CAC Conclave calls for strengthening of safe abortion services

New Delhi: Ten women die every day in India as a result of unsafe abortion. Approximately 30,200 abortions are expected to take place every day, of which 15,000 are estimated to be unsafe. This is primarily due to low levels of awareness about abortion legality and availability, coupled with lack of access to services. It is estimated that of these, 3,600 develop complications resulting in morbidity and mortality.

Keeping this scenario in mind, Ipas Development Foundation (IDF) organized a Conclave on `Expanding the Discourse on Comprehensive Care (CAC) in India’ on July 10 and 11, 2017 in the capital. Participants at the Conclave reiterated that there was an urgent need to strengthen safe abortion services by increasing the provider base and creating awareness on availability of comprehensive abortion care services across the country.

Unsafe abortion is the third leading cause of maternal deaths in India, contributing to eight percent of all maternal deaths annually. To facilitate faster decline in the overall maternal mortality in India, it is imperative that access to safe abortion services is made available at all levels of health facilities.

Women’s ability to exercise their reproductive choices is integral to the success of maternal health and family planning interventions at the national and state level. However, the challenges of repeated unintended pregnancies and unwanted births or abortions remain largely unattended due to lack of services coupled with myths and misconceptions associated with abortion.

Studies reveal that 90% of maternal mortality related to unsafe abortions could be averted by use of contraceptives in the post-abortion period. Also, the unmet need for family planning in the post-abortion period is very high which, if bridged, can save many young mothers.

Mr Vinoj Manning, Executive Director, IDF said that close to 10,000 doctors in the public sector in 13 States have been trained for providing safe abortion services to women. He said that the first CAC guidelines issued in 2010 was a significant landmark in national commitment to making abortion safer. This has been followed by other progressive policy moves including a mass media campaign. However, delay in the passage of amendments to the Medical Termination of Pregnancy Act, 1971 that would allow mid-level health workers to provide safe abortion services, and implementation challenges in light of laws such as Pre-Conception and Pre- Natal Diagnostic Techniques Act, 1994 and the Protection of Children from Sexual Offences (POCSO) Act, 2012 need to be addressed on priority.

Dr Atul Ganatra of the Federation of Obstetrics and Gynaecological Society of India (FOGSI) said that conflict in laws and lack of clarity about laws have resulted in denial of safe abortion services to girls below the age of 18 for fear of prosecution. He asserted that there was an urgent need to educate everyone, including the law makers and law implementers, about existing abortion laws. According to him, the 20-week deadline for medical termination of pregnancy needs to be changed since not all women can rush to the Supreme Court when faced with such situations. There have been numerous instances where providers have refused services and seekers have had to approach the apex court.

Expressing concern over the inconsistencies in sale of medical abortion drugs in Maharashtra and Uttar Pradesh, Mr Shanker Narayan, PSI India Private Limited, said that the price control of the drugs has impacted the availability of the drugs used for abortion since many pharmaceutical companies have stopped manufacturing these drugs due to reduced profitability.

Dr. Suchitra Pandit, FOGSI representative, highlighted the need for client-centered counseling and service provision for women from all strata and age groups. This would be a key step in increasing women’s access to safe abortion and preventing them from seeking services from untrained providers. Chakshu Roy of PRS Legislative Services urged the critical stakeholders to engage with lawmakers to keep them informed about the subject and the challenges faced by women, for facilitating more effective laws and policies. There is a need to involve a larger group of stakeholders beyond activists, lawyers and doctors for creating an enabling environment for abortion access in India.

The two-day Conclave was part of a series of events aimed at creating a favorable environment for making comprehensive abortion care services available to women in India. The purpose of this event was to create a wider community of advocates for CAC in India.

The CAC Conclave brought together lawyers, civil society, service providers, researchers, academicians along with other experts to enable sharing and leveraging of synergies at various levels. The key themes of discussion were the role of communication in increasing awareness about CAC; unraveling medical abortion-use in India and leveraging its potential for women; breaking the cycle of unwanted pregnancies; and abortion and law.