Induced abortion doubles in Maharashtra post-1995
Rita Dutta, Mumbai
It’s the flip side of improved accessibility to Medical Termination of Pregnancy (MTP) centres. From 2 induced abortions per 100 pregnancy outcomes during 1976-1995 to 4.5 induced abortions per 100 pregnancy outcomes in the period 1996-2000, induced abortions in Maharashtra have more than doubled.
The finding has been reported by a state-wide study covering 5,405 households, (distribution of rural-urban ratio being 3:2) recently conducted by the Centre for Enquiry into Health and Allied Themes (Cehat). This is the first household-based abortion study as compared to the earlier hospital-based study focusing on abortion-related mortality and morbidity.
The study recorded a 1.3 times higher induced abortion rate than the second NFHS and 1.8 times higher rate than RCH study.
Apart from the accessibility of MTP centres, the rise in figures in induced abortion is an indication of the failure of contraceptive methods, birth spacing and sterilisation and improved accessibility of sonography centres and its consequent increase in sex-selective abortions, say experts.
In the case of induced abortion, both rate and ratio is about 4.5 times higher in urban areas, indicative of better access of abortion services in urban areas, according to the study. The rate and ratio of induced abortion is double in Mumbai than the rest of the urban areas, due to the contraceptive use levels in Mumbai (as revealed by NFHS-2) being lower than rest of the state.
Expressing concern, Dr Suvarna Khadilkar, associate professor of obstetrics and gynaecology, J J hospital says, “Induced abortion has become synonymous with family planning.” According to a recent study conducted at JJ hospital, covering 200 women between 20 and 30 years of age, who had undergone induced abortion at the hospital, it was found out that 82 per cent did not use contraceptive methods because of myths and fear of side effects.
Similarly, efforts made by the Mumbai Obstetrics and Gynaecological Society (MOGS) in educating 5,000 students of various colleges in contraceptive methods in 2002 revealed insufficient knowledge of contraception. “Their knowledge of contraception was restricted to condoms, while pills were considered to be ‘bad’ and they were vague about birth spacing and withdrawal,” said Dr Duru Shah, immediate past president of MOGS.
However, Dr Usha Saraiya, immediate past president of Federation of Obstetrics and Gynaecological Society of India (FOGSI), sees more reasons to cheer than panic about the spate in induced abortions. “Induced abortions are better than criminal abortions. Earlier women who had undergone abortion would abort without informing their family members also about it. But as stigma associated with this is on the decline, and accessibility of the MTP centres has improved, it’s but natural that induced abortion would increase.”
It is interesting to note that while spontaneous abortion shot up from 4.2 to 7 per cent in urban areas during 1986-91, in rural areas it witnessed an increase from 3.8 to only 4.1 per cent. This is indicative of a significant proportion of induced abortions being misreported as spontaneous abortions in urban areas, the study states.
According to Dr Bipin Pandit, president, Association of Medical Consultants (AMC), “Though the medical intervention for spontaneous and induced abortions are the same, patients of spontaneous abortions enjoy the privilege of having a leave of 45 days and Mediclaim facility, which is not provided for induced abortions. Besides, while a centre has to be registered under the MTP Act for conducting induced abortion, no such certification is required for spontaneous abortion. This is the primary reason for induced abortions being misreported as spontaneous abortions.”
The study shockingly reveals that only 15 per cent abortions are within the defined framework of the MTP Act. “This is a pointer towards the liberal approach in the implementation of the Act, despite restrictive provisions within the MTP Act. No heed is being paid to the PNDT Act which prohibits sex-selective abortions,” opines Ravi Duggal, co-ordinator, Cehat.
The study further reveals post-abortion complications are higher for spontaneous abortions than induced abortions. “This is mainly because of the popular perception that spontaneous abortions are natural events and does not require medical attention,” says Dr Shah. The treatment not taken category for spontaneous abortions is an alarming 44 per cent amongst the lower strata of society. Induced abortions have lower complications because they are voluntary acts where consciousness about medical care is higher, adds Dr Shah.
And it’s the husband and/or some relative who have the final say on decision-making about abortion. The woman is unlikely to decide on her own in most cases, the study states.
With large dependence on private abortion services and care, the out-of-pocket burden on households is staggering. The 87 per cent private abortion market costs 7.5 times higher than the public sector abortion services. Interestingly, rural areas spend more than urban areas because of high access costs.