Population First and Pratigya webinar on Guttmacher study on Abortion Estimates in India
Tuesday 12th December, 2017
(9.30 AM to 10.30 AM)
Pratigya Campaign and Population First organized a webinar to discuss the much awaited Guttmacher study results on abortion estimates in India which were published in Lancet on the 11th of December, (EST) 2017 (https://www.thelancet.com/pdfs/journals/langlo/PIIS2214-109X(17)30453-9.pdf) . The study focused on incidence of unintended pregnancy and abortions in country, availability of abortion services, providers’ profile and quality of abortion services in India. The webinar was intended for media, journalists and other stakeholders who are interested in the subject and working/writing on these issues. The webinar is part a series of workshops conducted by Pratigya and Population First to sensitize media & journalists on abortion issues. The outcome from discussion was to ensure better understanding of study results and accurate reporting on abortion issues.
The panel comprised of Dr. Rajib Acharya (Population council), Professor Chander Shekar (International Institute for Population Sciences, IIPS), who were part of the study team in India. Mr. VS Chandrashekar (FRHS India), Ms. Anupam Shukla (FRHS India, Pratigya Campaign-Secretariat) and Dr. AL Sharda (Population First, Pratigya lead in Maharashtra) who facilitated the discussion. The panel discussed about significance of the study, methodology, data collection and analysis technique used and the key findings.
Dr. Rajib spoke about significance of study stating that although Abortion has been legal in India since 1971, there has been no comprehensive study on rate on abortion. Official statistics and national survey do not provide complete coverage and hence, this study is one of its kind and estimates the national incidence of abortion and unintended pregnancy for 2015. The indirect estimation technique used by Guttmacher Institute is widely used for conducting similar studies in 25 other countries and has been well adjusted for India’s situation. The abortion incidence was estimated through three separate components – abortions conducted in facilities (including private, public sector and NGOs), medication abortion outside facilities; and abortion outside facilities with methods other than medication abortion. A Health Facility Survey (HFS) was conducted in 4,001 public and private sector facilities (including NGO clinics) across six Indian states. Medication abortion sales data was collected from IMS Health and social marketing NGOs; it included both the combi-packs as well as Mifepristone use. For abortions that are not medical abortions and occurring outside the facilities, the study used data from Population council study conducted in 2009 and adjusted for the increased use of medical abortion pills. The study data was collected from six states (Assam, Bihar, Gujarat, Madhya Pradesh, Tamil Nadu and Uttar Pradesh) approved by a Technical Advisory Group (TAG) constituted under the study.
Prof. Chander Shekar explained that the study estimates:
- That nearly half of the 48 million pregnancies that occurred in 2015 were unplanned and a third of them resulted in abortion.
- 15.6 million abortions occurred in India in 2015, of which 81% were done through medication abortions.
- Although the abortion numbers seem high, the abortion incidence rate of nearly half of 70.1 unintended pregnancies per 1000 women aged 15-49 years is within the range of other South Asian countries like Pakistan, Nepal, Bangladesh, etc.
- Increasing numbers of medication abortion indicates women’s preference for non-surgical methods. 73% abortions were medication abortion done outside of the facility, with and without medical supervision.
- These days, women are able to detect the pregnancy at an earlier stage. Government has provided ‘Nishaya kit’ (pregnancy detection kit) that helps identify pregnancy at an early stage and Government programs should be designed to enable women who want to terminate a pregnancy have access to safe abortion services.
- The study doesn’t provide incidence of unsafe abortions, but it indicates that 5% of total abortions were done through other methods which were probably unsafe.
Chandra (FRHS India) added that NGO community is not surprised with the current numbers, as the official data is under-reported to a great extent. Since 2008, sales of conbi-pack MA drugs have increased between 11 million to 14 million combi-packs. It’s a simple and safe method. Government has taken various steps to strengthen CAC services and availability of combination drug by making them more accessible.
This study further reinforces the need to expand the provider base, after appropriate training to improve access to safe abortion, given the shortage of Gynaecologists and MBBS doctors, particularly in rural areas. In India, provider base, to provide early medication abortions, can be expanded to include qualified indigenous practitioners of alternate medicine such as Ayurveda, Homeopathy, Unani and Siddha and Nurses. World Health Organization (WHO) has also recommended task-shifting of Medication abortion in first trimester to nurses and doctors of complementary medicine in their recent guidelines (2015). Unfortunately, MTP Act has not kept pace with the improved technology and the proposed amendments to the Act which includes expanding provider base will go a long way in improving access and also ensuring the women seeking medical abortion receives correct information and medical supervision.
Currently, abortion is not a right but defined as provider’s method as per MTP Act. The notion that medical abortions are not safe at home is disproven by the study results. We should work to make at least first trimester abortions a women’s right. Access to safe abortion is an important component women’s sexual and reproductive right and her ability to have control over her body.
Dr. Sharda concluded the panel discussion with a vote of thanks to all the panelists. Following this, the floor was opened to questions from the participants. The discussion is attached here.