Abortion in India

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Abortion in India has been legal since 1971.

Contents
[hide]

• 1 Legal status
• 2 Sex-selective abortion
• 3 Indications for early medical abortion
o 3.1 General condition to be fulfilled
o 3.2 Choice between Medical and Surgical Abortion
• 4 Contraindications for medical abortion
o 4.1 Contraindications due to Medical Reasons
o 4.2 Psycho-social situations
• 5 References

• 6 External links

[edit] Legal status

As per India’s abortion laws only qualified doctors, under stipulated conditions, can perform
abortion on a woman in an approved clinic or hospital. The Indian abortion laws fall under
the Medical Termination of Pregnancy (MTP) Act, which was enacted by the Indian
Parliament in the year 1971. The MTP Act came into effect from April 1, 1972 and was once
amended in 1975. The Medical Termination of Pregnancy (MTP) Act of India clearly states
the conditions under which a pregnancy can be ended or aborted, the persons who are
qualified to conduct the abortion and the place of implementation.[1]

[edit] Sex-selective abortion

Giving or taking prenatal tests, including ultrasound scanning, solely to determine the sex of
the fetus was criminalized by Indian law in 1994. In 2002, the penalties were stiffened: up to
three years in jail and a Rs. 10,000 fine for the first offense and five years imprisonment and
Rs. 50,000 for the second.

According to the Consortium on National Consensus for Medical Abortion in India, every
year an average of about 11 million abortions take place annually and around 20,000 women
die every year due to abortion related complications.[2] Most abortion-related maternal deaths
are attributable to illegal abortions.[3] In the following table Number of abortions reported
includes legal reported induced abortions.[4]

Year 1972 1975 1980 1985 1990 1995 2000

Number of abortions
24300 214197 388405 583704 581215 570914 723142
reported

[edit] Indications for early medical abortion

[edit] General condition to be fulfilled

All women coming to a health facility seeking termination of pregnancy up to 7 weeks period
of gestation (49 days from the first day of the last menstrual period in women with regular
cycle of 28 days) provided the following aspects have been assessed and found appropriate:[5]

• frame of the mind of patient and her acceptability of minimum three follow-up visits
• ready for surgical procedure if failure or excessive bleeding occurs
• family support
• permission of guardian in case of minor as per MTP Act 1971
• easy access to appropriate health care facility

Only registered medical practitioners as prescribed by the MTP Act are authorized to
prescribe mifepristone with misoprostol for medical abortion (Definition 2(d) of section 2 and
MTP rule 3). Mifepristone with misoprostol for termination of early pregnancy not exceeding
seven weeks, may be prescribed by a registered medical practitioner as prescribed under
section 2 (d) and rule 3, having access to a place approved by the Government under section
4 (b) and rule (1), for surgical and emergency back-up when such a back-up is indicated. This
may include primary health care-clinic or hospital-based set-up. Initial workup, counseling,
prescription and administration could be in a clinic or in the consulting room. Home
administration of misoprostol may be advised at discretion in certain cases with an access to
24-hours emergency services.

[edit] Choice between Medical and Surgical Abortion

• Vacuum Aspiration (Suction evacuation) is the most commonly-used method for

termination of early pregnancies. However, being a surgical technique, it is associated
with risks of infection, perforation of uterus, incomplete abortion and post-procedure
uterine synechiae formation (Asherman's Syndrome).
• The success of abortion with drugs depends on multiple factors including the regimen
used,dosage schedule, route of administration and gestational age.
• Mifepristone with misoprostol is favourable if pregnancy is = 7 weeks.
• Surgical abortion is preferred if patient desires concurrent tubal ligation.
• If a woman fulfills the criteria for selecting either method, final choice to be given to
the woman.

'it is legalized in India.

[edit] Contraindications for medical abortion

For cases in which a pregnant woman has a serious medical disease and continuation of
pregnancy could endanger her life, the Indian MTP act lays a clear guideline under which
medical abortion is contraindicated.
[edit] Contraindications due to Medical Reasons

• smoking > 35 years

• anemia – hemoglobin < 8 gm %
• suspected /confirmed ectopic pregnancy / undiagnosed adnexal mass
• coagulopathy or women on anticoagulant therapy
• chronic adrenal failure or current use of systemic corticosteroids
• uncontrolled hypertension with BP >160/100mmHg
• cardio-vascular diseases such as angina, valvular disease, arrhythmia
• severe renal, liver or respiratory diseases
• glaucoma
• uncontrolled seizure disorder
• allergy or intolerance to mifepristone / misoprostol or other prostaglandins
• lack of access to 24-hours emergency services.

[edit] Psycho-social situations

These include the cases in which

• women unable to take responsibility

• anxious women wanting quick abortion
• language or comprehension barrier
• not willing for surgical abortion in case of failure

[edit] References
1. ^ "Medical Termination of Pregnancy, 1971". Medindia.com.
http://www.medindia.net/Indian_Health_Act/the-medical-termination-of-pregnancy-
act-1971-introduction.htm. Retrieved 2008-12-10.
2. ^ "Introduction". Consortium on National Consensus for Medical Abortion in
India.
http://www.aiims.edu/aiims/events/Gynaewebsite/ma_finalsite/introduction.html.
Retrieved 2008-12-03.
3. ^ "Current status of abortion in India". Consortium on National Consensus for
Medical Abortion in India.
http://www.aiims.ac.in/aiims/events/Gynaewebsite/ma_finalsite/report/1_1_1.htm.
Retrieved 2008-10-11.
4. ^ Historical abortion statistics, India Historical abortion statistics, India
5. ^ Guidelines for Medical Abortion in India

• Katz, Neil S. Abortion in India: Selecting by Gender. 20 May 2006. 1 Jan. [1]
• Abortion, Femail Infanticide. 3 Jan. 2003. 1 Jan. [2]

http://en.wikipedia.org/wiki/Abortion_in_India

Sarika Yadav
Enigma of being Indian Woman

“You can tell the condition of a nation by looking at the status of its women.”-

Pt Nehru

As we are celebrating our 60th Independence Day there is lot, to be proud of in the last years.
India has metamorphosed itself from being a poor 3rd world country into a strong contender
for the tag of next super power in the coming years. More recently we got our 1st woman
president Mrs. Pratibha Patil - 40 years after we have had our 1st woman prime minister. It
won’t be wrong to say, we still have a woman pseudo prime minister in Sonia Gandhi…with
due respect to Dr. Manmohan Singh. Even the most advanced western nations can not boast
of such statistic. But before being over enthusiastic about the whole thing let me ask a very
simple question…is India really such a safe haven for women growth and development? Do
these success stories reflect the ground realities of an ordinary woman? Let me through some
data …

“A rape occur every 34 minutes. Every 42 minutes an incident of sexual harassment takes
place, every 43 minutes a women is kidnapped, every 93 minutes a women is killed...”.
Aren’t these figures just staggering? The Crime against women continues unabated. Absolute
number for crime against women went up from 1, 28,320 in Year 2000 to 1, 43,615 in 2004.

According to British journal The Lancet more than 10 million girls in

India have gone missing due to sex selection and abortion in the last
one decade; this despite foetal sex selection of government having
banned in 1994. Who should own responsibility of these deaths?

If there is much to celebrate in the last 60 years; it’s also a story of

missed opportunities despite the legal frame work women are still
reined by rigid patriarchal society. They are still treated as second
class citizens. We might be food surplus country in the 21st century
nutritional stress is a rude reality, yet, 80% of women are suffering some or the other kind of
malnutrition. Maternal mortality rate in India is even higher than those of some sub-Saharan
countries at 407 per 100,000 live births; which is 92 for Sri-Lanka and 56 for China. What
kind of development we are talking about whose perks is not evenly divided between
different members of the society.

At the core of Indian national hood lies the commitment to freedom, equality and social
justice. The constitution is firmly grounded in the principle of liberty fraternity equality and
justice. It emphasizes the importance of greater freedom for all and contains number of
provisions for the empowerment of women. The principle of gender equality is enshrined in
the Indian constitution. It doesn’t only grants equality to women but also empowers states to
make positive discrimination- In favor of weaker sections of the society. So, we have the will,
we have the laws than what is lacking it’s the serious implementation, even after so many
years the message has not reached the masses. Discrimination is still rampant; every woman
in this country has right to dignified life, to realize their full potential; right to be protected
form major source of un-freedom –violence, discrimination, fear, injustice.

Every year we do abysmally low on Human Development Index in spite of having high GDP
growth rate. High growth has not succeeded in giving high standard of living to a majority of
the society and women make a big chunk of it, ultimately Human development boils down to
expanding people’s choice, enhancing their capabilities and promoting their freedoms.

It’s not, that there have been no women success stories in India.
There are lot of women who have done reasonably well in their
respective fields and have made country proud Kiran Mazumdar
Shaw, Indra Nooyi in business. Kiran Bedi in police, Mayawati in
politics Sania Mirza, Sania Nehwal in sports, Aruna Roy, Vandana
Shiva as civil right activist, just to name a few. But these success
stories are still few and far between. 24 million women in India are
illiterate largest in terms of numbers in a single country with sex ratio
of 933-1000 male worst in the world. Only 4.5% of women are
working, in the organized sector. We have to wake up to the genocide of unborn girl child
and the 3rd graded living conditions that most women are condemned to. In the words of
Nobel laureate Amartya Sen “India with its 1 billion plus population, has to account for some
25 million ‘missing women’.” Imagine how many Sanias and Kiran Bedis didn’t even see the
light of the day.

Gender equality is more than a goal in The need is for the stricter implementation of
itself. It is a precondition for meeting the laws for crime against women and educating
challenge of reducing poverty, women towards their rights. Better
promoting sustainable development and representation of women in the policy
building good governance. making bodies. Their representation in
Koffi Annan, Former Secretary General Indian parliament and state legislative is not
of UN more than 10%, though better representation
have been achieved at grass root, The 73rd
and 74th Amendments (1993) to the
Constitution of India have provided for reservation of seats in the local bodies of Panchayats
and Municipalities for women, laying a strong foundation for their participation in decision
making at the local levels. Through the experience of the Indian Panchayat Raj Institutions
(PRI) 1 million women have actively entered political life in India. It has guaranteed that all
local elected bodies reserve one-third of their seats for women. Contrary to fears that the
elected women would be rubber stamp leaders, the success stories that have arisen from PRI
are impressive. Women leaders in the Panchayati Raj are transforming local governance by
sensitizing the State to issues of poverty, inequality and gender injustice. Passing of women
reservation bill will certainly be a big positive step in the path of women empowerment.

(Sarika Yadav is a successful entrepreneur and woman activist based in Ghaziabad and has
interest on women development and feminist issues.)

http://www.ngoinsight.com/specialreport2.htm\
WALK ON THE WATER
Tuesday, May 25, 2010
Sex Selective Abortion

At Nalampalli village near Salem, India, a girl spoke of how her mother-in-law had just killed
her sister-in-law’s third daughter. “My husband’s mother wrapped the newborn girl in a wet
towel. She threw it on the ground and pushed it with her toe. ‘Who wants this?’ she said and
went out of the room. All of us stood there, afraid to pick the baby up. My sister-in-law, who
was weak after the delivery, just wept. A few hours later, the child died. They got a doctor’s
certificate to say it had pneumonia.” The year was 1999. They had discovered new and
‘better’ methods of killing since then.

A thousand miles away from the American continent, where abortion, sex selective or not, is

an issue that swings presidential elections, India stands out for its cold apathy towards a

problem it refuses to confront. Female infanticide, in the mind of the common man, is a

medieval malaise that has unfortunately persisted with the years. The Indian hasn't woken up

to the reality of how abortion, with its latest technology and decreasing costs, has increased

the number of "unborn girls"[1] in modern India. For that matter, even the larger issue of

abortion would still be taboo in most parts of India. The young Indian elitist, for all his

education, doesn't broach the topic, for fear of being type cast as anti liberal. The young

mother in poor rural India would only see it as innovative alternative to an otherwise painful

ordeal (that of killing the born girl child). Anyways, ethics and morality struggle to play even

second fiddle to the perennial Indian election issue, bijli, sadak, pani (electricity, roads, and

water). But when you have 500,000 infant girls[2] "disappear" mysteriously every year,

yielding a highly skewed male to female ratio, you cannot help but wonder that there’s

something wrong somewhere.

In India, Abortion was legalized in 1971, brought in as a measure to curb population growth.

But it has hardly done so, and has only compounded the problem of female infanticide vis á

vis sex selective abortions. The hard truth is that abortion in India has served as an easy way
to put to death unborn girls who are thought to be a burden to families that are part of a

highly patriarchal society. Girls are a burden, because they have to be married off with a

dowry, a practice that is highly prevalent to this day amongst the most educated of Indian

families. As a result, there are now 11 million[3] abortions performed in India every year,

lesser than the 13 million[4] in China, but overwhelmingly larger than the 820,151[5] in the

United States.

It is widely accepted the problem is both has both social and economic triggers to it. And

while both aspects have cures to it, there is no doubt that the legalization of abortion has

equipped female infanticide in India. Add to it the lack of regulation and the inherent

propensity of anyone to take advantage of poor India, and one will realize why it is almost

impossible to regulate abortion, whatever the motive.

Abortion may have valid justifications, but it just cannot continue to facilitate female

infanticide. The policy makers in India need to decide whether the freedom of choice is worth

more than the freedom of life for these girls. The government has to begin to look into

banning abortion as a way to curb female infanticide. Certainly, population control is

secondary to the lives of these female “fetuses”. And so is the prospect of gender imbalance.

India can thus no longer afford to ignore this issue.

[1] “unborn girls” - Arundhati Roy

[2] The Lancet – www.thelancet.com

[3] Consortium on National Consensus for Medical Abortion in India

[4] China Daily

820,151 - Number of legalized induced abortions in the US in 2005, Centre for Diseases
[5]
Control
bortions are a major cause of maternal morbidity and mortality in India. Estimated number of
abortions a woman will have throughout her reproductive years is 1 to 2.6. Estimated annual
number of induced abortions varies nationwide from 0.6 (GOI, 1991-92) to 6.7 million
(Chhabra and Nuna, 1994).

Table 1.1.1
Estimated annual number of induced abortions
nationwide

Source Induced abortions

(million)

Shah, 1966
3.9
IPPF, 1970
6.5
Goyal et al, 1976
4.6
ICMR, 1990 (based on 1988
1.9
estimates)
5.0
UNICEF, 1991
0.6
GOI, 1991-92
6.7
Chhabra and Nuna, 1994

The statistics of induced abortions in India is grossly inadequate as hospital records cover
only legal and reported abortions. NFHS surveys also underestimate the true levels. Indirect
estimates mainly depend on ratio of induced abortions to live-births, ill-timed and unwanted
pregnancies, age specific fertility rates and Bongaart’s proximate determinants of fertility.
The ratio of illegal to legal abortions varies from 2:1 (ICMR, 1983-84) to 10:1 (Khan et al,
1998). Maternal mortality attributable to abortions in India is 12-18% and is mostly
contributed by illegal abortions
nationwide.

Unsafe abortions are also an important cause of morbidity in the form of pelvic infections
including grade-III sepsis (with peritonitis, septicaemia, septic shock, acute renal failure and
DIC), incomplete abortion, haemorrhage and terine or cervical injury. Reliable data on
mortality are not available.

Table 1.1.2
Estimated annual number of induced abortions
nationwide

Maternal
deaths
Location Source
attributable to
abortion (%)

India, 1982-83 18.1 ICMR

India, Rural, 1989 10.8 Table 1.1.1 Office of
the
Registrar
 General,1991
Office of the registrar
India, Rural,1993 11.7
General,1993
ICMR Task Force,
India,1993-1994 12.6
1998
India,1994 12.6 GOI, 1998
Office of the Registrar
India,1991-1995 18.0
General, N.D.
The facilities for safe abortions fall short of the need
of abortion as reported MTPs are about 600,000 per
year but total induced abortions are estimated at
between 1.9 and 6.7 million. Under-reporting by
government and private institutions is a major
reason. In India, certified facilities for MTP have
increased from 1877 to 9271 between 1972 and
1993-94. States with the highest number of MTP
facilities per 100,000 population are Maharashtra,
Kerela, Gujarat, Haryana and Punjab. There is a
mismatch between availability of government-
equipped facilities, MTP-certified doctors and
facilities where services are available.

Regarding indirect estimates of abortions, a very high rate of induced abortions is seen in
Nagaland, Bihar, Meghalaya, Arunachal Pradesh, Uttar Pradesh, Orissa, Madhya Pradesh,
West Bengal, Assam and Tripura.

A variety of methods in use for MTP include D&C, Electronic Vacuum Aspiration (EVA)
and Manual Vacuum Aspiration (MVA) in first trimester, extraamniotic and intraamniotic
instillations and D&E in the second trimester. MTP training centers (teaching hospitals),
however, prefer EVA, D&C and induction methods and only 25% doctors are trained in
MVA (CORT, 1995-97). There is a large range of clandestine abortion-providers that vary in
the country from doctors (including those who are uncertified ‘safe illegal providers’) to
Ayurvedic practitioners, homeopaths, Auxillary Nurse Midwives (ANMs), nurses,
compounders, spouses or attendants, untrained practitioners, Traditional Birth Attendants
(TBAs), shopkeepers, etc.

Methods used by informal providers vary from tablets (ayurvedic preparations, papaya seeds,
chloroquin tablets, high-dose progesterone and highdose estrogen and progesterone)
injections (carboprost and ayurvedic preparations), surgical methods (D&C, catheters, intra-
amniotic saline or glycerine) to intravaginal sticks, roots, iodine-benzoin paste, decoctions
and massage, papaya and custard apple seeds etc.

Action Research and Training in Health (ARTH) is conducting a study of abortion services in
Rajasthan (2002) and has mapped all health- providers in 5 rural and 1 urban block of two
districts (Population 1,388,687). Out of a total 1746 providers, 78% were practising
paramedics and private unqualified persons, 5% Indian System of Medicine (ISM)
practitioners and 17% medical doctors. Population per provider was 4700 for doctors, 958 for
other categories, which are also better dispersed within rural interiors and urban slums.
Almost half (48%) of informal providers (all except medical doctors) provided abortion
services as treating delayed periods. Methods employed by informal providers ere tablets in
55%, injections in 36%, and massage/herbs in 5% as compared toinvasive methods in 4%.
Informal roviders seemed to prefer ‘medical methods’.

Most women who seek abortions are 20-35 years old, married with 3 or more children and
wish to limit their families and seek abortion services especially in the first trimester (ICMR
1989). Second trimester abortions represent 10-40% of all abortions (ICMR 1981) and are
more likely to be seen among adolescents and women seeking sex selective abortions. More
than 11% second trimester abortions have been reported in Rajasthan and Uttar Pradesh, 60%
in Orissa and 35% in Tamil Nadu.

Abortions among adolescents vary from 5.7% of all abortions in urban government hospital
settings to 27- 30% of all abortions in some clinics (Chhabra 1988, Solapurkar and Sangam,
1985) and 59-76% of abortions among unmarried adolescents are in second trimester
(Chhabra 1988; Aras, 1987). Abortions in adolescents are more likely to be performed by
untrained persons in unhygienic conditions and can contribute to 20% of all abortion-related
deaths among adolescents (GOI).

Safe abortion services in India remain inaccessible in rural areas despite MTP Act and Rules
because facility and provider requirements are restricted and geographical distribution of
facilities is skewed. Most private facilities exist in cities and most rural government facilities
do not provide abortion services.

Certified facilities have low caseloads due to lack of confidentiality, high costs, difficult
consent, and pressure to accept sterilization or IUD. Even at many government facilities,
services are not available due to lack of trained doctors, functional equipments, anaesthetists
and electricity (Barge et al, CORT 1998) and limited training capacity. There are limited
MTP training facilities with merely 166 MTP training institutions in 1994. Given such a
situation, where safe abortion services are not easily accessible, the problem of abortion is of
great magnitude and makes a major contribution to maternal deaths.

The question arises as to how best can medical methods be used to enhance access to safe
abortion in India.

http://aiims.aiims.ac.in/aiims/events/Gynaewebsite/ma_finalsite/report/1_1_1.htm