Updated Report: ABORTIONS IN INDIA 2021

 ABORTIONS IN INDIA

What is an Abortion?

An abortion is a medical means of ending a pregnancy. If an abortion takes place by itself, that is, naturally, it is called a miscarriage, also known as spontaneous abortion. Worldwide, around half of all reported unintended pregnancies end in abortion. Abortion is legal throughout India and in many other countries. Doctors usually perform abortions in the first trimester or the early part of the second trimester. The first trimester lasts from conception to week 12 of pregnancy. The second trimester is from week 13 to week 28. In the first trimester, options for abortion commonly include –medical abortion and vacuum aspiration. About 10 weeks after her last period, a woman can usually access this type of abortion. It simply involves medication. Sharing the complete report for State of Abortions in India



TABLE OF CONTENTS


  1. Abortions: Causes, Types and Risks…………………………………………………..............1-4

  1. What is an Abortion?...............................................................................................................1

  2. Causes of Abortion…………………………………………………………………………1-2

  3. Types of Abortion…………………………………………………………………………..2-3

  4. Post Abortion Care………………………………………………………………………...3-4

  1. Abortions in India: An Analysis……………………………………………………………….5-9

  1. National Estimate of Abortions in India……………………………………………………5

  2. Age of Abortion: The Alarming State of Teenage Pregnancies…………………………5-6

  3. Major Areas of Concern…………………………………………………………………...6-8

  1. Shortcomings in the health care sector…………………………………………..6-7

  2. Lack of awareness, prejudice, and social stigma………………………………...7-8

  3. Prolonged legal proceedings…………………………………………………….......8

  1. Recent Developments and the MTP (Amendment) Act 2021……………………………8-9

  1. Abortion Laws Across the World…………………………………………………………...10-12

  2. The Impact of COVID-19 Pandemic on Abortions………………………………………..13-14 





Abortion: Causes, Types and Risks


What is an Abortion?

An abortion is a medical means of ending a pregnancy. If an abortion takes place by itself, that is, naturally, it is called a miscarriage, also known as spontaneous abortion. Worldwide, around half of all reported unintended pregnancies end in abortion. Abortion is legal throughout India and in many other countries. Doctors usually perform abortions in the first trimester or the early part of the second trimester. The first trimester lasts from conception to week 12 of pregnancy. The second trimester is from week 13 to week 28. In the first trimester, options for abortion commonly include –medical abortion and vacuum aspiration. About 10 weeks after her last period, a woman can usually access this type of abortion. It simply involves medication. However, after 10 weeks, surgical options like vacuum aspiration and dilation, and evacuation become more common. Then, in the second trimester, a woman may have to undergo –dilation and evacuation or labor induction abortion.


Causes of Abortion

There can be varying reasons or causes of abortion. These may be influences by the culture, traditions, and society, or may be totally personal to the woman. 


  1. Unintended pregnancy

One of the most common reasons for abortions is unintended pregnancies. These usually occur due to non-usage of contraceptives or birth control pills, or using broken or ineffective contraceptives. 


  1. Health of the fetus

Advancement in pre-natal screening and diagnostic testing has enabled more women to be faced with a diagnosis of fetal anomaly, generally in the second trimester of pregnancy. Chromosomal abnormalities of the fetus are another leading cause of the abortion. If it is found out that the child born would be abnormal the woman usually aborts the child. Many women opt for abortion in these circumstances: for example, 90% of pregnancies with a prenatal diagnosis of trisomy 21 (Down's syndrome) will be terminated [1] . Women’s reasons for terminating pregnancies due to fetal anomaly could be rooted in the financial and emotional burden caused by raising a child with disabilities.


  1. Health of the mother

The American College of Obstetricians and Gynecologists issued a statement saying that abortions are necessary in a number of circumstances to save the life of a woman or to preserve her health. Unfortunately, pregnancy is not a risk-free life event. Complications that might lead to termination of pregnancy to save a woman's life include severe infections, heart failure and severe cases of preeclampsia, a condition in which a woman develops very high blood pressure and is at risk for stroke [2].  Even though there has been advancement in technology and medicine, there are still a considerable number of diseases which call for aborting of the fetus.


  1. Abnormalities in Reproductive Organs

Uterine anatomic abnormalities, also known as uterine malformations, can interfere with the ability to carry a pregnancy to term, due to which women have to terminate their pregnancy. Another anomaly can be related to the incompetence of the women’s cervix. During pregnancy, it is possible that the cervix opens earlier than it should. As a result a woman may have to abort, suffer a miscarriage or have a premature delivery.


  1. Consumption of Alcohol, Tobacco, and Drugs

Consumption of alcohol, tobacco and drugs exceeding the law threshold can lead to termination of pregnancy even though the pregnancy was otherwise wanted. Data from a UCSF Turnaway Study showed that nearly 5% out of 956 women reported ATOD as a reason for abortion [3]. Smoking while pregnant has been linked to a variety of health problems, including -premature birth, low birth weight and miscarriage and cot death.


  1. Financial reasons

Some women or families may not be financially viable enough to have a child in the family. Financial incapability as a reason for abortion is very common. Financial difficulties could be caused by varying reasons. They may include, the mother being unemployed, the woman being widowed, unmarried, poverty ridden, no earning member in the family, single motherhood, already having multiple children, too many members in the family, etc. In 2004, a structured survey was completed by 1,209 abortion patients at 11 large providers, where higher proportions of women who were unmarried or cohabiting, nonwhite, poorer and unemployed said they could not afford to have a child now [4]


  1. Other Reasons

These may include factors like family and spouse not permitting the woman to have a child. Another trend, especially common in India and China, is sex selective abortions. During the Pre-Conception and Pre-Natal Diagnostic tests, if the child is found out to be a girl, it is aborted.


Guttmacher Institute’s study (2004) on the reasons for abortions


Reason

Proportion of women citing the reason

Desire to avoid single motherhood

48%

Cannot afford a baby because unmarried

42%

Cannot afford a baby because they are a student

34%

The baby would interfere with their job/employment

50%

Immaturity

27%

Attained desired child bearing

38%

Having children or other dependants 

32%

Husband or partner wanted the abortion

24%


Types of Abortions


  1. Medical/Non-surgical Abortion

This abortion is performed in the 2-10 weeks of pregnancy. In this process, the drugs mifepristone and misoprostol are prescribed so as to stop the process of pregnancy. While Mifepristone stops the pregnancy from developing, Misoprostol triggers the uterus to empty. This process may cause cramps, bleeding or pelvic pain, and clotting. Mostly, within around 4–5 hours, the pregnancy tissue likely passes from the body, but it can take longer. This process is relatively safer as it doesn’t require the use of surgical means. According to clinical studies, this method is 95–98% effective when used correctly and within a nine-week gestational limit. Further, it doesn’t involve anesthesia. The recovery process is also rather simple; there is only bleeding and cramps for some weeks. However, women may have to go through the side effects of the medications, which may consist of –fever, nausea, diarrhea, fatigue etc. 


  1. Vacuum aspiration

This abortion is performed in 2-12 weeks of pregnancy and involves using gentle suction to end a pregnancy. A doctor begins the vacuum aspiration procedure by inserting a speculum into the woman’s vagina. They then apply medication or use an injection to numb the area. Then, they use thin rods called dilators to open the cervix and insert a tube into it. After this, the unborn child and the placenta are suctioned out through the tube. This is a quick 5 to 10 minute process. For the most part it is pain free, since the vaginal area is numbed. However, in certain cases women may experience bleeding, nausea or cramps. The woman would need an hour rest after the procedure and consume antibiotics. Furthermore, irregular bleeding can occur for several weeks after the procedure. 

 

  1. Dilation and evacuation

This Abortion process is performed in the 13-21/22 weeks of pregnancy. In this procedure, an anesthetic is given to the patient. In this, a sponge-like material, which is the speculum, is placed in the cervix of the woman. Then, they use dilators to open the cervix. After this, with the help of suction curettage and forceps, the unborn child and placenta are removed from the womb. At times the child is dismembered. There can be potential risks of excessive bleedings, infections in the vaginal area or the uterus, and possible injury to the uterus due to the forceps. According to the American College of Obstetricians and Gynecologists, the risk of injury to the uterus or other organs during a second-trimester abortion is less than 1 in 1,000. Regardless, this procedure is considered as a safe and effective method of abortion.

 

  1. Induction abortion

This Abortion procedure is performed in 13-21/22 weeks of pregnancy. In this process, the mother is given drugs to make her enter into labor which usually starts in 2-4 hours. By this, the pregnancy is terminated. However, in this procedure, the placenta cannot be removed completely. Therefore, the cervix has to be kept open for the doctor to perform suction curettage.

 

  1. Labor induction

This Abortion procedure is performed in 22-29 weeks of pregnancy and is a late-term method of ending a pregnancy in the second or third trimester. During this process, medications are used to start labor, which causes the uterus to empty over a period of around 12–24 hours. A woman can take these medications by mouth or the doctor may place them into the vagina or inject them into the uterus. In this abortion, it is possible that the child is delivered alive. There is intensive cramping during this method of abortion. The recovery process is longer; the woman may have to stay at the hospital/clinic for one or two days. In this procedure there are risks of the medications causing side effects like diarrhea, nausea etc. If complications happen, they may lead to hemorrhage, rupture of the uterus or cervical injury.

 

  1. Hysterectomy 

This Abortion procedure is performed in the 22-38 weeks of pregnancy and can be considered the last resort. This procedure is performed only in those situations when there are no possibilities of labor induction or the labor induction has failed. It is similar to C-section as the abdomen is cut to remove the unborn child. 

 

Ideally, pregnancy should be terminated in the first three months since conception. It is usually the safest time. In certain cases, the abortion is done in the second trimester. However, performing an abortion in the third trimester is very risky and is generally done because of an emergency. Therefore, one must opt for earlier abortions as they are safe and relatively cheap [5].

 

Post Abortion Care

A large number of women experience bleeding after an abortion. In all procedures of abortion, there is a possibility of bleeding and spots. It is also normal to pass blood clots. Consistent heavy bleeding may be a sign of complications. Consistent bleeding can be identified as going through two or more maxi pads in one hour, or bleeding heavily for 12 hours or more. If the blood is bright red after the first 24 hours post-abortion, as compared to a darker red, or if it accompanies a stabbing, persistent pain, it can also be a sign of complication. 


Apart from the medication method, in other procedures it’s typically advised that the woman waits for about two weeks before having sex or inserting anything vaginally. This reduces the risk of infection, and is an important part of post-abortion care. If a woman has unprotected sexual intercourse following an abortion, she should consult a health professional or visit a hospital with regards to what measures she must take to prevent pregnancy.


While both medical and surgical abortions are usually considered to be safe, they may sometimes result in serious complications. One such complication is infection. Infection can be caused due to incomplete abortion, i.e. in cases where some parts of the tissue are left in the uterus or exposure to bacteria. The later can happen if the woman engages in sex too soon. Symptoms of infections include strong-smelling vaginal discharge, fever, and severe pelvic pain. Untreated infections can result in pelvic inflammatory disease. Incomplete or failed abortion, in which the fetus is still viable or was not fully evacuated from the womb, can cause serious medical complications. Symptoms such as severe abdominal pain and bleeding can be that of uterine perforation. Excessively heavy bleeding, strong-smelling vaginal discharge, and severe abdominal pain can be symptoms of an emergency condition.


A woman can become pregnant as soon as she has sexual relations. Assuming there are no complications from the abortion, almost any contraceptive method can be started immediately. A woman should talk to the health worker about choosing a family planning method which best meets you and your partner's needs. After a spontaneous or induced abortion, the recommended interval to the next pregnancy is at least six months, both for the mother's and the baby's health [6].

 

 

 

 

 

 

Abortions in India: An Analysis

 

National Estimate of Abortion in India [7]

According to the first national study of the incidence of abortion and unintended pregnancy in India, conducted by the researchers at the International Institute for Population Sciences (IIPS), Mumbai, the Population Council, New Delhi, and the New York–based Guttmacher Institute, an estimated 15.6 million abortions were performed in the country in 2015.

 

TYPE OF PROCEDURE 

PERCENTAGE 

Medical Methods of Abortion

81%

Surgical

14%

Typically unsafe methods

5%

 

The study also estimated the incidence of unintended pregnancy in India and found that out of the total 48.1 million pregnancies in 2015 out of which about half were unintended—meaning they were wanted later or not at all. The estimated unintended pregnancy rate was 70 per 1,000 women aged 15–49 in 2015. 

 

LOCATION

NUMBER OF ABORTIONS

Health Facilities

3·4 million

Medication abortion outside health facilities

11·5 million

Methods other than medical abortion done outside health facilities

0·8 million

 

The above findings suggest that a large number of women rely on self-administration of drugs. Therefore, there is a need of intervention from health facilities to provide women with accurate knowledge about these drugs and assist them with follow-ups. Interventions are also needed to expand access to abortion services through better equipping existing facilities, ensuring adequate and continuous supplies of medication abortion drugs, and by increasing the number of trained providers. 

 

Age of Abortion: The alarming state of teenage pregnancies

 

The following data was released by the WHO with regards to the pregnancy and abortion trends in girls of developing regions falling under the age group of 15-19 years [8].


IMPLICATIONS

NUMBER OF GIRLS AFFECTED

Pregnancy 

21 million

Giving birth

12 million 

Unintended pregnancies

10 million

Abortions 

5.6 million

Unsafe abortions

3.9 million


In 2015, abortions among teenage girls had seen an alarming rise at 67 percent. Civic data accessed through RTI act by Chetan Kothari further showed that out of nearly 31,000 women who opted for medical termination of pregnancy, 1,600 were below the age of 19. According to the Union Home Ministry, 37.6 per cent of pregnant women died during abortion in 2017. As many as 141 between age group 15-24 and 201 women between 25-34 age group, died due to abortive outcome [9]


The abovementioned data is extremely alarming. Unintended pregnancies and followed abortions can have very harmful effects on the under-aged girl’s body. Studies suggest that the safest and best age for pregnancy is during the 20s and 30s. However, this trend of growing teenage pregnancy shows, how many girls die of maternal mortality due to the risks involved with early pregnancies. There can be varying reasons for the same, but one of the most vital would be child marriage. According to the WHO, in least developed countries, at least 39% of girls marry before they are 18 years of age and 12% before the age of 15. UNICEF estimates suggest that each year, at least 1.5 million girls under 18 get married in India, which makes it home to the largest number of child brides in the world - accounting for a third of the global total. Nearly 16 per cent adolescent girls aged 15-19 are currently married [10].


Adding to the increasing number of child marriage cases is the upsurge in rape cases of minor girls. In a number of these cases girls get pregnant. In most of such instances, the girl and her family takes suo moto steps to terminate the pregnancy, which is extremely unsafe. Abdominal massages, drinking herbal concoctions and inserting sticks in the vagina are common methods to terminate unwanted pregnancies. As many as 194 women filed writ petitions in the Supreme Court seeking permission for abortion between June 1, 2016, and April 30, 2019. As many as 97 of these cases involved rape victims, 82 of whom were less than 18 years oldThirteen out of these 82 girls were denied abortions [11]. Well, teenage pregnancy in itself is risky and dangerous; however, if the girl conceives that might cause her more mental and physical trauma. Many lawyers suggest that it is better to let the girl abort the child. In some cases, the organs of the girl (vagina, uterus) are very small and underdeveloped that it is very difficult for her to conceive a child. Due to this, early abortion should be preferred. 


Major Areas of Concerns


  1. Shortcomings in the Health Care Sector

There have been many shortcomings on the part of the health care department with regards to women’s health in general and maternity care in specific. Rural India has a 75% shortage of gynecologists and obstetricians. Due to this, most rural women take the unsafe routes of delivery or abortion. There is hardly any assistance from health care professionals and post delivery or post abortion follow up care. Section 19 of the Protection of Children from Sexual Offences Act of 2012, states that any person who is aware that a minor is pregnant should report her to the police, regardless of the girl’s consent. So in instances when a doctor is aware about the pregnancy at an early stage, they do not perform abortion with fear of getting involved in the legal proceedings [12]


Foundation for Reproductive Health Services India conducted a survey among 1,500 chemists and found out that about 79 per cent of chemists no longer stock MA (Medical Abortion) drugs to avoid legal issues and excessive documentation requirements. 54.8 per cent of chemists also said that they feel MA drugs are over-regulated as compared to other schedule H drugs. Since medical abortion is the safest and most preferred method of abortion, it is worrying that MA drugs are unavailable in so many places [13].


According to The Health Workforce in India report by the World Health Organization, as many as 73 districts had no nurses with a medical qualification. These nurses, in turn, may not be equipped with proper and adequate knowledge of pre and post abortion care. According to Health and Family Welfare statistics in India 2019-20, in total 51.2% women had at least 4 antenatal care visits; urban women had 66.4% and rural women had 44.8% [14].


Name of the State

Percentage of Mothers who had at least 4 antenatal care visits 

Uttar Pradesh

26.4%

Delhi

68.6%

Arunachal Pradesh

26.7%

Madhya Pradesh

35.7%

Nagaland 

15%

Bihar

14.4%

Rajasthan

38.5%

Uttarakhand 

30.9%


Most problems at birth are caused by prematurity, fetal growth restriction, congenital abnormalities or asphyxia. With access to antenatal care, especially in early pregnancy, many of these can be prevented or anticipated. Lack of access to appropriate ANC may have potentially adverse short- and long-term impacts on Indian women and newborns. These adverse effects may include maternal death or health loss from hemorrhage, hypertensive disorders, sepsis, and abortion [15]. Thus, the fact that a large number of women do not have adequate amount of antenatal visits is alarming and a possible contributing factor for abortions. 


  1. Lack of Awareness, Prejudice, and Social Stigma

According to a 2012 BioMed Central study, less than half the women from Bihar and Jharkhand knew that abortion is legal [16]. Because of absence of adequate health facilities in rural and semi urban areas, there are hardly any awareness drives to educate people regarding abortions. In some areas people are unaware that abortion is legal in India, in other areas people know it is legal but believe that it is unsafe, and in some places people choose to terminate the pregnancy by their own without the guidance or assistance of a health professional. All these factors put the life of the mother at a great risk. Adding to the unawareness is the prejudice. A considerable amount of people, mostly those having an orthodox thinking, would not abort the child or let their daughters, wives, or daughter in law abort the child. In some instances where it is revealed that the child is a boy, the family pressurizes the woman to keep it, even though the pregnancy was unintended in the first place. In South American countries and East Asian countries like the Philippines, there is extreme lack of awareness. In the poverty ridden areas, teenage girls are deprived of sex education and have little to no knowledge of birth control. 


Even in supposedly liberal countries like the United States of America, abortion is a hotly debated issue. Many believe that abortion is murder and thus past the first trimester, the feotus must not be killed. A certain faction believes that abortion is immoral and the unborn child’s life takes primacy over the mother’s rights to her body. The stigma attached with pregnancy and the shame associated with rapes, deters families to consult health professionals. Instead, they try to take things in their own hand. Usually, lack of guidance and follow ups from health professionals, even in the case of medical abortions, can have dire consequences.


CEHAT (Centre for Enquiry into Health and Allied Themes) a Mumbai-based research institute conducted a study in two antenatal departments of public hospitals where they asked women about their experience of domestic violence. Of the 142 women who disclosed abuse in their marriages, 31 reported that their current pregnancy was the result of rape by their husbands. All 31 sought abortions. Of these, 24 women were less than 20 weeks’ gestation but only five of them were able to have an abortion. Of the rest, the 19 women who were less than 20 weeks and the seven who beyond 20 weeks were all forced to continue their pregnancies [17]


There were varied reasons which forced these women to continue with their pregnancies. In some instances, since it was the first pregnancy, the women were informed that abortion may lead to infertility. The fear that they wouldn’t have a second pregnancy deterred them from abortion. However, it is false. Abortion doesn’t lead to infertility. In other instances, women had to seek the permission and consent of their spouse. Even though in India an adult woman doesn’t require the consent of her spouse for abortion, yet several providers insisted upon the spouse’s consent. Another issue women face is that, regardless of the gestation period or week of pregnancy, doctors insist on using the method of Dilation and Evacuation. There can be multiple reasons for this insistence, the doctors may not be aware of other possible methods; they may believe that it is the safest method, or there is a profit motive behind it. Dilation and Evacuation would require for the woman to have an overnight rest at least. This overnight rest is a source of money for many private hospitals, due to which they suggest methods which require the woman to stay overnight. The fear of surgery, in turn, forces the woman to not abort.  


  1. Prolonged Legal Proceedings 

A study presented the experiences of 74 women (including two minor girls) were raped and sought abortion. Out of these, fifty five women were within twenty weeks of gestation period, while the other nineteen were beyond the 20 weeks; these also included the minor girls. None of them who sought abortion after the 20 weeks were allowed to abort, including the two children, even though they followed the due course of law. Out of the other 55 who were within the 20 week period, only 36 were able to abort, due to delay on the part of the court [18]


Before, the MPT (Amendment) Act 2021, abortion was allowed till the period of 20 weeks from conception. In those instances, if a woman or a girl has asked the court to permit for abortion before the 20 weeks termination, often times, the legal proceedings would take so long, that by the time the judgment is passed, the woman would have already crossed the 20 week limit. Recently, a 14 year old minor had reached the supreme court of India to ask for permission for abortion during the 26th week of pregnancy. The Supreme Court then asked for further medical advice on the case. The medical advice means further delay. In this situation, where the gestation has already entered the 26th week, it would anyway be dangerous to terminate the pregnancy if anytime later. 


Recent Developments and the MTP (Amendment) Act 2021

The debate on abortion has been very much consistent in the US politics. However, after the recent MTP (Amendment) Act, it has come to vogue in India as well. An abortion is a procedure to end a pregnancy. It uses medicine or surgery to remove the embryo or fetus and placenta from the uterus. The procedure is done by a licensed health care professional.  The path of abortion is used mostly to end an unplanned pregnancy. These happen when birth control or contraceptives are not used, is used incorrectly or fails to prevent a pregnancy. Abortion is also used to end a pregnancy when tests reveal that the fetus is abnormal. Therapeutic abortion refers to an abortion recommended when the mother's health is at risk [19]. Abortion is legal in India as the Medical Termination of Pregnancy Act, 1971, legalized it. However, according to the MTP Act, 1971 abortions could only be performed up to 20 weeks of gestation. The recent Medical Termination of Pregnancy (Amendment) Act 2021 has increased this period to 24 weeks. Before, women seeking to terminate the pregnancy beyond 20 weeks had to go through a protracted legal course. This in turn was antithetical to the reproductive rights of women. Women were denied rights to their own body and uterus. A study in the India Journal of Medical Ethics (2015) noted that 10-13% of maternal deaths in India are due to unsafe abortions. This makes unsafe abortions to be the third-highest cause of maternal deaths in India.


Women’s bodies have always been in jeopardy. It is hers but also everyone else’s. The main criticism of the 1971 act was that a woman had to go door to door for the termination of her pregnancy. It becomes crueler in the case of Rape survivors who have to burden themselves with the child of their perpetrator. However, the recent act also requires for the opinion of one registered medical practitioner for the termination of pregnancy up to 20 weeks of gestation. It introduces the requirement of the opinion of two registered medical practitioners for termination of pregnancy of 20-24 weeks of gestation. The act does not take into account the time sensitive nature of a pregnancy. It doesn’t provide a time frame within which the Medical Board has to make a decision. Any delay may cause more complications for the woman. The argument, that women still need approval from a governing body remains. Another point of contention remains the issue and determination of viability. Viability is the period from which a fetus is capable of living outside the mother’s womb. Over years, with improvement in technology and infrastructure, the period of viability also improves. Currently, viability is usually placed at about seven months (28 weeks). But, it may occur earlier, even at 24 weeks. Thus, late termination of pregnancy may get in conflict with the viability of the fetus.


A pregnant woman is allowed to seek abortion under the MTP Act if - The pregnancy could be harmful to her life, physical or mental health and there is a good chance that the child could suffer physical or mental abnormalities. If an abortion is performed, the reason of which, doesn’t lie in the aforementioned framework, that abortion becomes a punishable offense under Section 312 of the Indian Penal Code. The recent amendment has also replaced the word ‘husband’ with ‘partner’. Due to this, the act now also covers and applies to unmarried women. Further, the act has a privacy clause, that makes revealing the identity of a woman seeking abortion a punishable offense.

Abortion Laws across the World


According to Reproductiverights.org, over the past several decades, monumental gains have been made in securing women’s right to abortion, with nearly 50 countries liberalizing their abortion laws. Some of this reform has been incremental, enabling women to access legal abortion only when there is a threat to her life or when pregnancy results from rape. But many of these changes have been truly transformative, overturning absolute bans on abortion in favor of women’s reproductive autonomy [20].


International human rights law supports the right to choose whether to continue a pregnancy or not. India is among the countries that consider a woman's social or economic circumstances too to permit abortion. The Medical Termination of Pregnancy (Amendment) Act extends the upper limit for permitting abortions from the present 20 weeks to 24 weeks of pregnancy.


Number of countries

Percentage of women of reproductive age 

Laws

26

5%

Abortion is prohibited 

39

22%

abortion is allowed to save the woman's life

56

14%

Permit abortion on the basis of health or therapeutic grounds.

14

23%

Abortion is permitted under consideration of women’s socio-economic condition

67

36%

Abortion on request is permitted 


  1. Abortion is prohibited 

The laws of the countries in this category do not permit abortion under any circumstances, including when the woman’s life or health is at risk. Most Asian and African countries have these laws. For eg – Congo, CuraƧao, Dominican Republic, Egypt, El Salvador, Haiti, Honduras, Iraq, Jamaica, Laos Madagascar, Malta, Mauritania, Nicaragua, etc.


  1. Abortion is allowed to save the woman's life

Examples -Afghanistan, Antigua & Barbuda, Bahrain, Bangladesh, Somalia, South Sudan, Sri Lanka, Venezuela, etc.


  1. Permit abortion on the basis of health or therapeutic grounds

The laws of countries in this category permit abortion to preserve the mother’s health. The question of health can be physical or mental. There are countries which permit abortions to preserve a woman’s mental health, like – Algeria, Angola, Israel. While, some countries permit abortions only on grounds of preserving physical health, namely – Zimbabwe, Monaco. The World Health Organization advises that countries permitting abortion on health grounds should interpret “health” to mean “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”


  1. Abortion permitted under socio-economic grounds

These laws are generally interpreted liberally to permit abortion under a broad range of circumstances. These countries often take into account a woman's actual or reasonably foreseeable environment and her social or economic circumstances in considering the potential impact of pregnancy and childbearing. For example: India, Japan, Hong Kong, Great Britain, Finland etc.


  1. Abortion permitted on request

Examples are: Australia, Belarus, Belgium, Germany, Portugal etc.

 

Varying Abortion Permissions required in different countries [21]



Rape

Incest 

Fetal impairment 

Spouse authorization req.

Parental authorization req.

Sex selective abortion prohibited

India




Japan 





Hong Kong




Great Britain






Chile 





Indonesia 




UAE 




Iran






Syria





Israel 




Colombia 




Taiwan 


China 






Kosovo 





Saudi Arabia





Barbados 



Republic of Korea




Mauritius



Fiji



Rwanda 




Kuwait 





The above table testifies on how in some supposedly developed countries, women hardly have any rights over their body. They don’t even have the right to terminate a pregnancy caused by rape. Whereas, in some relatively less developed African Nations, like Rwanda, women have the right to abort a child born out of rape or Incest. In most West Asian countries (Middle-East) like Saudi Arabia, UAE, and Syria, there are provisions of requirement of spouse and parental authorization for termination of pregnancies. And, in China, sex selective abortions are allowed. On this point, India is ahead of China as it enacted the Pre-Conception and Pre-Natal Diagnostic Techniques Act in 1994 to ban sex-selective abortion and stop female foeticide.



The impact of COVID-19 Pandemic on Abortions


Inaccessibility to healthcare

The Covid-19 pandemic and the consequential lockdown has also resulted in abortion health care not reaching to people. During the lockdown, when there was fear, uncertainty, and lack of means of transport, women found it difficult to reach out to health care professionals. In such circumstances women usually took birth control pills without prescription from a health professional. One such case was reported by TheGaurdian.com as well. A woman took medications without consulting a medical practitioner. Until hours after taking the medication her bleeding didn’t stop. This, as mentioned above, can have serious implications. 


Unavailability of medications

During the initial phase of the lockdown, inter-state movement and transportation was completely banned. This disrupted the supply chain of abortion and birth control medications. Therefore, it is highly likely that in many areas medicines for the termination of pregnancy were unavailable. 


Foundation for Reproductive Health Services India’s survey [23]


Name of the state 

Percentage of pharmacies having abortion pills

Punjab

1%

Haryana

2%

Madhya Pradesh

6.5%

Tamil Nadu

2%

New Delhi

34%

Assam

69.6%


Inaccessibility to contraceptives 

Another problem that arose during the pandemic was the lack of accessibility to birth control pills and contraceptives. The Foundation for Reproductive Health Services India (FRHS), an affiliate of Marie Stopes International, estimates that lockdown disruption could leave 25.6 million couples unable to access contraception, leading to an additional 2.3 million unintended pregnancies and 834,042 unsafe abortions [23]. According to International Planned Parenthood Federation, in parts of West Africa, the provision of some contraceptives fell by nearly 50 percent compared to the same period last year [24].


Marital rapes and unintended pregnancies

Since marital rape is legal in India it is difficult to quantify the occurrences of marital rape during the pandemic. But its frequency can be guessed with the help of the data on domestic violence. According to a report in The Hindu, between March 25 and May 31 2020, 1,477 complaints of domestic violence were made by women. This 68-day period recorded more complaints than those received between March and May in the previous 10 years. Even though domestic violence is not indicative of marital rapes, but it can assumed by the similarity in the nature of the crime, that marital rapes would also have increased drastically. Marital rapes, in circumstances where contraceptives were either unavailable or inaccessible, would have resulted in a large number of unintended pregnancies.


Lack of attention to maternal care

Furthermore, due to the pandemic, most public hospitals were made to divert their resources in dealing with the virus. Many hospitals were converted into COVID-19 centers exclusively. Due to this maternal and abortion care was compromised upon. Because of the lack of transport facilities and shortage of protective equipment, many private clinics also had to shut down. Even though abortion was listed as an essential service, a considerable number of women were unaware about it. As a result of all these, women either couldn’t or didn’t reach out for termination of pregnancy. In certain cases, as abovementioned, the woman herself consumed the medications for termination, and in other cases, after the easement of the lock down, she visited a doctor for abortion. In the latter case, the woman might have already reached the third trimester of her pregnancy. A member of the IPPF European network’s executive committee reported that even after NGOs in Romania pressured the government to declare the services essential, many hospitals still weren’t providing abortions. 


Unsafe measures of abortions

Apart from consuming unusual dosages of medications which lead to excessive bleedings and other complications, many other instances of unsafe measures were reported in different parts of the world. The Women Promotion Center of Kenya reported that some young women in Nairobi’s Kibera slum resorted to using broken glass, sticks and pens to try to abort pregnancies.


 



 






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