Pregnancy is usually considered a happy, blessed occasion, something most women rejoice over. But there are circumstances which leave no option but termination of the pregnancy in the best interests of the mother.
When a foetus is aborted in a healthcare facility by a registered medical practitioner trained in doing MTPs – medical termination of pregnancy – using methods recommended by WHO, it is called ‘safe abortion’. Safe abortions do not usually interfere with future pregnancies. But when a pregnancy is terminated using unscientific methods, without a registered medical practitioner’s guidance, several complications are possible, some of which could be fatal.
Heavy bleeding, damage or perforation of the uterine area (uterine rupture due to use of sharp instruments), cervical tears, problems in future pregnancies or inability to conceive and carry a foetus to term, sepsis, infections and death are the main fallouts of unsafe abortions.
When MTP is a necessity
Despite debates in some countries, which ban or partially ban MTPs, abortions are sometimes needed when the mother’s life is at risk due to complications arising out of the pregnancy, or when the pregnancy is the result of sexual abuse or incest, especially involving minor and mentally unstable girls, for instance. MTPs may also be recommended if investigations show that the foetus has abnormalities deformities. Sometimes, abortions are resorted to when contraceptive failure has led to an unwanted conception, and the couple is psychologically and/or economically not ready for parenthood.
Legal ramifications
In India, as per the amended MTP Act (2021), abortion is legally allowed for married and unmarried women up to a maximum of 24 weeks of pregnancy. Genetic abnormalities can be identified after 20 weeks. The woman’s consent is enough if she is above 18 years and is mentally fit. In case of a minor or a mentally challenged woman, consent of her legal guardians is required. If the MTP happens before 20 weeks, one gynecologist can take the decision about the procedure. If the MTP happens between 20 and 24 weeks, consultation with two gynaecologists is required. In exceptional cases, if MTP is required after 24 weeks, a state-level medical board consisting of government health authorities, a paediatrician, a gynecologist and a radiologist will decide on the step. The decision has to be taken within three days and the procedure undertaken within five days.
Medical management
Speaking about the correct way to go ahead with MTPs, Dr Bhavana Kasa, consultant gynecologist and obstetrician at Rainbow Hospital, Hyderabad, says, “MTPs are free of cost in government healthcare facilities and are usually an out-patient procedure if done within three months of pregnancy. If done after three months, then a 24-hour stay at the hospital may be required. MTPs from the seventh month onwards may require a small surgical procedure. Usually, oral medication is given and manual vacuum aspiration is done to suction out the foetus through the vagina. If pregnancy is formed in the fallopian tube, pills may not be sufficient to abort the foetus. Injections and laparoscopic surgery might be required. The patient is given antibiotics and pain relief medicines, advised a couple of days of rest and asked to come back for a follow up and further scan a fortnight later.”
Processes involved
“If the monthly period is missed for one or two weeks, a urine test and Beta HCG blood test should be done without delaying. If the test results are positive, visit a clinic and see a doctor. Carry all health records and reveal any existing ailments to the consulting doctor. A scan can reveal the time and stage of pregnancy,” adds Dr Bhavana.
Why unsafe abortions are resorted to
There are various socio-economic-psychological factors which force people to try performing an abortion themselves, or go in for unsafe MTPs. Dr Bhavana says, “Most patients fear stigma and lack of confidentiality. Therefore, they visit quacks and unlicensed practitioners. There is also a lack of awareness about oral pills and proper medical methods such as injections and surgical evacuation. Previously, if the pregnant woman was a minor, the police had to be notified and doctors were afraid to take up medico-legal cases. But now, with the amended MTP Act, this is not required and patient care is prioritised before the matter needs to be reported.”
“Sometimes, people take over-the-counter emergency contraceptive pills to stop conception, but they take the medication after the cut-off time of within 72 hours of intercourse. Due to the delay, pregnancy develops and the effect of the contraceptive pills at the wrong time causes hormonal issues and other complications, necessitating an abortion,” adds the doctor.
Statistics pertaining to MTPs
As per a 2017 study done by New-York based Guttmacher Institute and the Indian Institute for Population Sciences (IIPS), Mumbai, around 15.6 million abortions were conducted in India in 2015. The abortion rate was 47 per 1,000 women aged 15-49 years. The study was also published in the Lancet.
Abortions were done on one-third of all pregnancies and nearly half of the pregnancies were unintended.
