As US abortion ban sparks fierce backlash, India forges ahead in reproductive rights

Activists say governments must do more to ensure women’s safety during abortions

Politics

September 13, 2021

/ By / New Delhi

As US abortion ban sparks fierce backlash, India forges ahead in reproductive rights

American NGO Planned Parenthood provides reproductive health care in the United States and globally, and advocates heavily for pro-choice laws (Photo: Wikimedia Commons/Douglas Fron)

The passing of a new law in Texas that literally bans abortions has caused an outrage around the world, especially since the United States is seen as one of the most liberal countries in the world. India may be miles ahead in legalising abortions and making it relatively easier to access, but abortions remain a taboo subject in India as well. One of the most serious consequences that reproductive rights experts fear is the possible rise in unsafe abortions, which is statistically much worse in developing countries like India, where unsafe abortions are the third-leading cause of maternal deaths. Activists are concerned that despite a recent amendment to abortion law in India, it still denies women the final say on the matter.

In 2012, an Ireland-based Indian dentist, Savita Halappanavar, made international headlines after she died due to complications caused by a septic miscarriage when, despite going through a previously life-threatening incident, her request for an abortion was denied on legal grounds by doctors. The nationwide outcry prompted an amendment to abortion legislation in Ireland, a fervently Catholic and conservative country, within months.

Almost a decade later, however, conservatives seem to have scored a major win in the United States as several Republican-run states seem to be getting inspired by a new law in Texas that makes abortions almost impossible. Texas Senate Bill 8, which became effective on September 1, is by far the most restrictive abortion ban in North America.

Colloquially, the law has been referred to as the “heartbeat bill” because it prohibits abortion when medical professionals can detect a heartbeat in the foetus. Contrary to the Roe v Wade verdict of the US Supreme Court in 1973, which allows termination up to 24 weeks, this new ruling prevents abortions from a mere 6 weeks of impregnation, incidentally before many people even realise or test for pregnancy.

“What can be detected by the ultrasound at this time is not a true heartbeat, because the heart is not fully formed at that stage and would not be detectable by a stethoscope on the mother’s belly. Often, we cannot even call the baby a foetus at this stage and refer to it as the embryo. Unfortunately, people are basing a lot of their decision-making on something they don’t fully understand,” Dr Anshu Reddy, a Los Angeles-based obstetrician and gynaecologist tells Media India Group.

One of the most contested aspects of the bill is that it does not make an exception for pregnancies caused due to rape or incest. When asked about this, Texas Governor Greg Abbott gave a vague reply, saying the state would “work tirelessly to make sure that we eliminate all rapists from the streets of Texas,” presenting a pipe dream rather than a solution.

As controversial as the subject of abortion is, both religiously and morally, the bill indisputably has many supporters even outside of Texas. Sanya Borisova, a 27-year-old California resident and a supporter of the Republican party, describes herself as pro-life.

“I myself could never bring myself to consider abortion an option because my own view is that there is something living in me and I can’t just get rid of it. Once the foetus develops a heartbeat, it also is a living human that deserves a choice. Adoption and surrogacy are always options. I know people argue that your morals don’t matter when it comes to someone else’s decisions but then that argument could be used for manslaughter or serial killers. And the plan B, levonorgestrel, or the “morning-after pill, is available as well,” says Borisova.

Although medically-supervised abortions are readily available in the US, a 2012 study by Boston Medical Centre revealed that teenagers in low-income communities, which have the highest teen pregnancy rates in the US, have the most difficulty in accessing emergency contraception. In addition to its high cost without health insurance as one pill can cost up to USD 60, the study also revealed that some pharmacists in poorer areas were misinformed about the law and had mistakenly denied teenage girls access to the pill.

Moreover, due to stigma and shame attached to teenage or unmarried pregnancies, carrying a baby to term for adoption may not be a viable option for many. Lack of financial support or family support will also prevent women from being able to get the procedure done in another state, as travel costs and logistics, especially during the Covid-19 pandemic, have gotten worse.

Pandemic increases abortion risk

The effect of the pandemic on women seeking abortions has been a huge issue in India as well, especially in the beginning of the lockdown in 2020 when, according to a study by IPAS, an Indian reproductive health NGO, abortion access for 1.85 million women was suddenly compromised and health care centres reported a spike in calls for help.

Even though it was finally identified as an essential service a few weeks into the lockdown, the lack of mid-level healthcare staff trained in India, restricted access to contraceptives, pregnancy tests and a hospital, as well as severe stigma against pre-marital sex in Indian society, makes it difficult for many women to get an abortion.

Bangalore-based Ayushi Singh (*name changed), was 21 years old last year when she became pregnant, and she struggled to find a doctor who would see her not only during the pandemic, but without her parents’ permission. After trying at two different clinics, she was finally able to seek a friend’s gynaecologist relative, who performed the procedure.

“My own gynaecologist, who I have been seeing for years, just flat out refused. She said I needed my mother or father there, even though she knew I could not tell them,” explains Singh.

Cases like these may be surprising, but not sparse. As in the US, rural Indians have it much worse, with government hospitals refusing to allow procedures which are technically very much legal. Many women have reported being turned away by doctors due to moral reasons or subjected to invasive exams and asked to show identification documents even for prescribing the ru-486 abortion pill, despite the fact that neither is required by law, and violation is punishable by imprisonment.

Legally though, India remains miles ahead of the United States in recognising and allowing abortions and earlier this year, it pulled ahead even further. A breakthrough decision by the Indian government, in stark contrast to SB 8, was Medical Termination of Pregnancy (MTP) Amendment Act 2021 passed on March 25, which dropped the marriage clause and the term “married woman and her husband,” allowing unmarried women abortion access, and crucially raised the upper gestation limit to 20 weeks, and 24 weeks for special categories such as minors and victims of rape.

Need to make abortions not just legal, but safe as well

However, abortion rights activists across the country say this is not enough, as up to 20 weeks, a woman still requires the lawful permission of a doctor, and in the case of rape, incest and foetal anomalies until 24 weeks, that of two doctors as well as an entire medical board including a gynaecologist, radiologist or sonologist, paediatrician and other members notified by the government are required. Moreover, medical abortion pills are classified as Schedule H drugs, meaning a pharmacist needs to maintain a record of sales under the Drugs and Cosmetics Act, further questioning the validity of MTP Act 2021’s confidentiality clause.

Dr Reddy, in Los Angeles, explains that one of the biggest concerns of the Texan law is the possible rise in unsafe abortions. During a Rajya Sabha debate in March, the then health minister Harsh Vardhan said, “There is need for increasing access of women to legal and safe abortion services in order to reduce maternal mortality and morbidity caused by unsafe abortions.”

Indeed, even though abortion has always been legal in India and it is relatively accessible, it has also always been subject that is too much of a taboo to be discussed openly and is usually practiced behind a veil of shame.

According to a 2016 report by the World Health Organisation and Guttmacher Institute, at least 22,800 women die annually due to complications of unsafe abortion worldwide, and between 2 and 7 million survive unsafe abortion but sustain long-term damage or disease – numbers are far more severe in developing countries compared to the West.

In India, unsafe abortions are the third-leading cause of maternal deaths, and 10 Indian women die daily due to unsafe abortion as per a 2015 report by Ministry of Health and Family Welfare. IPAS also reported that only 22 pc of 15.6 million abortions happen in healthcare facilities in India. The lack of awareness and absence of sex education has also resulted in 80 pc of Indian women not knowing that abortion within 20 weeks is actually legal. Often, it means that most women turn to risky abortions conducted by unqualified practitioners in unhygienic conditions.

“The new law still sets a time limit for termination of pregnancies caused by sexual assault. If the doctor says no, or the third-party does not authorise it, then we cannot get it. Women should be the only ones who get to judge their own decisions. We can hardly tell those close to us about it, so I cannot imagine having to deal with an entire medical board to make such an important, life-changing decision. You never know what someone is going through: a change in financial situation, a medical disability of the baby, these are all valid reasons,” says Singh.

As some experts predict a third wave of the Covid-19 pandemic and danger of further lockdowns, activists say the option of “telemedicine” should be extended to those seeking abortions, an option introduced in the United Kingdom and a few other countries during the lockdowns, along with more training for village healthcare workers, in order to terminate unwanted pregnancies in the safest and fastest manner possible.

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