It has been an incredible feeling to see so many events being organized across the globe in support of the International Day for Decriminalization of Abortion!!
Decriminalization is indeed an idea, whose time has come. The internet has enabled this great coming together of activists, advocates, campaigners, and so many others to speak up boldly and to proactively demand safe abortion as a right for women.
This is just the first step on a long journey. A very long journey indeed, as was brought home to me while I spent 28th September in Iswal, a village outside Udaipur city in Rajasthan (India), attending a meeting for CommonHealth members.
The ambience played to every cliché about Indian villages: there were camels, cows, donkeys and stray dogs roaming around while groups of tribal, nomadic men and women gathered around campfires and small tents at a tiny hillock a few meters from our meeting hall.
The host organization, ARTH runs (among many other things) a small clinic and maternity centre in this village, where 3 trained nurses manage 24/7 shifts and conduct deliveries of almost 30-40 women every month. They also see women coming in with unwanted pregnancies, maybe five to eight a month.
A doctor comes in every Monday and offers surgical abortion services. I was amazed to hear that over 80% of the safe abortions are done using Mifepristone and Misoprostol. All the women in the community of the 20 odd villages that use this centre, know that they need to come in early in their pregnancy for medical abortion, and most of them turn up before 3 months. It is not often that they see someone in the second trimester who needs to be referred to the city hospital. Interestingly, the nurse I spoke to also said that most women are fine with a baby of either sex and they have rarely had anyone attempting a sex selective procedure.
At the meeting the next day, we spoke of the International Campaign for Women’s Right to Safe Abortion and this was followed by some very interesting discussions.
1. Sex-Selection: One participant, who works with the local branch of an NGO said that the authorities had become so sensitive to abortion clinics due to the sex selection issue, that their application for the certification of their clinic has been pending for over 2 years. This was in spite of the fact that they perform only 1st trimester abortions. We then spoke about how someday we may be able to easily determine the sex of the fetus even in the first trimester. Then what will the authorities do ? Ban 1st trimester abortions ?So, is the Government really against sex selection, or against abortions ?
2. Clandestine and Unsafe Abortions: unsafe abortions continue to take place and the clinic continues to see 10-12 women per month with morbidities. There is also a large cadre of para-medical persons performing abortions clandestinely and under unsafe conditions. We discussed how making good quality and safe abortions freely accessible in the public sector would prevent this in a big way.
3. Publicity: One of the participants said that we really need to have more public communication for the rights of women to access safe abortions. We then shared that the issue of how abortion gets publicity only in a negative way—either due to a death or sex selection or some negative context. This helps perpetuate the stigma and also give credence to myths that abortion causes infertility etc
As a result of the harassment and negative publicity, targeted police actions, most private doctors have stopped doing even first trimester abortions despite being trained and registered. Second trimester abortions are of course being routinely referred to other centers.
Some interesting suggestions offered by the group were to insist on institutional pregnancy terminations the way institutional deliveries are being promoted.
The key take home messages were:
- Safe abortion is no longer being seen as an integral part of maternal health and this needs to change !
- We need to hold the public sector accountable for safe abortion services being available and work to ensure that free medical abortion services are provided.
- Awareness building work about safe abortion is critical and perhaps we need to start with our own civil society movement.
We also realized that conversations on sexuality is integral to discussions on contraception, abortion and adolescent sexuality. Until we can do this, we will find it difficult to have layered and nuanced programmes.
On that note our group discussion came to an end and left me with the feeling that there is still so much to be done, but also feeling hopeful that there are so many, many champions, men and women, who are ready and willing for the long haul. Some day the rights for all women to access safe abortions will become a reality!