State level meeting to Advance Women’s to Comprehensive Abortion Care Jaipur, Rajasthan, 8th December 2017

Shri Naveen Jain, Mission Director, National Health Mission (NHM) Rajasthan speaking at Pratigya consultation

Friday 8th December, 2017
(9.30 AM to 2:30 PM)

Shikshit Rojgar Kendra Prabandhak Samiti (SRKPS) the lead partner of Pratigya in Rajasthan in collaboration with NHM, Rajasthan convened a meeting with state drug controller & inspectors to discuss the conflation of PCPNDT and MTP Act, which is impacting access to safe abortion care in the state. The discussion was focused around the challenges to abortion access and solutions to strengthen implementation of the Medical Termination of Pregnancy Act (MTP Act) implementation in Rajasthan. The meeting participants included state and district level staff of the state’s Department of Medical, Health and Family Welfare, state PCPNDT and MTP officials. Pratigya partners, i.e. Ipas, PSI, PHS India, ARTH, FOGSI representatives were also present at the meeting.

State of Rajasthan has taken many pioneering initiatives in to address the issue of sex selection, which has been well recognized nationally. However, it appears that in some areas, the overzealous implementation of the interventions in the field has resulted in stigmatizing abortions and abortion providers, resulting in reduced access to safe abortions in the state. There has also been unnecessary scrutiny and demands on documentation from chemists and distributors of medical abortion drugs, which has resulted in reduced access of this life saving drugs for women. The meeting was an opportunity to ensure that the interventions to prevent sex-selection do not adversely impact access to safe abortions in the state. The meeting objectives were:

Mr. Rajan Choudhary initiated the discussion and talked about the current context of abortion access in the state. It was followed by a brief presentation on Pratigya intent and objectives from Ms. Anupam Shukla. She clarified the MTP and PC PNDT Act and highlighted the challenges faced by trained providers in providing MTP services in light of the overzealous implementation of PC PNDT activities in the state. She also discussed the ways in which Drug controllers can play a critical role in ensuring availability of Medical Abortion drugs in the state. The state maternal mortality ratio (244) is higher than the national average. Unsafe abortion is among the leading causes of maternal deaths, a state intervention in this direction can help save many womens’ lives. In India, 24.3% pregnancies are unintended due to the poor negotiating power of women around sexual and reproductive activities, non-consensual sex, poor access to contraceptives and lack of awareness regarding sexuality and reproduction. (Recent Guttmacher study results have shown that half of the 48 million pregnancies are unintended and one-third of them results in abortion). Lack of adequate numbers of trained providers, negative communication on abortion (in PC PNDT campaigns) also creates barriers for women seeking abortion services. The data shows that only 9% of total abortions might be sex-selective in nature, the government should take appropriate measures to ensure that women are able to access safe abortion services in the state.

Shri Naveen Jain, MD NHM as a chief guest addressed the gathering and asked Drug controller & inspectors to help women in exercising their abortion right by ensuring availability of MA drugs in the market. He reassured that his campaign ‘Daughters are Precious’ and other PC PNDT activities aim towards preventing sex –selection practice and doesn’t interfere with abortion services. He clarified that the PC PNDT decoy operations are conducted to nab the quacks or unskilled people who are involved in the illegal act. During the discussion with Drug inspectors, it was found that State Human Rights Commission (SHRC) had issued a letter to state citing issues of sales of MA drugs without the prescription after which strong regulation was imposed by the drug authorities resulting in non-availability of drug in the market. MD, NHM asked State Drug Controller Mr. Ajay Phatak to immediately respond to SHRC and send a clarification note to district authorities at the earliest. Citing abortion as women’s right he urged all the participants to come forward and work towards ensuring women’s access to safe and legal abortion services as per MTP Act.

Dr. Atul Ganatra (FOGSI) shared providers’ challenges in performing first and second trimester abortions. He clarified that since the widely available ultrasound technology only could accurately determine the sex of the foetus in second trimester, the authorities should ensure that the PC PNDT activities should not affect first trimester abortions at all. Even the second-trimester abortions should be made available to women as per the MTP Act. He explained the legal documentation and requirements for providers performing abortions at the private and public sector facility. The government should also encourage the providers to report all MTP cases in the MIS, to determine the total number of abortions in the state.

Talking about the medical abortion drugs availability in market, Mr. Ranjan Panda (PHS India) shared that MA drug sales were increased from their introduction in 2002 till 2012. However, a sharp decline is noticed in the past few years due to increased regulations on MA sales and additional record keeping requirements resulting in declining interest of the retailers and distributors in keeping the product. The sales have dropped by 10% in 2016, and women are forced to buy the product from illegal sources at higher price. Mr. Ajay Phatak, Drug Controller assured appropriate actions in this direction.

Dr. Sharad Iyengar from ARTH shared his experience of working on safe abortion in Rajasthan. ARTH had conducted monitoring of DLC functioning in selected districts and confirmed that there has been an increase in MTP facilities during the year 2007 to 2010 in private or public sector. However, the reporting has been dropped from 38, 365 (in 2007) to 27,000 during the year 2016-17.

He emphasized that pre-procedure counseling is an important step before providing MTP, and the women confidentiality should be maintained as per the Act. The provider should have non-judgmental attitude and should respect the women’s decision to abortion and post-abortion contraception.

Ms. Karuna Singh (Ipas Development Foundation) talked about the MTP reporting status in the state. She also talked about the DLC accreditation and abortion reporting software that IDF is piloting in the states of Madhya Pradesh, Uttar Pradesh and others. She highlighted the need to create more training facilities to train more MTP providers in public sector. Relating to IDF experience from other projects, she said that there is a need to orient chemists on Medical Abortion drug information and use. The MA drugs should be made easily available in the market, which will itself limit the illegal sales. Towards the end, the drug controller reassured that adequate measures will be taken to improve availability and accessibility of the MA drugs as per the Drug and Cosmetics Act. Meeting ended with a vote of thanks to all participants.

Saving lives of women from unsafe abortions Call to Action

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