Maverick Story's - 16 hours ago

Unplanned Pregnancies: Access to Safe Abortion Care Critical to Women’s Health and Rights

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Need for Autopsy in every death;

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Pregnancy – ignominious & Abortion – catawampus:

While delving into the consequences of medical abortion, it was revealed that it is mostly the sellers (Chemist / Pharmacist) who are ill-informed about the Medical Abortion (MA) drugs. A report published by the Foundation for Reproductive Health Services (FRHS) India reiterates the fact, that almost 54% of the total number of chemist in the country are unaware of the availability, and use of the MA drugs.

FRHS has derived per survey conducted – in the states of Punjab, Haryana, Madhya Pradesh, and Tamil Nadu, only 3% of the end-users are aware of the dosage & time; routes of administration; expected side effects; signs of possible complications; ascertaining the success of the MA drugs; but only 1% of the chemists in these states are aware of the modalities. These figures are indeed alarming, but what is evidently shocking is the fact that the chemists mostly are reluctant to stock, or, sell these medicines citing regulatory compliance. The survey has more revelations – that the majority of chemists reported the influence of “Beti Bachao, Beti Padhao” as a reason for a government ban.

The reduction in unsafe abortions in the country can be largely possible with direct attribution to the availability of MA drugs. If access to MA drugs is compromised, the fostering of visions towards the reduction in unsafe abortions will be lost and women may be forced to resort to unsafe methods. This is likely to adversely impact the gains in maternal mortality and morbidity made over the past couple of decades.

A holistic approach can be solicited in providing MA drugs by a doctor in his/her consulting room with the drugs procured from a nearby chemist. If access to MA drugs is compromised vide overregulation’s, women would be forced to seek a surgical abortion from a facility, reducing choice. Access to safe abortion will also reduce since there are only 16,296 approved abortion facilities in the private sector in the country, whereas MA can be provided by all Ob/Gyns and approved MTP providers in their clinics/consulting rooms, which is estimated to be 60,000-70,000. This reduction in access and choice may force many women to seek abortion services from unsafe providers.

As per the Consortium on National Consensus for Medical Abortion in India – at the moment, septic abortions account for 98 out of 1000 maternal deaths. The reasons for developing a septic after abortion is largely due to: sticks comprising 77%, surgical methods like D&C accounting to 23%.

Misuse of surgical procedure:

This procedure is being misused in different situations mostly in an abusive manner. India has a meagre male-to-female sex ratio, and female foeticide is still prevalent in rural areas. Thus, sex determination during pregnancy and the abortion of female foetuses is the dominant cause to the declination of the country’s female population. Moreover, misuse of this procedure has demonstrated to have long-term consequences for the mother’s health, including long-term illness, infertility, and even maternal death. But, in contrary there is a shortness in the legal and proper monitoring methods which could prevent any illegal use of this procedure.

Safe abortion in India carries risks that depend on the health facility, the skill of the provider, and the gestational age of the foetus.

With unsafe abortion, the additional risks of maternal morbidity and mortality depend on what method of abortion is used, as well as on women’s readiness to seek postabortion care, the quality of the facility they reach, and the qualifications (and tolerance) of the health provider. Methods of unsafe abortion include drinking toxic fluids such as turpentine, bleach, or drinkable concoctions mixed with livestock manure. Other methods involve inflicting direct injury to the vagina or elsewhere—for example, inserting herbal preparations into the vagina or cervix; placing a foreign body such as a twig, coat hanger, or chicken bone into the uterus; or placing inappropriate medication into the vagina or rectum. Unskilled providers also improperly perform dilation and curettage in unhygienic settings, causing uterine perforations and infections. Methods of external injury are also used, such as jumping from the top of stairs or a roof, or inflicting blunt trauma to the abdomen. The main causes of death from unsafe abortion are haemorrhage, infection, sepsis, genital trauma, and necrotic bowel.

Obtaining accurate data for abortions is challenging, and especially so for unsafe abortion. Two-third of the country do not have the capacity to collect data, and data collection varies from region to region in both quantity and quality. Because unsafe abortion is often done clandestinely by untrained individuals or by the pregnant women themselves, much of it goes undocumented; figures are therefore estimates. Data which are mostly fragmented, suggests that even as the overall abortion rate has declined, the proportion of unsafe abortion is on the rise. From 2013, the overall number of abortions declined, but the unsafe abortion rate was steady, constituting an increase from 44% to 48%.

Finally, The MTP Act 1971, until recently, permits MTP based on the opinion of a single RMP only up to 12 weeks of gestation and up to 20 weeks of gestation based on the opinion of two RMPs. The 12-week deadline was practically hard to be followed, as it is not rare for pregnancies to be confirmed only after 12 weeks of gestation. The 20-week deadline was also often passed, as foetal anomaly scans were usually done after the completion of 20 weeks of gestation, leaving no time for an MTP in the event of a foetal anomaly being detected in the scan. This led many women crossing the 20-week deadline to again adopt unscientific methods and approach unqualified individuals for such abortions.

On a larger perspective, to minimise the fallacies of such practices, every death due to abortions should be included under the purview of a clinical autopsy – which would despise anyone who culminates an arrogant contempt for womanhood.

To be continued…………………