Many things amaze me in India – there is plenty to shock and awe on a daily basis. But nothing has yet amazed me more than the extreme power and endurance of Indian women. As I have delved into the issue of access to safe abortion for women in Southern Rajasthan as part of my work at ARTH, this has become more and more apparent to me. Unwanted pregnancy can result from many things – lack of power in a relationship to determine when and how often a woman wishes to become pregnant, lack of knowledge about different varieties of family planning, lack of access to those family planning methods, or a change in emotional, financial, or other circumstances of a woman and/or her family as she realizes she has become pregnant, amongst other things. But seeking to end her pregnancy safely, legally, and confidentially becomes a huge hurdle that many women throughout India cannot overcome. The state of Rajasthan is largely rural with high fertility rates, low contraceptive use, and strong son preference. There is a noted unmet need for family planning and a ‘per capita availability of legal abortion services of one per 157,354 individuals’, displaying obvious limited access to safe abortion (Elul et al., Population Council, 2004). Particularly in rural Rajasthan, women have significantly fewer MTP (Medical Termination of Pregnancy) facilities and providers than in urban areas, making it more difficult for them to access safe and legal MTP services when they need them. This has led some of these women to seek services from informal providers, which results in the estimated 10% of all maternal deaths in Rajasthan due to abortion complications and the 26% of women in Rajasthan who experience post-abortion morbidity (Jejeebhoy, 2010). In addition, the issue of sex-selective abortion has exacerbated the issue further as the sex ratio in the state has continued to decline. At present, there are 883 girls for every 1000 boys aged 0-6 in Rajasthan (Census Provisional Data 2011). This has created a backlash against 2nd trimester MTP due to the ability to check for the sex of the fetus at this stage of pregnancy. Some providers no longer do this procedure, which further limits women’s access to safe MTP in certified facilities, often leading them to risk their lives by utilizing clandestine providers.
Safe abortion has often been made the scapegoat of reproductive health by many, including the United States government, through laws like the Global Gag Rule. But when we look at statistics of women dying from unsafe abortion in places like Rajasthan – where women have so little agency over their own reproductive health in the first place in terms of the size of their families, the frequency of their births, and the sex make-up of their children – it makes sense that women should have access to a procedure that they will always seek. There will always be a demand for MTP, and Rajasthan is proof that when safe services are not provided, women pay the price, despite the fact that many circumstances that led up to the requirement of an MTP service (such as no agency in contraceptive decisions, involvement in an abusive relationship, threat of violence or abandonment from her husband if she produces more girl children) are outside that woman’s control. Abortion is not an issue to be taken lightly and is not a pleasant topic, but it is one that must be confronted for what it is – that its safe provision can save lives.
Elul B., Bracken H., Verma S., Ved R., Singhi R., & Lockwood K. (2004). Unwanted Pregnancy and Induced Abortion in Rajasthan, India: A Qualitative Exploration. Population Council. Retrieved from www.popcouncil.org/pdfs/SAReport.pdf.
Jejeebhoy S.J., Francis Zavier A.J., Acharya R., & Kalyanwala S. (2011). Increasing Access to Safe Abortion in Rural Rajasthan: Outcomes of a Comprehensive Abortion Care Model. New Delhi: Population Council.
Provisional Population Totals Census 2011. Government of India: Ministry of Home Affairs. http://censusindia.gov.in/2011-prov-results/prov_data_products__rajasthan.html