Lancet- Rules push women to unsafe abortion options


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MUMBAI: A paper published in Lancet medical journal last May had shown that criminalizing abortion does not prevent it but rather pushes women towards unsafe options. Several studies have estimated that of 6.5 million abortions that take place in India annually, a staggering 57% could be unsafe.

The highlight of the paper, based on figures from the US-based Guttmacher Institute and the World Health Organisation (WHO), was that abortion rates in developed countries fell significantly from 46 per 1,000 in 1990-94 to 27 in 2010-14. Developing nations, however, only registered a 2-point fall. Some 25% of 56.3 million pregnancies ended in abortion in 2010-14.

Interestingly, the study also showed that abortion rates were not very different in countries where it was completely illegal (37 per 1,000 women) to where it was available on request (34), suggesting that criminalizing abortions was detrimental to women’s health. Globally, 73% of abortions were obtained by married women compared with 27% by unmarried women in 2010-14.

“Around 8% of maternal deaths in India are attributable to unsafe abortions. There are two main reasons behind unsafe abortions in the country— one is the MTP law itself that has a stringent cut-off time and the another is lack of qualified obstetricians and gynaecologists in rural parts of the country,” said Dr Vinoj Manning, country director of Ipas, a non-profit body that works towards women’s reproductive rights.

In 1971, when the MTP Act was passed, medically induced abortions were unheard of. In this non-surgical approach, a pill or an injection is used to induce labour and deliver the foetus. “Today, it is the most preferred and the safest method, yet women have to go to quacks because the law itself is a hurdle. No qualified gynaecologist would perform an abortion after 20 weeks even if the reasons are compelling,” said a senior gynaecologist from a public hospital. A woman in India dies every two hours due to unsafe abortions. The doctor said it only pointed towards a grave unmet need for contraception and access to safe abortion.

The medical fraternity believes there is an urgent need to amend the Medical Termination of Pregnancy Act, 1971, which restricts a woman from terminating pregnancy after 20 weeks. The proposed law that changes this and allows women the right to abort till 24 weeks in exceptional situations is awaiting Parliament’s approval for nearly two years.

Gynaecologist Dr Nikhil Datar said morbidities related to unsafe abortions is a serious area that is seldom talked about. Gynaecologist Dr Sangeeta Pikale said unsafe abortions could be curbed by picking foetal anomalies within the 20-week deadline if women undergo tests on time, in good centres.

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