At Safdarjung Hospital in New Delhi, the majority of gynaecology emergencies fall into two categories — women in labour pain and women bleeding profusely due to incomplete medical abortions.
“Every night, almost two women turn up hanging between life and death, bleeding heavily or suffering from infection because of an attempt to abort a pregnancy gone wrong,” says Sarita Devi, a nurse at Safdarjung Hospital. “They all narrate the same tale. They bought and used an MTP (medical termination of pregnancy) kit from the local drug store.”
Safdurjung Hospital, which has a blood bank and allied facilities, is equipped to treat these women immediately and save their lives, but those who undergo abortion without medical supervision in remote parts of the country are not so fortunate.
It is estimated that every hour two women die in India due to unsafe abortions and many are maimed or injured. No survey has been done to find out the exact number. The above estimate was made by Ipas India, an NGO that has been campaigning for safe abortions.
Dr Neelam Singh, a gynaecologist and secretary of Lucknow-based non-profit Vatsalaya, has spent more than a decade studying the issue of unsafe and sex-selective abortions in remote rural regions. She believes that the estimate is just the tip of the iceberg. “Abortion pills (MTP kits) are on open sale and quacks, midwives and nurses perform abortions across the country, but there is no medical infrastructure and expertise necessary to save a woman’s life if something goes wrong,” she says.
She says that abortion is an invasive procedure in which one wrong move can lead to bleeding or infection or perforate the uterus, leading to death if medical attention is not immediately provided. Rural healthcare centres are not always equipped with blood banks and the necessary infrastructure needed to save the life of a woman.
Death And The Maiden
Last November, 15 women bled to death at a sterilisation camp in Chhattisgarh. This camp was planned, funded and run by the government. In India, neither are sterilisation camps uncommon nor are sterilisation related deaths, but the tragedy drew attention to national policies that disregard women’s health and well-being.
India has one of the lowest sex ratios in the world — 94 women survive for every 100 men, says the 2011 Census. UN statistics show that an Indian girl aged 1-5 years is 75 percent more likely to die than a boy — a rate worse than any other country.
Politicians and the media alike have pointed fingers at the cultural preference for sons and medically unsupervised child-bearing, ignoring the lack of adequate policies, insufficient spending and unexecuted laws.
According to the preliminary report of the government-appointed High- Level Committee on the Status of Women, “Broadly girls and women continue to be disadvantaged at different stages in the life cycle… Women and girls from poor, vulnerable and marginalised communities continue to suffer from high levels of malnutrition, infection, mortality and morbidities at various life stages and face huge barriers in accessing timely and affordable health services.”
The report also mentions that every fifth woman who dies due to maternal causes is an Indian; more than one in three women have chronic energy deficiency; undernutrition is increasing among women of child-bearing age and prevalence of mental disorders is higher among women.
In a five-part series, Tehelka will highlight five reasons why women die in India. The experiences of these women along with data, budget and legal analysis will show that women’s health remains an untended concern.
Passed in 1971, the Medical Termination of Pregnancy Act made abortions legal in India. It was amended in 2002 to approve medical abortion, which depends on medicines — alternative to surgical procedures to terminate an early pregnancy — in order to expand women’s access to safe and effective abortion.
However, this increased reach of abortion pills, in other words, the MTP kits, was not followed up with the infrastructure to manage complications with emergency back-up facilities. Many studies and media reports on abortion pills have shown that chemists, unaware of the protocol and side effects, sell the drug without prescriptions in violation of the Act.
In a petition filed at the Chhattisgarh High Court last summer, the National Alliance for Maternal Health and Human Rights conducted field visits and used RTI to disclose that district-level committees for the implementation, monitoring and review of the MTP Act had not been formed or were not functioning in the state.
The petition stated that until 2011, not a paisa had been allocated for the provision of MTP services at health facilities in Chhattisgarh. It showed that providing MTP services to women is not a priority for the state, which has effectively denied women access to a critical healthcare service recognised by law.
The petition also showed the example of the Balod district hospital, which did not have the provision for a blood bank or a blood storage unit and therefore could not save the lives of women suffering from bleeding due to unsafe or incomplete abortions.
Apart from the non-availability of safe abortion services, there are many reasons why women prefer quacks or midwives for an abortion, says health worker Sanjai Sharma, who signed the petition. The primary reason is the stigma associated with pregnancies outside marriage.
“The absence of safe abortion services at public health facilities means a thriving business for quacks, nurses and midwives,” says Pune-based lawyer-activist Varsha Deshpande, who has filed cases against private clinics in Maharashtra for conducting illegal sex-selective abortions. “Chemists and drug companies profit from the rampant sale of MTP kits, risking the lives of women.”
In a petition filed at the Supreme Court last year, the New Delhi-based Human Rights Law Network had argued that the non-availability of safe abortion services was not only a direct violation of the MTP Act but also of the Indian Constitution and international human rights.
“The lack of access to maternal healthcare exposes gender discrimination, which is a clear violation of the right to life of the women and an offence to human dignity,” the petition stated. In April 2014, the Supreme Court ordered the Union government to examine the violation of abortion-related fundamental rights.
In the past few years, the Human Rights Law Network, the Federation of Obstetric and Gynaecological Societies of India and the National Commission for Women have called for amendments to the MTP Act.
Last year, the Ministry of Health and Family Welfare proposed a new Bill to enable increased access to safe abortion services. However, the Medical Termination of Pregnancy (Amendment) Bill, 2014, has further diluted the medical safety accorded by the earlier Act by saying that abortions can be performed not only by allopathic doctors but also by ayurveda, unani and homoeopathy practitioners, as well as nurses.
The proposal has met with criticism from doctors and civil society members on the grounds that it would further risk the lives of women. In a letter to the health ministry, the Association of Medical Consultants noted that the amendment will further risk the life of a woman by allowing unqualified doctors to perform abortion.
The proposed Bill has also increased the abortion limit from the current 20 weeks to 24. According to lawyer-activist Deshpande, allowing nurses, unani and ayurveda practitioners to abort third trimester foetuses would lead to increased sex-selective abortions. “The only positive aspect of the new legislation is that it allows unmarried women to get abortion legally,” she adds.
The proposed Bill is silent on other crucial needs such as creating widespread awareness on abortion, creating public health services and making them available and, most importantly, starting a campaign to de-stigmatise abortions.