A spurt in the cases of self-administered abortions using medical abortion (MA) pills, especially in the absence of adequate medical supervision, is increasingly leading to botched up abortions, excessive internal bleeding, infections, and in certain cases, loss of fertility in women. Despite a legal ban on over-the-counter sale of these abortion pills without a prescription, they are widely and easily available. These “do-it-yourself” abortions, experts told The Sunday Guardian, have become a popular choice among women, since they allow them to terminate unwanted pregnancies in absolute privacy for as low as Rs 500.
According to a recently published study by Lancet, out of the 15.6 million abortions that took place in India in 2015, 81% were carried out within homes using MA pills.
CONFIDENTIALITY OVER SAFETY
Despite having heard and extensively read about MA pills and their side-effects, Priyanka (name changed), was taken in for a shock when the bleeding, the pain in her abdomen, and the vomiting did not stop for a month after she had taken the pills. She had “easily” procured the pills from a pharmacist, without seeking a doctor’s consultation. A “nightmare” of a month later, the bleeding did stop. Yet, she did not see a doctor to check if all was fine. “The whole point, after all, was to maintain confidentially,” she said.
Medical abortion (MA) is a method of termination of early pregnancies (up to seven weeks) using a combination of WHO-approved drugs. Though abortion pills have been recognised as a safe technology despite common side-effects like bleeding, vomiting, nausea and headache, the informal and unsupervised use of these pills can lead to severe health complications in women.
Dr Nimmi Rastogi, a gynaecologist from New Delhi, said: “Abortion pills are being used by very young girls and this practice puts their fertility at stake. Some women use it excessively, almost every second or third month. In cases of late pregnancies (beyond seven weeks), use of these pills has led to incomplete abortions after which a surgery had to be carried out. Use of these pills causes pelvic infections too, and aggravates the problem in women who already have infections.”
Experts unanimously noted that women who use abortion pills rarely even go for an ultrasound, which is important to localise pregnancy, before consuming the pills. Dr Ramandeep Kaur, Consultant, Obstetrics & Gynaecology at Fortis Hospital, said: “There are cases when the pregnancy is in the Fallopian tube and not in the uterus. In such cases, consumption of these pills can lead to rupture of the tube and internal bleeding. The patient may even go in shock and die due to excessive internal bleeding, though that happens rarely. Sometimes, blood transfusion has to be carried out in cases of excess blood loss.” According to Dr Rastogi, the chances of developing complications in cases of unsupervised medical abortions are more than 40%. “Consumption of medical abortion pills is safe as long as there is a proper diagnosis followed by tests, ultrasound and regular follow-ups. In 40% of the cases, use of these pills backfires,” she told this newspaper.
Medical experts also added that the lesser educated women fall at the mercy of quacks who run unregistered clinics in slums and back-alleys. On the condition of anonymity, a woman who does daily chores in homes at Rohini, told this correspondent how one of the girls in her area had an incomplete abortion after she approached a quack for the termination of her pregnancy. “The girl was pregnant for over seven weeks and should not have been given abortion pills. But the quack went ahead which led to a botched up abortion. She had to be admitted to a private hospital and had to be operated upon,” the woman said.
Lack of awareness and a trained provider base for performing abortions, and the stigma related to unplanned pregnancy and abortion, are putting single women in vulnerable positions, experts noted. Most women who are single, experts say, back out from approaching proper hospitals or private clinics for the fear of being found out. In certain cases, as the one mentioned above, women go out to seek professional medical support, but end up consulting non-qualified medical practitioners. It’s a simple “no questions asked” process. Dr Rastogi added: “The stigma around abortion is such that nobody wants to discuss their abortion history. In most cases, unmarried girls get into the trap of unsupervised medication and quacks, simply because they want to get past the situation. For them, these abortion pills are a boon since they get to win over by a simple measure and a Rs 500 kit..”
Dr Ramandeep Kaur said that government and private bodies need to run campaigns to make people aware of the consequences of self-administered abortion pills. No targeted campaigns have been done so far in this regard.
Poonam Muttreja, Executive Director, Population Foundation of India, said: “Increase in awareness through a strong behaviour change communication programme can bring about a change in attitudes and social norms that could break the silence surrounding these issues and make it okay for women to visit a registered medical practitioner. Women should also have access to reliable helplines where they can receive information about whom to approach and the necessary steps that could be taken when they need assistance.”