Delhi: Healthcare is rarely a part of vote-seeking rhetoric in India, and women’s health never is.
Patriarchal communities are wont to deify women who suffer in silence, ostracise those who want equal rights, and ignore those who are sick, even when medical treatment is available free. As a result, women in many parts of India are still encouraged to seek medical treatment only to deliver a healthy baby, preferably a boy.

Women are denied sex education in school and information about contraceptives and abortion services out of it, which result in millions of unintended pregnancies every year. Close to half (48%) of all pregnancies in the country are unintended largely because women, both married and unmarried, have no information about safe sex or don’t have access to contraceptives, according to India’s first large-scale study on abortions and unintended pregnancies study published in The Lancet in 2017.

Two in three (67%) abortions in nine of India’s northern and eastern states that account for half the country’s population are unsafe, with young women between the ages of 15 and 19 years most likely to die from complications, according to a study of 1.87 million pregnant women published in BMJ Global Health this week.

Poverty, gaps in health services, and teen pregnancy are the leading causes of unsafe abortions usually performed by unskilled persons in unregistered places, found the study, which used data from India’s Annual Health Survey (2010-13) for the states of Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttar Pradesh, Uttarakhand and Assam.

India’s Medical Termination of Pregnancy (MTP) Act, 1971, makes it legal to abort a foetus up to 20 weeks of pregnancy if there is a risk to the woman’s life or her physical or mental health, or if there is substantial risk of the child being born with physical or mental abnormalities. Pregnancies caused by rape or contraceptive failure are considered a threat to a pregnant woman’s mental health. Section 5 of the MTP Act additionally allows abortion beyond 20 weeks if it’s posing an immediate threat to a pregnant woman’s life.

One in three of 48.1 million annual pregnancies in India end in an abortion, with 15.6 million abortions taking place in 2015. The numbers are huge and despite abortion up to 20 weeks being legal for close to half a century, many women don’t know that abortion is legal, with knowledge ranging between 36% in Bihar, and 12% among Jharkhand youth between ages 15-24, show two different studies published in 2012-13. This results in an estimated 800,000 women undergoing unsafe abortions by using traditional methods to abort the unwanted foetus, or going to untrained pharmacists, chemists and informal vendors for services.

Under the MTP Act, surgical abortions can be done only by trained, certified doctors in registered clinics and hospitals, while abortion pills — combinations of mifepristone and misoprostol — can be prescribed to abort foetuses up to seven weeks old outside registered centres. Around 12.7 million (81%) of all abortions in India are medical abortions, and 2.2 million are surgical terminations of pregnancy, found The Lancet study.

Training village-level healthworkers (auxiliary nurse midwives, ANMs), nurses and Ayush practitioners to prescribe simple abortion pills in the early stages of pregnancy and make refer complicated cases to hospitals can help reach millions of women. Better regulating the healthcare sector to provide quality services to all, including contraceptives, safe delivery and abortions, irrespective of age or gender will ensure women and, by extension, future generations, don’t suffer avoidable complications of something as natural as a pregnancy.