It's only right that women decide - When it's about our bodies
Rashi Kulkarni,* from Maharashtra, a 21-year-old working mother, was pregnant for the second time and didn't want to have another baby just yet. She went to a private clinic for advice on terminating her pregnancy.
The doctor told her that her pregnancy had progressed beyond the first week, she would need a surgical procedure, and would not be able to terminate it with medical abortion pills. Rashi didn't know what to do; she would not be able to afford either of these procedures, did not want to stay at home for a second pregnancy, and wanted to keep working.
Mitali Landage,* a community health worker, also from Maharashtra, told me that in all her years of work, she has often guided women such as Rashi. She has witnessed the limited information that most women have about abortion services - where to access them, the time limit for safely accessing them, what the medical abortion pills are, or their correct dosage, for instance.
Rashi's story isn't unique, unfortunately. Even after many years in the field, we still see and hear of too many stories where women get misguided, don't have the information to get appropriate services and care, and risk unsafe abortions that at times, result in death. Unfortunately, we don't know the full scale of the problem. The Lancet estimates that there were 73 per cent medical abortions in India in 2015 that occurred outside health facilities, which makes them risky, more expensive and harder to track.
Abortion was legalised in India almost 50 years ago under the Medical Termination of Pregnancy Act (1971). The act states that it can only be granted at the discretion of a medical provider - one medical provider must sign off for first trimester abortions, and two for second trimester abortions. However, providers are often unwilling to grant an abortion because of associated stigma, as well as other legal issues, such as the conflation with the Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act.
In a landmark judgment in August 2017, the Supreme Court of India ruled that all citizens have a constitutional right to privacy. In its statement on abortion, the apex court noted, "A woman's freedom of choice whether to bear a child or abort her pregnancy are areas which fall in the realm of privacy." However, the question that remains unanswered is whether the 1971 Act will be amended or strengthened so that women have the information and the right to decide and then avail the necessary and affordable service and care.
As highlighted in the story above, women also often incur financial hardships when accessing abortion services. Mitali says sometimes government facilities, where abortion services should be free, charge Rs 1,000 for surgical procedures and Rs 3,000 for medical ones. Private services cost up to Rs 60,000, if the woman is in her second trimester.
If women are to go to some private, unregistered facilities - they could be charged anywhere between Rs 40,000 and Rs 50,000. Many a times, couples or women, who are unable to bear this financial burden take up loans or continue with an unwanted pregnancy.
Women experience many barriers to fully exercising their rights when it comes to choosing if and when they want to have children. In keeping with the spirit of the International Women's Day, March 8, we must commit to ensuring no other woman has the same experience as Rashi.
To start with, we need policies that have the rights of women at the centre and ensure women have access to information and services for terminating unwanted pregnancies at no or reasonable cost. In addition, healthcare providers must be trained and sensitised, especially in government facilities, so they willingly provide proper post abortion contraception counselling. Furthermore, abortion providers who are unregistered and unqualified must be tracked and penalised.
Every time a woman is unable to access reproductive and sexual health services, is denied her rights, we as a society, take a step backwards. When a woman has control over her reproductive decisions, the information to choose the right option and access to services that protect her life, health and dignity; families, communities and economies thrive. Together, we can and must make that possible for every girl and woman.
*Names have been changed to protect identities.
(Anjali Nayyar is executive vice-president and Ria Basu is senior programme associate, Global Health Strategies)