With the Medical Termination of Pregnancy (MTP) Act coming into effect in 1972, India conveyed a strong message that it cared for the health of pregnant women who wanted to safely terminate their pregnancies. Yet, even four decades later, many women are still unaware that abortion is legal. Even access to safe abortion centres is severely restricted, especially in rural areas. As a result, there is a great mismatch between the number of abortion seekers and MTP-certified providers and centres. According to a 2008 study in Contraception journal, nearly three-quarters of abortion-certified facilities are in the private sector. Add to this the stigma and discrimination that women seeking abortion face, and it is not surprising that a large number of women still turn to unskilled providers to perform abortions using unsafe methods in unsuitable settings. In 2010-11, over six lakh abortions took place in government-approved institutions. The number of unsafe abortions taking place every year is not known. According to a 2008 WHO report, about “two thirds of all abortions” that take place in the country are outside authorised health facilities. As a result, abortions cause an estimated eight per cent of maternal deaths in India — a majority of which are due to unsafe procedures — according to the Registrar General of India’s data.
To complicate the situation further, the Pre-natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act, 1994 meant to prevent sex determination to avert female foeticide can work at odds with the MTP Act. It cannot be denied that selective abortion of girls has been increasing in India. As per 2011 census data, the sex ratio of girls per 1,000 boys dropped from 927 to 914 during 2001-2010, and from 945 to 927 during 1991-2000. Yet, a long-lasting solution can be achieved only by bringing about a cultural change and not by clamping down on abortion services and drug availability. A holistic approach is needed that will not lead to more women seeking out unsafe abortion providers, resulting in an increase in maternal deaths. The Protection of Children from Sexual Offences Act, 2012 and the Criminal Law Amendment Act, 2013 have also made matters worse for minors seeking abortion services. Even if minors indulge in consensual sex, the resultant pregnancy is presumed to be the result of rape and doctors may feel obliged to inform the authorities. While the 2012 and 2013 Acts have gone to great lengths to protect the interests of women and minors, these laws may unwittingly force minors to seek the services of untrained providers, thus putting their life in jeopardy. Reducing unsafe abortions will remain a distant dream if different Acts work at cross purposes.