According to the Brihanmumbai Municipal Corporation (BMC) – a civic body that
governs the city of Mumbai,
that the city witnessed a 44% rise in the number of abortions in the year
2012. While 19,701 abortions were
registered in 2011, BMC data from various public and private hospitals and
nursing homes in 2012 showed 28,455 abortions.[1] So, what is the reason for the sudden increase? It would be interesting if given information about abortions has
been presented by age and socioeconomic status.
The health experts say that the steep
increase in the number of abortions shouldn't be linked to sex-determination
tests. "Most of these abortions have been carried out in the first
trimester when it isn't possible to detect the sex of the fetus," said a
doctor with a BMC hospital. Public
health officials say it is largely due to better reporting of data by hospitals/clinics
brought on by computerization. However, it
appears that young women are increasingly using abortions or repeat abortions as a form of birth
control.
Abortion is the
termination of pregnancy by
the removal or expulsion from the uterus of
a fetus or embryo prior to viability. An abortion can occur
spontaneously, in which case it is usually called a miscarriage, or it can be purposely induced. The term abortion most commonly refers
to the induced abortion of a human pregnancy. It can be medical or surgical. Abortion is legal in India. The Indian
abortion laws fall under the Medical Termination of Pregnancy (MTP) Act, which
was enacted by the Indian Parliament in the year 1971. The MTP Act came into
effect from April 1, 1972 and was once amended in 1975. India’s abortion law is
liberal. As per India’s abortion laws only qualified doctors under stipulated
conditions can perform abortion on a woman in an approved clinic or hospital.[2]
If Mumbai
alone has so much of abortion cases, if the whole country is taken into account
the figures would be blasting. Officially there is no
precise estimation on annual incidence of induced abortion. The statistics
which Ministry of Health and Family Welfare (MoHFW) publishes pertains only to
the reported MTP cases conducted in government's recognized hospitals/clinics. According to available official statistics, the number
of abortions performed as per MTP Act has increased from 388,405 in 1980-81 to 620,472
in 2010-11. However, these figures are only the tip of an iceberg as it is
estimated that in India less than ten percent of the abortions are carried out
in government recognized institutions.[3] India recoded around 6.5 million abortions in
2008 of which 66% were deemed unsafe, as per the MoHFW, Government of India.[4] It
means an additional 6.0 million abortions are conducted illegally. Majority of
these cases are done in rural areas having inadequate facilities and hence done
in an unhygienic and unscientific way. All such abortions are considered as
illegal and hence not reported in any official statistics. These illegal
abortions are a major determinant of continued high levels of maternal
morbidity and mortality in India. According to, the MoHFW, 8% (approximately
4,600 deaths annually) of all maternal deaths are due to
unsafe abortion
Now question arises: Why Women Choose Abortion?
Or what are reasons behind the abortion decision?
A woman's decision to have an abortion is "motivated by multiple, diverse
and interrelated reasons," as per the
Alan Guttmacher Institute.[5] In other words, reasons
why women have abortions are diverse and vary dramatically across the world.
Some of the most common reasons are to postpone childbearing to a more suitable
time or to focus energies and resources on existing children. Others include
being unable to afford a child either in terms of the direct costs of raising a
child or the loss of income while she is caring for the child, lack of support
from the father, inability to afford additional children, desire to provide
schooling for existing children, disruption of one's own education,
relationship problems with their partner, a perception of being too young to
have a child, unemployment, and not being willing to raise a child conceived as
a result of rape or incest, among others. An additional factor is risk
to maternal or fetal health, which was cited as the primary reason for abortion
in over a third of cases in some countries and as a significant factor in only
a single-digit percentage of abortions in other countries.[6] Some
abortions are undergone as the result of societal pressures. These might
include the preference for children of a specific sex, disapproval of single or
early motherhood, stigmatization of people with disabilities, insufficient
economic support for families.
The MoHFW
collects information about reasons behind MTP cases at the time of abortion.
Table 1, based on more than 330,000 responses, clearly indicates that “failure
of contraceptive” was the main cause behind the induced abortion. It means about half of women having abortions were using a
form of contraception (traditional or modern) at the time of becoming
pregnant. Inconsistent use was also part of this response including lack of
access to or rejection of available contraceptive methods. More than one fourth felt that negative impact on
the mother's physical and mental health was another important reason. Taken at
face value, this reason may sound selfish. But a pregnancy that occurs in the
wrong place at the wrong time can have a lifelong impact on a woman's ability
to raise a family and earn a living. Less than half of the acceptors were
illiterate and literate below primary (45%). Official statistics also indicate
that more than 60% of acceptors were between 20 to 29 years of age. It means
most of them were married.
Table1: Distribution of MTP cases by reasons
for terminations, 2003-04
|
Reasons
|
Per cent
|
|
Failure of contraceptive
|
46.3
|
|
Grave injury to physical and mental health
|
26.1
|
|
Danger to life
|
12.1
|
|
Substantial
risk and rape
|
4.9
|
|
Others
|
10.6
|
|
Total
|
100.0
|
|
Total number of MTP cases who responded
|
331,441
|
|
Source: Family Welfare Statistics in India -
2006, Ministry of Health and Family Welfare, GoI. New Delhi.
|
|
Based on the field study, the Forum for Population
Action estimated that most abortions in the study areas were obtained by poor
women because they have much higher rates of unintended pregnancy.[7] The following statements recoded
during the study reflect concerns that play a role in influencing women to
terminate their pregnancies:
·
I
don't want more children or I'm done with childrearing
·
I'm
not ready to become a mother or not ready for another child
·
My
husband/partner/parents wants me to have
an abortion
·
There
are problems with the health of fetus
·
There
are problems with my own health
·
Available
family planning methods are not suitable
·
Quality
of family planning services is not up to the mark
·
I
don't want others to know about my pregnancy
What is future of abortion in India?
In other words, whether number of abortions will increase? This requires an understanding of relationships
between contraception and abortion. According to Cicely Marston and John Cleland[8] that the “relationship between levels of contraceptive use and the
incidence of induced abortion continues to provoke heated discussion, with some
observers arguing that use of abortion decreases as contraceptive prevalence
rises and others claiming that increased use of family planning methods causes
abortion incidence to rise”. Based on the data from several countries, the
authors concluded that: “Rising contraceptive use results in reduced abortion
incidence in settings where fertility itself is constant. The parallel rise in
abortion and contraception in some countries occurred because increased
contraceptive use alone was unable to meet the growing need for fertility
regulation in situations where fertility was falling rapidly”.
In India,
looking to the present state of family planning, the contraceptive use alone will not be able to meet the growing need for
fertility regulation since fertility is falling rapidly. Many
experts, therefore, feel there is a reason for the rising numbers — fewer
options for women with regard to
the method of abortion. Approximately 35 million pregnancies occur
each year in India. Out of this, more than two in five pregnancies are
unintended by the women who experience them, and half or more of these
pregnancies end in abortion including induced abortion. It is estimated
that around 26.5 million children are born in India every year and out of this
about 6 million births have been classified as unplanned or unintended. Approximately two-thirds of these
pregnancies resulted from non-use of contraceptives; clearly indicating the
need for easy availability of quality family planning services with proper
“method mix”. India's family planning program has largely failed to encourage
the use of reversible methods, particularly among young women (age 15-25) who
are in the most fertile years of their reproductive period.[9] In
addition, around one-third of unintended pregnancies resulted from the
ineffective use of contraceptives, which suggests the need for improved
counseling and follow-up of couples that adopt a method. In other words, there is a tremendous need to revamp the family
planning program in India to provide services looking to the needs of clients,
since abortion is increasingly being used as a form of
contraception.
What ever may
be the case; the trend of increase in abortions each year like Mumbai is very
negative and should be viewed seriously by the government and voluntary/donor
organizations, before things go out of hand.
[2] Chandrasekhar, S. 1994. India's Abortion Experience: 1972-1992. Denton, TX: University of
North Texas Press.
[3] For details, refer: Khan M.E., Barge Sandhya and Philip
George. 1996. “Abortion in India: An
Overview”, Social Change vol. 26(3 & 4).
[4] Refer: Kounteya
Sinha, “Encourage women for safe abortion: NRHM”, Times of India, July, 7,
2012.
[5] Refer a note entitled: “Women and Abortions:
the Reasoning behind the Decision”, circulated by the National Organization for Women (NOW), an
organization of feminist activists in the United States.
[6] Bankole, Akinrinola; Singh, Susheela; Haas, Taylor. 1998. "Reasons Why Women Have Induced Abortions:
Evidence from 27 Countries". International Family Planning
Perspectives 24 (3):
117–127.
[7] Devendra Kothari. 2010. Fertility preferences
in Rajasthan: An analysis, FPA Working Paper, Jaipur: Forum for Population
Action.
[8] Refer: Cicely Marston
and John Cleland. 2003. “Relationships between Contraception and
Abortion: A Review of the Evidence, International
Family Planning Perspectives, 26 (1).
[9] Refer: Author’s Blog - Controversy over Injectable
contraceptives in India: How to resolve it? August 1, 2011 at link
kotharionindia.blogspot.com.
