Let’s Talk About: Getting an Abortion in India

Abortion is a powerful emblem of female liberation: it symbolizes the right to exercise bodily autonomy and to reject the confines of the childbearing role. Every woman, transgender, and gender-diverse individual deserves unrestricted access to safe abortion. And nowhere is this more true than in India, where 15.6 million (156 lakh) abortions take place every year.

Because of the pandemic, however, thousands of Indian clinics have been closed or out of stock of abortion pills. Desperate individuals who urgently need care have been forced to either carry to term or turn to unsafe abortions. By one estimate, 1.85 million women were not able to terminate their unwanted pregnancy during the lockdown. Now, more than ever, the need for prioritizing reproductive healthcare is critical.

In light of this current situation as well as the recent 2020 amendments to abortion legislation, we’re diving deeper into the details of getting an abortion in India, including laws, barriers to accessibility, and scope for improvement.

What does the law say about abortion?

The Medical Termination of Pregnancy (MTP) Act of 1971 was the original piece of abortion legislation, which legalized abortion up to 20 weeks for women under certain conditions and only with at least one doctor’s approval. In January of 2020, however, the law was revised and expanded to meet a wider scope of needs. Here’s a breakdown of the strengths and criticisms of India’s abortion law, in its current form:

The Good

• Gestation limit expanded from 20 to 24 weeks for pregnancies resulting from sexual violence
• No abortion limit in the case of fetal abnormalities
• Privacy of the name and particulars of a person undergoing an abortion
• Only the abortion-seeker needs to consent (consent of partners or parents is not required)
• Abortion is available to “any woman or her partner”, an inclusive language change from the previous “any married woman or her husband”

The Bad

• Strips abortion-seekers of autonomy — the final power to approve or deny an abortion still lies with the medical provider, not the seeker themselves
• Not inclusive enough — bill only mentions “women”, excluding transgender and gender-diverse individuals
• Gestation limit is still too short — many survivors of sexual violence need abortions post 24 weeks

This law still has a very long way to go, clearly. But it is an important step forward, expanding its protection of fundamental reproductive rights. In theory, any person seeking an abortion within the first 6 months of their pregnancy should be able to obtain one.

In practice, however? Not exactly.

What are the barriers to accessing safe abortion?

This is the final, most important place where the law falls short: it fails to address the systematic obstacles in public healthcare faced especially by underprivileged individuals. One study found that 56% of abortion-related deaths were due to a lack of access to appropriate healthcare services, and this risk was higher for rural women. Here are just a handful of issues that abortion-seekers may face in India:

Lack of Providers

Most primary and community health centers don’t provide abortion services, due to a shortage of trained staff and inadequate supplies. As a result, the vast majority (78%) of abortions happen through taking abortion pills at home, often without a prescription or medical supervision. Mid-level providers that are more accessible to rural folks, such as nurses and midwives, aren’t trained on medical abortions and can’t be there to assist in case of complications. The current provider base is too limited and inaccessible to ensure safety to those who need it most.

Lack of Information

Self-medicated abortion can be safe and effective — provided there is accurate information and awareness about how to go about it, and emergency care available if needed. “Women are taking abortion drugs by themselves without understanding the dosage, procedure,” says Dr Alok Banerjee, an advisor at the reproductive health NGO Parivar Seva Sanstha. “Then they are coming to us with incomplete abortions, with a dead fetus inside.”

Cost

Both the direct (e.g. medication) and indirect (e.g. transportation) costs of abortion can pose serious barriers to underprivileged individuals. According to these women, the entire abortion process drained their wallet of Rs. 10,000. Shortage of public health services leads abortion-seekers to the private sector, where costs are higher and non-standardized — unmarried, younger women are frequently charged more.

Procedural Bottlenecks

Consider this 28-year old woman who sought an abortion from her district hospital, but got turned away because she didn’t have a valid proof of ID. She turned to an unqualified doctor who gave her abortion pills, and as a result ended up in the hospital with low blood pressure and profuse vaginal bleeding. Bureaucratic requirements like ID cards can significantly hamper access to getting ultrasounds and abortion services.

Stigma

Although unmarried individuals have the legal right to abortion, they are frequently turned away due to doctors’ discriminatory attitudes. Women are often denied services if they come alone, without a husband or male partner. A husband’s signature may even be required to approve the abortion, despite what the law says (which raises the next problem).

Lack of Awareness About Legality

All the laws in the world about abortion are useless if the citizens aren’t aware of them. A 2012 survey conducted in Jharkhand showed that 95% of women, married and unmarried, were unaware that abortion is generally legal. This may be due to the intense national scrutiny of sex-selective abortion (which is very much illegal, and rightly so), giving the impression that all abortion is banned. As a result, when abortion-seekers are turned away unfairly by doctors, they may not even be able to argue for their rights under the law.

What are the solutions?

Ameliorating the current situation involves strengthening public healthcare infrastructure, expanding the provider base, and raising awareness. Proposed solutions include:

• Training and certifying mid-level providers like Ayurvedic and homeopathic doctors, nurses, and midwives on administering abortion services
• Educating communities on contraception methods and safe medical abortion
• Tightening regulations on drug sellers and chemists selling abortion medication, to ensure quality and safety
• Changing legislation to remove the gestation limit, include non-cis women, and empower abortion-seekers to obtain abortions on their own terms
• Increasing access to telemedicine providers who can guide or supervise medical abortion without compromising pandemic safety

A safe abortion is a human right. Although India has made immense progress over the years, it can and should strive to do far better to guarantee its citizens the reproductive health and freedom they deserve.

This article was written by Rithana Srikanth.