Abortion in India

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CHANGE Staff
CHANGE Staff
Abortion in India A Complex and Conflicting
Agenda the relationship between technology (
reproductive and contraceptive) and social change
is a complex one (Wajcmen1994)
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Existing Abortion Scenario
Indias second trimester abortion rate is
thought to be among the highest in the world and
increasing. (Chhabra and Nuna 1994) Studies
show that women undergoing sex selective abortion
are the groups most likely to attempt second
trimester abortion (Johnston2002) Illegal and
unsafe abortions continues to be high, with an
estimated 6.7 million abortions per year
performed by untrained persons in unhygienic
conditions. (Khan, et al 1998)
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Existing Abortion Scenario (contd.)
- It is hard to access second trimester
abortion within the legal framework
laid out by MTP Act,1971. Resulting in women
often going to uncertified providers.
- Sex selective abortion more
often than not is a second trimester abortion
and is illegal as per the PNDT Act, 1994.
- This double illegality (Johnston2002)
has severe consequences for women.
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The Dual Agenda

• Promoting safe abortion
• Curbing sex selective abortion

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Dual Agenda (contd.)
- Any engagement with abortion cannot be
undertaken without engaging with sex selective
abortion (SSA) - SSA adds to and underscores the
profound complexities within which abortion and
the debate surrounding it is enmeshed - the
intersecting spaces inhabited by SSA and womens
right to safe and legal abortion creates thorny
overlaps - legislative, policy and programmatic
responses to one or both appear filled with
ambivalence and contradictions - at the
implementation level a tremendous challenge to
operationalize both efforts to secure an
effective ban on SSA and continue to create
conditions for womens access to safe and legal
abortions
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Legislative Response to the Dual Agenda

MTP Act (amendments) PNDT Act
(amendments) - increase access at the primary
health care level - decentralization of
authority of approval and registration from the
state to the district level
- expand the ban to include preconception and
pre-implantation procedures for sex selection -
maintenance of written records by diagnostic
centers/doctors - vesting state, district and
sub- district Appropriate Authorities powers
equivalent to civil courts to ensure enforcement
of the Act
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Locating the Legislative Response within
the Policy Framework
- National and state population policies place
emphasis on the attainment of replacement levels
of fertility (2.1) - Imposing a two-child norm
has been increasingly highlighted - The strategy
to attain this ranges from building voluntary
support for small families to the use of economic
incentives and disincentives (e.g.
preferential access to housing as an incentive or
denial of government jobs as a disincentive. -
Further, policies have (un)officially make access
to MTP contingent on acceptance of a terminal
method. - The shift toward smaller families has
not been accompanied by a reduction in the
desire for sons. - The attainment of a two-child
norm needs to be placed within this context. - It
is possible to infer that son preference within
certain settings could intensify, where couples
will strive to both reduce family size and have
the desired number of sons using sex selection
strategies.
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Locating the Legislative Response within the
Socio-cultural and Economic Context

• - Son preference continues to play a significant
  role in fertility
• preference.
• - Among women with two children 83 with two sons
  and 76
• with one did not want more children (NFHS-II)
• - As opposed to that 47 of women who have two
  daughters
• said they did want more children (NFHS-II)
• - Son preference is mediated strongly by
  perceived economic,
• socio-cultural and religious utility of having
  sons (Mutharayappa,et al)
• - In addition more contemporary factors defined
  as the prosperity
• factor (Agnihotri) contribute significantly to
  SSA

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Locating the Legislative Response within the
Socio-cultural and Economic Context (contd.)
- As India undergoes a fertility transition
certain regional patterns are emerging in terms
of factors and how they influence SSA Type A
Driven by Cultural Factors and Family Planning
Goals (e.g.Tamil Nadu) Womens Parity (number
and sex of living children) State
Population Substituting existing policies str
ategies for discrimination (e.g. two-child
norm) (female infanticide)
SSA High Rates Of
Sterilization
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Locating the Legislative Response within the
Socio-cultural and Economic Context (contd.)
Type B Driven by Economic Factors (e.g. Punjab
and Haryana) Prosperity
(High Per Capita
Expenditure) Low Female High
Gender Gap in Labor Participation SSA
Literacy Upward mobility/Consumerism
(increase in dowry payments)
Type C Driven by Notions of
Choice and Autonomy (e.g. Delhi and
Chandigarh) High Levels of Female
Education Access to Information
Prosperity And Technology
SSA (high per capita expenditure) Preference
for Small families
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Locating the Legislative Response within
Reproductive Health Programs
- A tremendous bias continues to exist for female
sterilization (Half of currently married women
are using some method of contraception. 34 of
the half opt for female sterilization) - Women
who want to space births but not end
child-bearing continue to rely heavily on
abortion as a method of family planning (70 of
the demand for spacing methods is not being met
- NFHS-II) - Meeting the unmet need for spacing
methods will help reduce rates of abortion but
does not fully address the reasons why abortion
is sought. - Reducing second trimester
(late-term) abortions will continue to pose
serious challenges as in most instances the
pregnancies are perceived as unintended only when
the fetus is detected as being female.
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Locating the Legislative Response within
Reproductive Health Programs (contd.)
- the dual legislative response of increasing
access (MTP amendment) and securing an effective
ban (PNDT Act) appears problematic at the level
of implementation. - in particular if PNDT
implementation remains ineffective women
will continue to seek late-term SSA outside the
legal framework - this highlights the need to
monitor implementation of both at the state and
district level - work at the programmatic level
to reduce unsafe abortions has to be combined
(integrated) with restraining sex determination
(engagement with the medical community) - a
better understanding of the existing political
economy of diagnostic technologies, the role of
industry, regulation is critical - Also take into
account that in trying to restrain the
non-medical use of diagnostic technologies its
legitimate use is not undermined
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The Niche for Research, Policy and Programmatic
Interventions
A Research Agenda - Identification of gaps -
Feasibility of Research - Action research to
monitor implementation at the clinic/PHC level -
Updating our information and understanding of the
new generation of diagnostic and reproductive
technologies - In the case of promoting safe
abortion piloting strategies and
process documentation of early response
mechanisms that address unintended pregnancies.
The need to develop, test viability of an
approach that is located on a continuum of
technology provision beginning from emergency
contraception, to medical abortion to MVA and so
on and so forth
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The Niche for Research, Policy and Programmatic
Interventions (contd.)
A Policy Agenda - Systematic and sustained policy
analysis and advocacy - monitoring policy
implementation on an on-going basis
including resource allocation A Programmatic
Agenda - collaborating with contraceptive service
delivery organizations as well as social
marketing agencies to both test new approaches
(guided by research) as well as documenting the
process - working with medical associations and
other government agencies to monitor both the
non-medical use of technologies as well as
provision of new technologies within a framework
that takes into account issues of QOC, womens
access to information and counseling etc.