May 18, 2008

Unsafe abortions, a silent scourge

Savita Joglekar, a mother of two, didn't realise what she was getting into when she visited a local dai (midwife) in her village in Maharashtra, to abort an unwanted pregnancy. The dai gave her a bitter concoction and an abdominal massage and told her to return later.

The next day, after hearing that she had not bled, the dai inserted a stick into her private parts. Running a high temperature and crying out in pain, Savita had to be rushed to a hospital. The doctors were shocked to see her — her uterus was badly damaged and the intestines were punctured. Luckily, she was saved in time.

In a country where over 18,000 women die every year due to unsafe abortions, Savita is one of the few survivors. It's a sad reality that 8% of all maternal deaths are due to unsafe abortions. An estimated four million women undergo unsafe abortions every year in India — one-fifth of the global figures.

Abortion is still a dirty word and most women, especially in rural India, shy away from seeking legal medical help. As a result, most of them end up visiting the local dai.

"It's only when things get out of control that they visit a primary health centre. It's the last resort in most cases. By the time a doctor sees them, many of them are beyond help," says Elizabeth S Maguire, president and CEO, Ipas. The NGO works with the National Rural Health Mission to reduce maternal deaths due to unsafe abortions.

In a few cases, the women have been so badly injured that they have no chance of ever becoming pregnant again. Take Lily Toppo's case. When the 14-year-old schoolgirl became pregnant, her family took her to a local nurse in their village in Jharkhand for a secret abortion. While doing the procedure, the nurse perforated the rectum. And it was 48 hours before the girl was rushed to a hospital and operated upon. Three months later, the doctors are still not sure whether she can get pregnant again.

A study done by Ipas in 2007 in Jharkhand, found that 20% of the reported abortions were carried out at home through unsafe methods, of which 51% women had post-abortion complications. A similar study in Madhya Pradesh, conducted in 10 hospitals, showed that 29% women brought to the hospitals, suffered from post-abortion complications. In 67% women, complications included incomplete or failed abortions. Yet another study undertaken in 2000 by King Edward's Medical College highlighted that 67% women admitted to hospitals in Maharashtra, reported complications, of which 6% were life-threatening while 3% resulted in deaths.

In Puducherry, a survey done by Jawaharlal Institute of Postgraduate Medical Education & Research in 1999 found that 41.8% suffered from post-abortion complications and 24% had to be hospitalised.

Unfortunately, few women are aware that the quite common, but unsafe, method of dilation and curettage (D&C) is a big reason for complications. The WHO guidelines clearly state that this method increases the risk of complications. It advises that either medical vacuum aspiration or medical abortion should be followed.

Safe techniques not only save a woman's life but money too. It was found that after safe techniques were introduced in South Africa, deaths from unsafe abortions dropped by 91%.

But what stops most women from visiting a hospital is the lack of legal abortion facilities closer to their homes. "The government mandates that every primary health centre must provide legal abortion service but in reality, that doesn't happen," points out Vinoj Manning, country director, Ipas.

Also, very few trained service providers are available today, making it difficult for PHCs to provide services. Besides, while very few women (just 13%) are aware that abortion is legal, only 0.3% know that it's legal to abort up to 20 weeks of pregnancy.
Contrary to popular wisdom, it's the married women who opt for abortions. "In rural areas, most girls get married young and have children while in their teens. When they don't want more kids, they try to abort," says Manning. Despite all efforts, the problem still persists. As Maguire says, "Safe abortion is not just about health; it's a human rights issue. It's about women's empowerment." For women like Savita, it's more than that — it's their right to life.

meenakshi.kumar@timesgroup.com on Times of India

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