Women in India can have abortions in government-run Primary Health Centres (PHCs) free of charge. Although there are around 2500 PHCs spread across India, there are only 250 to 300 centres that offer abortions, says Dr Kurtkoti, who heads the abortion committee at the Federation of Obstetric and Gynaecological Societies of India.
Abortions are counted as unsafe when they don’t follow the guidelines in the 1971 Medical Termination of Pregnancy (MTP) Act. This sets out the conditions under which abortions can be performed and by whom.
Lack of providers
“Abortions can only be performed in government-recognised MTP centres by doctors trained in obstetrics or gynaecology, or by a general practitioner who has undergone training for 25 cases,” says Dr Kurtkoti. “Abortions that don’t follow these guidelines are therefore illegal and considered unsafe.”
“The rise in the number of unsafe abortions is because of the lack of legal providers. There are not enough doctors who can carry out abortions in the PHCs. And bureaucracy makes it time consuming and tedious for the government to recognise more MTP centres,” the doctor says.
Sticks and stones
An abortion at a private hospital costs anywhere between 2000 and 10,000 rupees (30-150 euros). Women who can’t afford it are forced to seek help from illegal providers to end their pregnancies.
Dr Kurtkoti says these women face a range of serious risks. “The biggest risk is incomplete abortion and bleeding. Secondly, there’s the risk of infection which could lead to pelvic inflammatory disease.
“Septic abortion, which happens when sticks and pebbles are stuck in to the vagina – this is still practised in many rural areas – to perforate the uterus could even lead to death because of haemorrhage. And finally, an infection could cause tubal blockage which could lead to infertility in the future.”
Explosion
The abortion rise is a “pan-India under-20 phenomenon”, says Dr Kurtkoti.
“Girls in the cities know where to go and how to get the abortion done. They have enough information. But the ones in rural areas don’t know much and they try and hide it and suffer from the social taboo. But generally speaking, there is an explosion in the number of abortions,” he says.
No point preaching
The Pune-based practitioner thinks advocacy and counselling are the best way to deal with unsafe abortion issues.
“There is no point in preaching morality. You can’t deprive youngsters of sex. What you can do is advocate safe sex. The first step is to promote contraception. Barrier contraception is the safest not just for pregnancy but sexually transmitted diseases as well.
“But if unfortunately a woman has an unwanted pregnancy, then my advice to her would be to act quickly. If you need an abortion, the earlier the better. Approach any general practitioner and ask for guidance. If he or she can’t perform the abortion, they would recommend you to the right person,” Dr Kurtkoti says.
Have you got experiences of abortion in India?