Abortion Practice in India - Book Summary - Indian Literature - Heidi Bart Johnston, Summaries for Indian Literature. City University London

Indian Literature

Description: Women with access to fewer resources, for example low-income rural women and adolescents, are among those most likely to turn to unsafe abortion and have complications. Studies suggest that the choice of specific provider is most often not made by the woman inducing abortion but with or by her husband or other family members
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The Medical Termination of Pregnancy Act of
1971 greatly liberalised the indications for
which abortion is legal in India. The
Government intended for this Act to reduce
the incidence of illegal abortion and
consequent maternal morbidity and mortality.
However, 30 years after the groundbreaking
legislation, the majority of women seeking
abortion still turn to uncertified providers for
abortion services because of the barriers to
legal abortion. While some uncertified
providers offer safe services, many provide
unsafe abortions that result in complications
or death. Women with access to fewer
resources, for example low-income rural
women and adolescents, are among those most
likely to turn to unsafe abortion and have
complications. Studies suggest that the choice
of specific provider is most often not made by
the woman inducing abortion but with or by
her husband or other family members.
While the incidence of abortion in India is
unknown, the most widely cited figure
suggests that around 6.7 million abortions take
place annually. According to government data,
only about one million of these are performed
legally. The remaining abortions are
performed by medical and non-medical
practitioners. Levels of unsafe abortion are
very high in India, especially given that
abortion is legal for a broad range of indications,
and available in the public and private health
sector.
In the current situation abortion services are
not adequately decentralized, and regulatory
reform will have to take place before
decentralization of legal services will happen
in a meaningful way. To reduce morbidity and
mortality from unsafe abortion in this context,
several broad activities require strengthening:
decreasing unwanted pregnancies; increasing
access to safe abortion services; and
increasing the quality of abortion care,
including postabortion care.
Results of the studies reviewed suggest that
reducing recourse to unsafe abortion will be a
Abortion Practice in India: A Review of Literature
Heidi Bart Johnston
complex multi-step process that includes
increasing women’s access through improve-
ments in service delivery and addresses the
more complicated issues of rights and gender
power inequities. Strategies to make safe and
legal abortion services more attractive to
women and decision makers include:
increasing geographic accessibility;
increasing affordability; providing high quality
abortion care and prioritising confidentiality
of services. Addressing the system of barriers
limiting women’s access to safe abortion
services may require review and revision of
the MTP Act, 1971 and associated rules and
regulations.
This review suggests a need for expanded
community-based education to address specific
issues of women’s reproductive health and the
broader issues of women’s right to high quality
health care services. Household decision-
makers, men and women, would benefit from
awareness raising about the dangers of unsafe
abortion and the availability of safe abortion
services. Women with reduced access to
reproductive health resources, such as
adolescents and rural poor, should be a priority
focus in com-munity-based education.
This review of the current literature of abortion
in India suggests that abortion and associated
morbidity and mortality from unsafe abortion
are common and need to be a top priority safe
motherhood issue in India. Areas for
exploration to improve abortion care include,
but are not limited to: motivating qualified
practitioners to attend MTP training courses;
reviewing MTP Act and associated rules and
regulations to determine how the law can be
revised to decentralize abortion services and
otherwise better meet the needs of women;
upgrading facilities that currently offer MTP
services; orienting MTP services to meet the
needs of women most at risk of accessing
unsafe abortion; increasing awareness among
women and men of reproductive age of the
availability of safe abortion services and the
dangers of unsafe abortion; involving
communities and providers at all levels to
improve reproductive health care; and
improving adolescent reproductive health
services in general. Innovative interventions
need to be developed, implemented, monitored
and scaled up as appropriate.
Clearly a great deal is known about provision
of and access to safe and unsafe abortion
services in India and the need to improve safe
abortion and contraceptive choices to more
adequately meet the needs of women
experiencing unwanted pregnan-cies. Still, a
great deal more needs to be known before
programs are implemented to ensure low-
resource Indian women can readily access safe
abortion services. The cost in terms of
women’s health and lives emphasizes the need
to efficiently and effectively pursue efforts to
make abortion safer and more accessible for
Indian women.
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