradicts with the POCSO Act which says that if a girl below the age of 18 gets pregnant, it will be considered rape and if she comes to a doctor for abortion, he must inform the police. In such cases, it becomes very difficult for her to get an abortion. She is left with no option but to go for an abortion illegally and by paying a lot of money. The POCSO Act needs additional provisions on consensual sex and child abuse,” Manning says.
The MTP Act says that the abortion has to be done within 12 weeks to 20 weeks of the pregnancy, and by a registered medical practitioner. If the doctor finds a risk to the mother because of pregnancy, an abortion is allowed within a 20-week stipulation. The conflict arises when the complications to the mother or the foetus surface after 20 weeks. In such a case, even if the pre-conception and pre-natal diagnostic test shows abnormality, the law doesn’t allow abortion post the 20th week.
Take the case of Niketa Mehta. In the 24th week of her pregnancy, it was found that her foetus had a congenital heart block and would be born with handicaps. She moved the court seeking permission to abort. On August 4, 2013, the Bombay High Court turned down the couple’s plea as law disallows abortion of a foetus which is over 20 weeks old. In her 27th week, she had a miscarriage due to trauma lasting several weeks.
“After Mehta’s case, a change is being sought by many doctors. MTP experts are seeking a raise in the abortion time limit to beyond 20 weeks. If the doctors detect some health complications to the foetus or a disability and mental complications, they should be allowed to abort. Otherwise, it becomes very traumatic for the mother and the child as it happened in the case of Ireland’s Savita Halappanavar. The Irish Government refused to grant her permission to abort (abortion is illegal in Ireland) after the foetus was diagnosed with deformities. It put both the mother and the child at risk — they both died,” Manning says.
In any case, doctors tell you that an abortion, for any reason, is dangerous and therefore, it’s very important for the woman to be aware about its complications and take a call without any pressure.
“Abortion is dangerous because it can affect the health of the woman and can lead to infertility. Sometimes, the infection can spread to the stomach and the uterus gets ruptured. Patients are not aware about these fallouts. So even though abortion may be the only solution in many cases, it is a decision that needs to be taken with utmost care,” Dr Shobha Gupta, gynaecologist and Infertility Specialist from Mother’s Lap IVF Centre, says.
(The article appeared in The Pioneer Newspaper – http://www.dailypioneer.com/sunday-edition/sunday-pioneer/investigation/babydoomrising-abortions.html).