Abortion in India

Abortion in India has been legal since 1971.

Legal status

As per India’s abortion laws only qualified doc stipulated conditions, can perform abortion on a woman in an approved clinic or hospital. The Indian abortion laws fall under the Medical Termination of Pregnancy (MTP) Act, which was enacted by the Indian Parliament in the year 1971. The MTP Act came into effect from April 1, 1972 and was once amended in 1975. The Medical Termination of Pregnancy (MTP) Act of India clearly states the conditions under which a pregnancy can be ended or aborted, the persons who are qualified to conduct the abortion and the place of implementation.^[1]

Sex-selective abortion

Giving or taking prenatal tests, including ultrasound scanning, solely to determine the sex of the fetus was criminalized by Indian law in 1994. In 2002, the penalties were stiffened: up to three years in jail and a Rs. 10,000 fine for the first offense and five years imprisonment and Rs. 50,000 for the second.

According to the Consortium on National Consensus for Medical Abortion in India, every year an average of about 11 million abortions take place annually and around 20,000 women die every year due to abortion related complications.^[2] Most abortion-related maternal deaths are attributable to illegal abortions.^[3] In the following table Number of abortions reported includes legal reported induced abortions.^[4]

Year	1972	1975	1980	1985	1990	1995	2000
Number of abortions reported	24300	214197	388405	583704	581215	570914	723142

Indications for early medical abortion

General condition to be fulfilled

Any woman coming to a health facility seeking termination of pregnancy the following aspects have to be assessed and found appropriate:^[5]

• frame of the mind of patient and her acceptability of minimum three follow-up visits
• ready for surgical procedure if failure or excessive bleeding occurs
• family support
• permission of guardian in case of minor as per MTP Act 1971
• easy access to appropriate health care facility

Abortion in india can be done till 20 weeks of pregnancy. But an opinion of a second doctor is necessary between weeks 12 and 20. Only registered medical practitioners as prescribed by the MTP Act are authorized to prescribe mifepristone with misoprostol for medical abortion (Definition 2(d) of section 2 and MTP rule 3). Mifepristone with misoprostol for termination of early pregnancy not exceeding seven weeks, may be prescribed by a registered medical practitioner as prescribed under section 2 (d) and rule 3, having access to a place approved by the Government under section 4 (b) and rule (1), for surgical and emergency back-up when such a back-up is indicated. This may include primary health care-clinic or hospital-based set-up. Initial workup, counseling, prescription and administration could be in a clinic or in the consulting room. Home administration of misoprostol may be advised at discretion in certain cases with an access to 24-hours emergency services.

Choice between Medical and Surgical Abortion

• Vacuum Aspiration (Suction evacuation) is the most commonly-used method for termination of early pregnancies. However, being a surgical technique, it is associated with risks of infection, perforation of uterus, incomplete abortion and post-procedure uterine synechiae formation (Asherman's Syndrome).
• The success of abortion with drugs depends on multiple factors including the regimen used,dosage schedule, route of administration and gestational age.
• Mifepristone with misoprostol is favourable if pregnancy is = 7 weeks.
• Surgical abortion is preferred if patient desires concurrent tubal ligation.
• If a woman fulfills the criteria for selecting either method, final choice to be given to the woman.

Contraindications for medical abortion

For cases in which a pregnant woman has a serious medical disease and continuation of pregnancy could endanger her life, the Indian MTP act lays a clear guideline under which medical abortion is contraindicated.

Contraindications due to Medical Reasons

• smoking > 35 years
• anemia – hemoglobin < 8 gm %
• suspected /confirmed ectopic pregnancy / undiagnosed adnexal mass
• coagulopathy or women on anticoagulant therapy
• chronic adrenal failure or current use of systemic corticosteroids
• uncontrolled hypertension with BP >160/100mmHg
• cardio-vascular diseases such as angina, valvular disease, arrhythmia
• severe renal, liver or respiratory diseases
• glaucoma
• uncontrolled seizure disorder
• allergy or intolerance to mifepristone / misoprostol or other prostaglandins
• lack of access to 24-hours emergency services.

Psycho-social situations

These include the cases in which

• women unable to take responsibility
• anxious women wanting quick abortion
• language or comprehension barrier
• not willing for surgical abortion in case of failure

References

1. ^ "Medical Termination of Pregnancy, 1971". Medindia.com. http://www.medindia.net/Indian_Health_Act/the-medical-termination-of-pregnancy-act-1971-introduction.htm. Retrieved 2008-12-10. 
2. ^ "Introduction". Consortium on National Consensus for Medical Abortion in India. http://www.aiims.edu/aiims/events/Gynaewebsite/ma_finalsite/introduction.html. Retrieved 2008-12-03. 
3. ^ "Current status of abortion in India". Consortium on National Consensus for Medical Abortion in India. http://www.aiims.ac.in/aiims/events/Gynaewebsite/ma_finalsite/report/1_1_1.htm. Retrieved 2008-10-11. 
4. ^ Historical abortion statistics, India Historical abortion statistics, India
5. ^ Guidelines for Medical Abortion in India

• Katz, Neil S. Abortion in India: Selecting by Gender. 20 May 2006. 1 Jan. [1]
• Abortion, Femail Infanticide. 3 Jan. 2003. 1 Jan. [2]
• [3]

External links

• Medical abortion information for women in Hindi language The International Consortium for Medical Abortion (ICMA) Information Package on Medical Abortion
• [4] Abortion and Medical tourism in India.
• Abortion FAQ for First and Second Trimester abortion in India