When men and women have sex, women can get pregnant. Every act of sex does not cause a pregnancy but when there is a pregnancy, it is in the woman’s body. Never the man’s.It is this very basic biological fact that anchors the argument for women’s right to safe abortion.
For women to fulfil their potential as human beings in society, they need to be able to control their fertility. Since the pregnancy is borne by a woman within her body, risking her health and sometimes her life, she should be able to take a decision whether to be pregnant or not, and whether to continue a pregnancy or not.
Despite the maternal mortality rate having dropped in India in recent years, we still have one of the highest rates of women dying during pregnancy and childbirth.
The past few decades have seen a steady lowering of the age of menarche to 10 years of age now, while the age of menopause continues to be around 50. So a girl who is 10 today can expect to deal with about 480 menstrual cycles in her lifetime, while desiring maybe one or two children.
She will thus need a contraception that will protect her from having an unwanted pregnancy 398 times, without fail.
As one can appreciate from this, the risk of an unwanted pregnancy is always high.
Contraception.
In developing countries like India, about half of the sexually active women of reproductive age want to avoid pregnancy, but as many as 17%-50 % are not using any method of family planning.
Issues like lack of knowledge, myths, and misconceptions, as well as limitations in women’s autonomy and agency, means that access to such methods is often limited for some women who are unable to negotiate for it.
Further, of the estimated 87 million unplanned pregnancies that occur each year, around 26.5 million are due to inappropriate use or method failure. Even if all users were to follow instructions perfectly, there would still be nearly six million accidental pregnancies per year.
Unwanted Pregnancies.
In addition to problems of access and contraceptive failure, women experience many other life circumstances in which they want to interrupt a pregnancy, such as when resulting from rape, where it poses health and life risks to the woman, foetal abnormalities, economic and other personal reasons, such as being involved in an abusive relationship, having another small child, or any other reason impairing their ability to take the pregnancy to term and raise another child. With the increasing number of humanitarian crises, more women are likely to face unwanted pregnancies needing access to safe abortions.Methods of Abortion.
An unwanted pregnancy can be terminated by using surgical methods or using medical pills. The latter has been registered in India since 2002 and is available as a combi-pack containing Mifepristone and Misoprostol.
Barriers to Access in India.
Control over abortion access has been part of a long historical struggle, with the patriarchal culture, glorification of motherhood, religion, politics, and economics playing as big a role in every phase. When women want to terminate an unwanted pregnancy, whether it was planned or not, they will often face a multitude of barriers. These range from restrictive laws,negative provider attitudes and disinclination to interpret the law to the fullest, lack of service delivery facilities, and non-availability of medical abortion pills, among many other reasons.
India has had a law since 1971 which makes abortions legal but despite that there are difficulties in access and women continue to die from unsafe abortions.
The last two decades have seen a new hurdle to access emerging as a result of sex determination and the policy and programme responses to it.
Catch any Indian on the street right now, whether in cities, villages or inside 5 star meeting rooms and conventions, and ask them what they think about abortion. Chances are that you will be told it is a terrible thing because girls are being killed.
As a doctor and a woman I cannot stress how important it is that this conversation should change – and it should really be a conversation about why these two are separate issues and why women must always have the right to a safe abortion in order to control their own bodies and lives.
If there is a connection between abortion and female infanticide it is this: the reasons for both are often rooted in sexism.
These protectionist approaches reflect a lack of understanding that inherent gender discrimination in the society is the root cause of sex determination, and a lack of recognition that safe abortion is a woman’s right or a bodily autonomy issue.[xi]
Until a woman can control her body and her fertility she cannot be truly equal to a man in society.
What Do We Need?
We need to place safe abortion within the spectrum of sexual and reproductive health and rights, and advocate for de-criminalisation, legalisation, and accurate information on availability of abortion. We need to address stigma on sexuality and abortion, and bring in discussions on patriarchy, which leads to gender inequality and subordination of women to the extent that they do not have control over their sexuality and body.
We need to shift the conversation from pro-choice to pro-rights, since no choice exists in a vacuum. We need to question whether the laws preventing sex determination and punishing those involved push the decision burden on individuals, while not contributing to eliminating gender discrimination in any way.
We need governments to invest adequate budgets for providing services in the public sector, and to ensure regularisation of services (quality and costs) in the private sector. We need better tools for data collection, monitoring and evaluation, not just of technical quality, but also of women’s perceptions.
We need to invest in gender and rights training of health care providers, in the pre-service years and beyond. We need all service providers, whether in public or private, to be aware of and invest in data security measures, especially digital security, in order to ensure confidentiality and safety for the women and themselves.
We need to integrate safe abortion advocacy efforts with the entire intersectional movement around issues like safe motherhood, obstetric violence, sexual health and rights, reproductive health and rights, LGBTIQ rights, child marriage prevention, sexuality education, and violence against women.
We need to create a world where it is unacceptable for a woman to die because she was forced to seek an unsafe abortion.
Dr Suchitra Dalvie
MD,MRCOG
Coordinator, Asia Safe Abortion Partnership