Indian women and their abuse of contraceptive and abortion pills
The stigma attached to sexual activity has led women to risk their health and their lives.
India’s women have a drug problem. They’re popping pills at an alarming rate.
We’re not talking things like painkillers, which are known to be addictive. Indian women are abusing contraceptive and abortion pills in a dangerous manner.
A new study conducted jointly by the Indian Institute for Population Sciences, Mumbai; Population Council, New Delhi; and the New York-based Guttmacher Institute found that incomplete abortions, after the use of pills, caused 65% of complications in women seeking post-abortion care in Assam, 59% in UP, and 51% in Bihar.
The report The Incidence of Abortion and Unintended Pregnancies in Six Indian States, published on November 13, 2018, provides data for Assam, Gujarat, Bihar, Madhya Pradesh, Tamil Nadu, and Uttar Pradesh. These states account for half the women of reproductive age in India.
But these statistics beg the question, are women not using contraception?
There are two kinds of pills available to women to prevent pregnancy – oral contraceptives (OCPs) and emergency pills.
The former are low-dose hormone pills, which are meant to be taken daily for three weeks in a month, leaving the woman with one pill-free week. If taken correctly, OCPs are generally safe and highly effective with a 99% rate of success.
Emergency contraceptive pills (ECPs) are meant for exactly that: Emergencies. They are not a primary form of birth control. If by some accident, the main form of contraception fails – perhaps a condom breaks – then the ECP should come into play. If taken within 72 hours of sexual intercourse, it can prevent an unwanted pregnancy.
The Emergency Contraceptive Pill was introduced in India by the Ministry of Health and Family Welfare in 2002/ It was made available at medical counters from 2005.
A slew of advertising campaigns post 2005 led to a surge in their popularity. Most women (and men) don’t even know what they are officially called. To them, it is just the “i-pill” – Piramal Healthcare’s version is the most well known of all the ECPs available.
ECPs are definitely a great breakthrough in terms of contraception. It gives power to the woman to prevent a pregnancy not only when the normal method of contraception fails, it can help those who have been sexually assaulted. In a country like India, where sexual violence is a stark reality, ECPs give back some level of control to the woman.
Pooja* was 24 when she took four ECPs in two weeks. She had to be rushed to a hospital because she did not stop bleeding heavily for more than seven days. Considering she was an educated, urban woman pursuing a Master’s degree, she did not take into account the side effects clearly listed on the pamphlet provided with the pill.
And that is where the problem starts. ECPs are available over-the-counter with almost zero instructions from a medical health practitioner. Women are popping them like candy when doctors advise taking – under exceptional circumstances – maximum two ECPs in a month.
Pill-based abortion is a whole other minefield altogether.
Theoretically, medical method of abortion (MMA), through the use of pills, has a success rate of 95%-98% if administered properly and before nine weeks of gestation. It is also the safest form of pregnancy termination.
IndiaSpend had reported in November 2017 that as many as 56% of abortions in India are unsafe; 8.5% of all maternal deaths in India are due to unsafe abortion; and 10 women die every day due to this reason.
Why is a procedure that is considered routine killing so many women?
Dr Asha Sharma, a gynaecologist and obstetrician from Apollo Cradle Hospital in Delhi says, “Women are not given proper instructions regarding exactly how the pills are to be taken and when. They are not aware of the side effects and, therefore, do not know when there is a sign that something is wrong. More women should avail abortion pills from medical facilities instead of unauthorised dealers.”
The Lancet Global Health published a report in December 2017. This report, titled The Incidence of Abortion and Unintended Pregnancy in India, 2015, gave troubling figures.
Out of the estimated 1.56 crore abortions in the country in 2015, 73% or 1.15 crore were obtained through MMA medication outside health facilities, only 22% or 34 lakhs were procured in health facilities, and 5% were done outside health facilities using unsafe methods.
The Ministry of Health and Family Welfare has issued guidelines that require that Mifepristone and Misoprostol, the two-drug regimen used to induce abortion, can only be provided by a registered medical practitioner or a government hospital.
Due to fear of exposure and shame, many women buy it from informal vendors. The stigma related to sexual activity in India is leading women to risk their health and their lives.
In some cases, doctors themselves mislead patients. Garima*, an MBBS student, visited a doctor in order to get a prescription for abortion pills.
The doctor prescribed a dosage not enough to induce full abortion. He then asked her to visit his clinic in a remote part of town so that he could surgically finish the procedure a week later.
Unaware of her being a student of medicine herself, the doctor had confidently told her that he would help her.
It is evident that there is not enough of a conversation around sexual activity, contraception, and abortion in India.
Schools should make sex education mandatory so that young people are aware of the choices they have and the consequences of making ill-informed ones.
Women should not be asked inappropriate moral questions when they seek medical help for sexually-related activities.
Until this happens, women will continue bearing the brunt of this lack of awareness. They will go on endangering their lives by popping pills without understanding what they are for. It is a travesty of justice when a preventable death occurs for want of information.