Abortion Laws Seem To Be Fair To Indian Women, But What Is Their Reality?

Posted: May 27, 2019

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Women and the battle for their reproductive rights is still on despite a fair right to abortion in our Constitution. What does this really mean for women in India?

Recently, an unmarried young couple facing an unwanted pregnancy, visited my clinic seeking help.

“How did this happen doctor? We took precautions!”

“I know guys, unfortunately no form of contraception is foolproof. You can only do your best. How far along are you?”

“10 weeks doctor.”

“Why did you wait till now to terminate?”

“We went to a few doctors when the urine test came positive. Initially we thought it was stress, poor nutrition or hormonal imbalance that sometimes makes periods erractic. When we finally did the pregnancy test and ultrasound it was around 8 weeks. Then we visited a few doctors and they refused us because we are not married. They said to bring our parents.”

“But why? You both are in your twenties already right? It’s legal for you. It is legal if you are underage also, but you need parental consent.”

“Yes ma’am we are both working professionals. They refused us saying it is not legal. That’s why now we have to go for surgical method of abortion with you because it’s too late for medicine.”

Abortion rights for unmarried women

Do unmarried women have the right to a safe abortion without legal repercussions? Yes.

As per the MTP act of India, 1971, unmarried women too can obtain abortions safely and legally. Here are the experiences of five unmarried women who underwent abortions in India.

The couple who had come to me is an example of an unfortunate situation, where though the law is in place for unmarried couples to abort safely and legally, they were unable to do so.

More than half of all pregnancies in India are unwanted. 78% as of 2014 statistics. Of these, 25% are unwanted and eventually terminated.

Nearly half of all abortions worldwide are unsafe. Nearly 98% of these unsafe abortions occur in developing countries, with 55% in South East Asia. Half of all deaths (yes deaths) from unsafe abortions also occur in Asia.

A brief look at the MTP Act, 1971

A woman can seek an abortion on the following grounds:

  • To save the life of the pregnant person
  • To prevent grave physical or mental injury to the person as a result of the pregnancy
  • Pregnancy as a result of rape or incest
  • Fetal anomalies
  • Contraceptive failure in married women

Who can perform the abortion?

OBGYN and MBBS doctors with training in providing independent safe abortions.

Where can it be done?

At a healthcare facility certified by the CMO of the district as fit for performing abortions.

Till when can it be done?

  • Termination of pregnancy upto 12 weeks (3 months) requires the opinion of a single gynecologist.
  • Termination of pregnancy of 20 weeks, which is the current upper limit, requires direct supervision of two gynaecologists.

We have laws, we have legal rights for women, but does that mean they have, in this day and age, the freedom and right to obtain an abortion when they wish to? Yes!

Are they always able to get an abortion freely? No.

Most women do not face issues in getting an abortion if they visit the doctor within the first 3 months or 12 weeks of pregnancy. Beyond that, some doctors may not agree to terminate the pregnancy on any grounds other than that of a fetal anomaly.

Why do they go in for unsafe abortions?

Women in India are often denied the right to a safe abortion by their husbands, their families and sometimes by doctors themselves.

This happened to another patient who was denied safe abortion, ending up opting for unsafe abortion.

“Ma’am no one was giving us advice so one general doctor near our house gave us some tablets to take. He said periods will come. That was 3 weeks ago. She had a little bleeding, and now she is feeling dizzy, having pain in the stomach and vomiting. I am scared. What should I do?”

“Ok first of all, she may be having a pregnancy in the tube for which the medicines are different from what the general doctor gave you. You need to take her to a hospital urgently and she may need surgery, but please don’t panic, if you take her in time she will be fine.”

“But ma’am then our parents will come to know we will get into trouble.”

“That is something you can deal with later, right now saving her life is the most important thing!”

The World Health Organization defines unsafe abortion thus (slightly paraphrased): A procedure for terminating a pregnancy that is performed by an individual (you, your husband/boyfriend /good friend /chemist /quack) lacking the necessary skills, or in an environment that does not conform to minimum medical standards (like your house or a of a quack), or both.

In India, we have a law just to deal with this situation, in a safe and efficient manner. It is known as the Medical Termination of Pregnancy (MTP) act of 1971. Back then it was quite ahead of its time. It needs revision now, and several amendments have been proposed in 2014, but the same are yet to be translated into a concrete law.

It is disheartening that these safe services are, even today, underutilized. Women will not or cannot avail these facilities. There are several reasons for this with cost of treatment, fear of the procedure and legality and ignorance about the MTP act among them.

Where do Indian women in rural regions stand?

Women who faced no issues in getting an abortion had a few things in common. They lived in urban areas and were well educated and financially independent.

What  are the bottlenecks rural women face when trying to obtain an abortion from Government hospitals?

  • Requirement of ID card
  • “Requirement” of husband’s consent
  • In the absence of valid ID proof, hospital will not perform an ultrasound
  • Insufficient funds to get an ultrasound done privately
  • Refusal of admission in health centres if no attendant present

Honestly the above reasons are so lame yet so rampant, it’s ridiculous. Just like in today’s day and age kids should not be dying of diarrheal disease or malnutrition (but they do), no woman should die of an unsafe abortion simply out of despertion or for  lack of documentation.

Read here about a rural woman, who had migrated from another state, with an alcoholic husband and a year old baby, who nearly lost her life due to procedural hurdles at the Government hospital.

Why should we worry about unsafe abortions?

  • Complications usually occur in about 20-50% of women undergoing unsafe abortion
  • 20-30% of unsafe abortions result in reproductive tract infections
  • 20-40%  of which result in upper genital tract infections and infertility (tubal blockage)
  • 2% of women in the reproductive age group are infertile for this reason
  • 5% of women have long standing prolonged infections
  • Unsafe abortions also increase the chances of tubal ectopic pregnancy in the future (Pregnancy in the tube not the uterus, which can burst if undetected).
  • Increased chances of recurrent miscarriages
  • Increased chances of premature delivery.
  • Increased chances of the deaths of the pregnant women

The girl child in danger

Here is a scenario which happened with me a couple of times.

An aged woman (MIL), a pregnant young daughter in law and a son enter the clinic. Sometimes their daughter comes along too. Sometimes daughters.

MIL – Doctor aap ultrasound kar ke batao ki ladka hai ya ladki ab ki baar. (Please tell us the sex of the fetus)..

Me – That is illegal. Why do you want to know?

Mil and son look at each other uncomfortably, knowingly – Nahi agar ladki hai toh humein nahi chahiye. (we don’t want to continue the pregnancy if it is a girl baby)

Me – Hain? She is already in her fourth month, you can’t do anything and what you are suggesting is illegal please leave immediately.

MIL – Arrey doctor sahiba aap toh bura maan gaye. Aap hi koi aur rasta batao, ki shuru se hi ladka ho. (you have taken offence doctor, you tell us how to conceive a boy from the starting itself).

Me – Bilkul. Bura maan rahi hun. Aap ek lady doctor se bol rahey hain ki ladki nahi chahiye. Itna dimaag apni poti ko padhane mein lagayein toh woh bhi lady doctor ban jayein. (Of course I have taken offence, you are telling a female doctor that you do not want a female baby, you ought to use that brainpower in educating your daughters so they may become professionals instead).

Why are doctors hesitant to abort fetuses more than 12 weeks of age? For 10 million reasons.

Since 1991, 10 million female fetuses have been aborted in India. Of the 12 million female babies that are born each year, 1 million succumb to female infanticide.

The United Nations has reported that India’s female to male sex ratio between 0-6 years age group has fallen to 918 females per 1,000 males as of 2011, the lowest ever in a decade for the world’s second most populous nation.

“Gender-biased sex selection is first and foremost a reflection of how little our society values girls and women. The sharply declining child sex ratio in India has reached emergency proportions and urgent action must be taken to alleviate this crisis. The deteriorating ratio from 976 girls to 1000 boys in 1961, to 927 girls in 2001, and to 918 girls in 2011, demonstrates that the economic and social progress in the country has had minimum bearing on the status of women and daughters in our society,” says Ms. Lakshmi Puri, Deputy Executive Director of UN Women, Assistant Secretary General of the UN.

A sex ratio this skewed implies how little value females have in the Indian society. Something we know already; we face it in our daily lives.

The problem of female foeticide

It is well known among medical (and social) circles, that since the establishment of the PCPNDT* act that banned prenatal sex determination, Indians have been known to resort to other measures to fulfill their dream of having a son.

A lot fly to countries where sex determination is perfectly legal, find out the sex of the unborn baby, and on learning that it is a female, return to India insisting on an immediate termination of pregnancy. If they cannot get a doctor to do it, they go to a quack. Just so long as the female is not born alive and kicking. If by some chance an unwanted baby girl is born, there’s always female infanticide!

If a doctor is caught aborting a female foetus, they will lose their license to practise, even if they were ignorant of the patient’s intent.

Therefore, for pregnancies beyond 20 weeks, when the sex of a foetus can be determined, the law has made it mandatory to take permission, based on the advice of a medical board, in case there is a need for termination. But this law doesn’t stop people from aborting female foetuses; they go to quacks who are only too happy to do it for a bit of money, thus steamrolling over the wishes of the pregnant woman if she is not willing for this.

A colleague of mine told me of the harsh reality in rural areas where women deliver baby after baby despite not wanting to, because they are forced to by their in laws. The scenario is as follows.

“Doctorni sahiba, bahu/wife fir pet se hai. 4 mahine ho gaye hain. (Doctor, daughter in law is 4 months pregnant).”

“Hain? Aapke pehle se 3 betiyan haina? Ek pichle saal hi deliver hui thi? (What? Doesn’t she already have 3 daughters, one who is a year old?)”

“Haanji madam tabhi toh, humein toh bas beta chahiye. (Yes, that’s why we just want a son.)”

You should see the young woman in question carrying her new pregnancy. Barely having recovered from the last delivery, she is impregnated again so that the next, hopefully boy baby, may carry on the family name.

Can a woman to forced to become pregnant to fulfil family expectations? NO!

What does the law say about an Indian woman’s rights?

Does it give women any say in the matter of motherhood which is often denied to them by their own family?

It is the right of a woman to give birth to a child but it is not the right of a husband to compel his wife to give birth to a child for the husband. A woman is not a machine in which raw material is put and a finished product comes out. She should be mentally prepared to conceive, continue the same, and give birth to a child. The unwanted pregnancy would naturally affect the mental health of the pregnant woman.

Often I see patients who work as domestic help in the society I live in. One such woman came to me once. Twice. Thrice. The fourth time around I’d had enough.

“Didi aap apne husband ko kehte ho condom use karne ke liye? Yeh 7 mahine mein 4h abortion hai aapka! Yeh aapke sehat ke liya achcha nahi hai. (Why don’t you ask your husband to use a condom? This is your fourth abortion in seven months, it is bad for your health)”

“Doctorni sahiba main kya karun? Woh condom ke liye mana karte hai; unko acha nahi lagta. (What can I do, doctor? My husband doesn’t agree to condoms as they decrease his pleasure).”

“Toh aap copper T lagva lo. (So get an intrauterine contraceptive device inserted).”

“Woh paise nahi deinge. (He won’t pay for it)”

“Arrey 500 INR ki toh aati hai, aap le aao main aise hi laga dungi. (It costs Rs 500 only! You bring it; I’ll insert it for free).”

Husband would rather drink away her hard earned money than buy her a copper T. She doesn’t have the social support to leave the fellow.

Where does the law stand on this ? Does an adult woman require any consent, to be a mother or not, but her own? No!

The right of a woman to choose to be a mother or not emerges from her human right to live with dignity which falls within Article 21 of the Constitution.

Spousal consent requirements reflect patriarchal norms that rob women of bodily autonomy and equality. Courts in India have confirmed that abortion providers only require consent from an adult woman for an abortion. Husbands, boyfriends, brothers, parents and in-laws have no right to consent to termination or to refuse to consent to an abortion.

Where consent is needed, what does the law say?

For minors and those mentally challenged, a parent/legal guardian’s signature is required on the consent form. It is legal.

Foetal anomalies can sometimes only be detected after 20 weeks, and in India many women do not have ready access to the diagnostic tools necessary to check for abnormalities. Permission is needed from the court in such cases, and can further delay termination as happened in the case of Niketa Mehta. The courts decided  against the abortion of an anomalous foetus on the pretext that the 20 week window had been crossed.

Having said that, there have also been several cases where the courts did consent to termination of pregnancy beyond 20 weeks. A woman can also be permitted to terminate her pregnancy at 24 weeks, in cases where there is a danger to the health of the mother, as happened in this case.

What if the pregnancy is due to rape?

Then there is this horrifying true story of a 14 year old girl who was forced to marry her rapist and bring up the baby. The village elders and her family all came to the conclusion this was the best option, because of her family’s poverty and the fact that she had seven other siblings her father had to provide for. He could not afford to travel 50 kms one way to court to fight the situation, so this. It makes you wonder if India will ever progress.

Is this it for rape victims then? The ultimate solution is to marry your rapist and live happily ever after? Can there be a happily ever after when the beginning is such? Can they refuse to carry their rapist’s baby or do they have to live with it for the rest of the life?

What does the law say?

We cannot force a victim of a violent rape/forced sex to give birth to a child of a rapist (applicable to minors as well).

A rape victim shall not be further traumatized by putting her through a needless process of approaching courts for taking permission (for termination).

Yet though the law seemingly is in favor of safe, legal abortions, regardless of your age, marital status etc, why do women face such troubles? I wonder if men were in this situation, how much easier would life be for them? Heck, if men got pregnant, there may not be any laws in place.

When will women NOT have to fight for every right already permitted by law? And this, the most basic one. Why do they have to fight for control of their own body? Why does anyone else think they have the right to say what a woman can and cannot do with themselves.

Why is this of such importance now?

Recently, many US states, including the state of Alabama by passing what maybe arguably the most restrictive anti-abortion law ever to exist, has shown that the reproductive health of women resides in the hands, minds, and penises of men. Titled the Alabama Human Life Protection Act, this law prohibits women from having abortions under any circumstances, including following rape and incest. The only two exceptions to this law are when the foetus has an anomaly incompatible with life, and if the mother’s life is in danger as a direct result of the pregnancy and non uterine (ectopic) pregnancies.

A dire consequence of this act, would be an increase in the percentage of unsafe abortions.

There is a lot of progress to be made in India

We can first start by becoming aware of our rights. By educating ourselves and others who may not be able to read, supporting other women who may not be able to support themselves.

That would be a good start.

Image source: দেবর্ষি রায় from Brno, Czech Republic [CC BY-SA 2.0], via Wikimedia Commons and McKay Savage from London, UK [CC BY 2.0], via Wikimedia Commons

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Very feminist gynecologist. Cannot do without coffee and dogs. Bibliophile. Apart from seeing patients, most

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  1. what about married female who was forced into conceiving and wants abortion as there are no laws in India regarding marital rape

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