A 25-year-old woman in Nagpur used household utensils to self-abort last year by watching a YouTube tutorial. The procedure that involves a safe place, safe tools and a trained medical practitioner was carried out by herself, in her own home when her parents were away. The woman survived but she had to spend days in the hospital, recovering from an acute infection from the procedure that could have killed her.
This is not the only story of a botched abortion.
With barely any information available on accessible abortion, a lot of Indians are forced to find answers on the Internet, often ending up in hospitals if they are lucky to be alive. "This also happens because sexuality is stigmatised in this country," said Suchitra Dalvie, co-founder and coordinator of the Asia Safe Abortion Partnership.
India recognised abortion as a legal right with the Medical Termination Procedure (MTP) Act in 1971, that is two years before the landmark US Supreme Court Roe V Wade judgment that they recently overturned. And yet, women in India die every day due to unsafe abortions.
"There's no sex education in schools. Young people in our country don't have access to contraception. That just means we are pushing them to a dangerous place where they barely have any understanding of reproduction or contraception," said Dr Dalvie.
Unsafe abortions are the third leading cause of maternal mortality in India, according to the United Nations Population Fund (UNFPA)'s State of the World Population Report 2022. The report that included cases between 2007-2011 said that about 67% of abortions in India are unsafe, killing 8 women every day.
The Misinformation On Abortion Rights
The Nagpur incident was a repeat of a similar episode in Tamil Nadu in 2020 where a 27-year-old man was arrested for trying to abort his teenage girlfriend's pregnancy by pulling out the foetus of her womb with his own hands that he "learned" from a YouTube tutorial. The man bought gloves, surgical blades, scissors, and surgical gel after watching YouTube videos on home births.
It was only when the girl started bleeding profusely that the man took her to a government hospital a few kilometers away. Later, it was found out that the pregnancy was a secret kept away from the girl's family because she was too scared to tell them about it. And neither of them knew that she could get an abortion (even though they were unmarried) legally.
"The biggest misinformation is that there is no information on abortion rights," said VS Chandrashekhar, CEO at Foundation for Reproductive Health Services India (FRHS). He said that a large population of the country still does not know that abortion is legal and won't get you arrested.
Turns out, that only 20% of women in India know abortion is legal, according to Banerjee et al. BMC Health Services Research 2014. The rest either think it's a criminal act or they are unsure. The same study revealed that 71.1% did not know abortion is legal up to 20 weeks of gestation.
The recent amendment to the MTP Act (2021) changed the condition that only a "married woman and her husband" can terminate unwanted pregnancies caused by contraceptive failure to include all women, regardless of their marital status. The amended Act also increased the gestation limit for abortion from the earlier ceiling of 20 weeks to 24 weeks, but only for special categories of pregnant women such as rape or incest survivors. But reproductive rights activists say that the law still does not recognise abortion as a woman's choice that can be sought on-demand.
"Most women, especially from rural areas, think abortion is not legal," Dr Dalvie said.
There's more. The government's message against 'female foeticide' has got lost in translation, misinforming women that abortion itself is a crime. "The word 'kanya' often gets dropped from the message of 'kanya bhrun hatya' leaving behind 'bhrun hatya'," the doctor added.
The misinformation on abortion is rampant, both offline and online.
A YouTube channel with over 1.49 million subscribers suggests a list of food to eat in copious amounts- Papayas, pineapples, green tea - for a 'natural abortion'. The disclaimer that lasts less than a second says that the information provided is based on ayurvedic books, articles, traditional medicine, and ancient remedies.
There are multiple similar videos on the YouTube channel but just this one video has over 1.5 lakh views.
"None of these methods are effective. But while they are useless, they are relatively harmless," said Dr Dalvie.
The doctor who has been working to provide safe abortion rights to women said that there have been cases where women have landed at hospitals after trying to insert court hangers, knitting needles, and sticks inside their bodies. "Anti-malaria medicine, bleach, and even rat poison have been consumed by women to get rid of an unwanted pregnancy," she said. However, she added that none of these methods are effective, and are only likely to kill the woman.
Abortion Is Legal. So Why Unsafe?
In America, misinformation about abortion has long circulated in right-wing communities. A liberal watchdog group Media Matters for America found in 2019 that 63% of links with the most Facebook interactions came from right-leaning websites that pushed anti-abortion falsehoods among the top engaged abortion-related stories on the social media platform.
With the overturning of the Roe v Wade order, there's a fear that disinformation will spike further.
Just days after the court verdict in the US, a video with grinning toddlers that showed inspirational tales of women who reversed their medical abortion went viral. Emotionally charged videos and memes started going viral —they claimed that there are safe ways to "reverse" an abortion, or that surgical abortion causes cancer, or abortion pills cause infertility. None of them are true and there's no medical evidence that abortion pill reversal is possible. However, these were the videos that greeted social media users after the landmark Roe V Wade decision was overturned, pushing women's reproductive rights many decades back.
"India does not have the American problem but despite abortion being legal in India it is highly stigmatised and that leads to many unsafe abortions," said VS Chandrashekhar who has spent over three decades steeped in the reproductive health field in India and is currently the Country Director at MSI Reproductive Choices in Tanzania.
There are multiple barriers to getting a safe abortion. VS Chandrashekhar explained that the lack of information on the legality of abortion and where to get one are the reasons for unsafe abortions. In some cases, that lack of information translates to watching YouTube tutorials. And in others, it means going to a quack for a secret termination of pregnancy that may result in infection or death.
To make things worse, there is only a limited number of legal abortion providers. "The MTP Act states that in order to be recognised as a legal abortion provider one has to be approved by a district-level committee," said Chandrashekhar explaining why the number of legal abortion providers is so few. Only 24,000 abortion providers are legally allowed to do so in the private sector.
While government hospitals and primary healthcare centers are supposed to provide abortion services, they often don't. "They either don't have trained manpower or the equipment to provide abortion services leaving a large population with no choice but to find out on their own how to end an unwanted pregnancy," he said.
The 2015-16 National Family Health Survey (NFHS) showed that private clinics and hospitals, which are concentrated in urban India, were responsible for 52% of abortions. Only 20% of abortions took place in public healthcare facilities.
About 66% of India's population lives in rural parts of the country, where there is a severe shortage of obstetrician-gynecologists, according to the Indian health ministry's 2019-20 Rural Health Statistics Report. As a result, many abortions are often performed by midwives, auxiliary nurses, or birth attendants and are, therefore, considered unsafe.
The conflation between gender bias sex selection, the negative news around abortion, the stigma, and the numerous court cases — all add up to the unsafe abortion methods.
Between 1st June 2016 till 3rd February 2018, High Courts in India received 173 cases seeking permission for termination of pregnancies. Among these cases, 40 were below the gestation period of 20 weeks. "The fact that such cases came before the court show that people are not even aware that abortion is legal in India," said Anubha Rastogi, a lawyer and the author of the report 'Assessing the Judiciary's Role in Access to Safe Abortion' by the Pratigya Campaign.
"One needs to knock on the court's doors only when the gestation has exceeded the permissible limit or if the doctors refuse to conduct MTP for some reason. But there's a feeling that abortion is a crime and that's why people believe they have to go to court to get permission for it," Rastogi said.
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