People’s Journal of Scientific Research / Volume 16 / Issue 1 / Jan-June 2023

Unsupervised Medical Abortions: A Cause for Concern

of Safety

Ruchi Kalra

Department of Obstetrics & Gynaecology, People’s College of Medical Sciences & Research Centre, Bhopal

ABSTRACT: Medical abortions have been a national as well as social concern for the society, especially in India.

There have been certain laws, acts and amendments that have been designed to promote safe abortions.

Despite, the rules in place, there is still need to have more awareness as the women still face difficulties

in accessing abortion services. The reasons may include legal hurdles, stigma, financial concerns and

many more. Through this article, we would like to emphasize the role of government, medical

professionals, health care providers to come together and form more dependable guidelines that may

help women to access safer abortions.

KEY WORDS: abortions; MTPAct; contraception, abortion pills

Address for correspondence : Dr. Ruchi Kalra, Vice Dean (Academic) & Professor, People’s College of Medical Sciences &

Research Centre, Bhopal-462037, E-mail: drruchi.kalra15@gmail.com

Submitted: 20.05.2023, Accepted: 18.06.2023, Published: 26.06.2023

INTRODUCTION:

Women have the right to access safe abortion

services. The right to safe abortion is grounded in

principles of bodily autonomy, reproductive rights, and

women's health. Access to safe and legal abortion

services is essential to protect the health, well-being,

and human rights of women.

The World Health Organization (WHO)

recognizes that safe abortion services should be

available to every woman who needs them. Access to

safe abortion means that women can terminate a

pregnancy in a legal and medically safe environment,

with trained healthcare providers, using evidence-

based methods and practices. Safe abortion services

help prevent maternal morbidity and mortality

associated with unsafe abortion procedures[1].

International human rights frameworks, such

as the Convention on the Elimination of All Forms of

Discrimination Against Women (CEDAW) and the

International Covenant on Economic, Social, and

Cultural Rights (ICESCR), also emphasize the

importance of ensuring access to safe abortion services

as part of women's reproductive rights and healthcare.

Governments and healthcare systems need to

provide access to safe abortion services, following

national laws and policies, to ensure that women can

make informed decisions about their reproductive

health and have access to the necessary care and

support. This includes access to counselling,

information, contraception, and post-abortion care.

Promoting access to safe abortion services is

not only a matter of human rights but also contributes

to public health and social well-being. It reduces the

incidence of unsafe abortions, prevents complications,

and supports women's reproductive autonomy and

agency. It is important to continue advocating for and

working towards ensuring that all women have the

right to access safe and legal abortion services, without

facing barriers or stigma, and with the necessary

support from healthcare systems and providers.

Current scenario: This article highlights important

issues related to unintended pregnancies, unsafe

abortions, and maternal mortality in India: Below are

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How to cite this article: Kalra R. Unsupervised Medical Abortions: A

Cause for Concern of Safety. PJSR. 2023;16(1):43-46.

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People’s Journal of Scientific Research / Volume 16 / Issue 1 / Jan-June 2023

Kalra R. Unsupervised Medical Abortions: A Concern

some of the facts related to abortions in the Indian

Scenario

1. Unintended Pregnancies: Out of the 48.5 million

pregnancies that occur annually in India,

approximately 44% are unintended. These

pregnancies may result from a lack of access to

contraception or inadequate knowledge about

family planning methods.[2]

2. Abortion and Unsafe Abortions: Of the 16 million

unintended pregnancies, about 77% (approxi-

mately 12.32 million) result in abortions. However,

it is concerning that around 800,000 of these

abortions are unsafe. Unsafe abortions are

performed without proper medical supervision or in

unhygienic conditions, increasing the risk of

complications and maternal health problems.

3. Maternal Mortality: Among the unsafe abortions in

India, 10% result in maternal mortality, meaning

approximately 80,000 women may lose their lives

due to unsafe abortion practices each year. Maternal

mortality refers to the death of a woman during

pregnancy, childbirth, or within 42 days after

delivery.

4. Impact of COVID-19 Pandemic: Between January

and June 2020, during the COVID-19 pandemic in

India, it is estimated that there were significant

increases in unsafe abortions, unintended

pregnancies, and maternal deaths. The estimates

suggest that an additional 1 million unsafe

abortions, 650,000 unintended pregnancies, and

2,600 maternal deaths may have occurred during

this period.

5. Socioeconomic Disparities and Access Barriers:

Poor and illiterate women, those from marginalized

castes and religions, and those living in rural

regions face greater barriers to accessing safe and

legal abortion services. These disparities further

increase the risks they face, including the potential

for illegal abortions.

These statistics shed light on the challenges

faced by women in India regarding unintended

pregnancies, unsafe abortions, and maternal health.

Addressing these issues requires comprehensive

strategies that prioritize access to contraception,

education on family planning, safe abortion services,

and the empowerment of women in making informed

choices about their reproductive health. [3,4,5]

The Medical Termination of Pregnancy Act,

(1971): The act was enacted to provide a legal

framework for safe and regulated abortions in India.

The Medical Termination of Pregnancy (MTP) Act, of

1971 allowed for the termination of pregnancies up to

20 weeks gestation under specific conditions. These

conditions include:

(1)

If the continuance of the pregnancy would pose a

risk to the life of the pregnant woman or cause

grave injury to her physical or mental health.

(2)

If there is a substantial risk that the child if born,

would suffer f rom physical or mental

abnormalities that would be incompatible with a

normal life.

(3)

If the pregnancy is a result of contraceptive failure

in a married woman or her husband, where they

have voluntarily undergone family planning

procedures.

This article expresses concern about the issue

of unsupervised medical abortion and the potential

risks associated with it.

The appropriate time for medical abortion is

until 9 weeks or 63 days of gestation The studies have

reported a significant number of patients had self-

administered abortion pills, with a considerable

portion taking them after the approved period of 63

days of gestation. This indicates a lack of awareness or

adherence to the guidelines regarding the proper use

of abortion pills.

Unsupervised, self-administered abortion

pills in undiagnosed ectopic pregnancy can endanger

the life of a woman causing rupture of ectopic,

hemoperitoneum and hemorrhagic shock requiring

laparotomy and blood transfusions to save the life of a

woman.

The common presentation among these

patients can be excessive bleeding which can be a

serious complication requiring medical intervention.

Other complications observed included severe

anaemia and shock, which further highlight the risks

associated with unsupervised medical abortion.

Unsupervised abortion can be dangerous in Rh -ve

women and may cause isoimmunization, hyper-

tension, bronchial asthma, cardiac disease, and

epilepsy. [6]

The outcomes of these self-administered

abortions are also concerning. A Study reported a

majority of patients (62%) had incomplete abortions,

indicating that the abortion process was not

completed. Additionally, a significant portion (22.5%)

experienced failed abortions, where the abortion pills

did not effectively terminate the pregnancy. In some

cases, incomplete abortion was accompanied by

sepsis (7.5%), a severe and potentially life-threatening

infection.

Surgical evacuation was required in most

People’s Journal of Scientific Research / Volume 16 / Issue 1 / Jan-June 2023

Kalra R. Unsupervised Medical Abortions: A Concern

cases (67.5%), indicating the need for medical

intervention to complete the abortion process. Some

patients (12.5%) also required surgical evacuation

along with blood transfusion, emphasizing the potential

for severe complications arising from unsupervised

medical abortions.[7] At least 2-3% of women require a

blood transfusion, indicating the potential for

complications even when following the approved

methods.

The common methods adopted for abortion as

per various studies were pills followed by Ayurvedic

medicine, homemade concoctions (Kahva, papaya,

chilli), vaginal insertion of metal sticks/ herbs and

external massage. Interestingly, most do not seek

advice from a medical person but the source of advice,

as noted in various studies, is either a family member,

friend, village quack, nurse, Anganwadi worker, local

doctor or chemist.[8]

Access to abortion services can be impeded by

various barriers, which can vary depending on the

country or region. Here are some common reasons why

women may face difficulties in accessing abortion

services: [9]

1. Legal Restrictions: Restrictive laws and policies

surrounding abortion can create significant barriers

for women. In some places, abortion may be

entirely illegal or highly regulated, limiting access

to safe and legal services but in India, laws are

liberal which allows easy access to the services.

2. Stigma and Discrimination: Stigma surrounding

abortion can deter women from seeking services

due to fear of judgment, social ostracization, or

discrimination. This stigma can be perpetuated by

cultural, religious, or societal norms.

3. Limited Availability of Services: Inadequate

provision of abortion services, particularly in rural

or remote areas, can make it challenging for women

to access the care they need. This includes a lack of

trained healthcare providers, facilities, or

equipment to perform abortions.

4. Financial Constraints: Economic barriers, such as

the cost of the procedure, transportation,

accommodation, and time off work, can make

accessing abortion services unaffordable for many

women, particularly those from low-income

backgrounds.

5. Legal and Administrative Hurdles: Requirements,

such as long waiting periods, mandatory

counselling, parental consent requirements for

minors, or mandatory ultrasound examinations or

blood tests can create additional barriers and may

be barriers to accessing abortion services.

6. Lack of Information and Education: Limited

knowledge about available abortion services, the

legal framework, and women's reproductive rights

can prevent women from seeking appropriate care.

Insufficient sexual education and limited access to

comprehensive information about contraception

and pregnancy options can also contribute to

barriers.

7. Provider Refusals and Conscientious Objections:

Some healthcare providers may refuse to provide

abortion services due to personal or religious

beliefs. This can limit the availability of services

and create barriers for women seeking care.

The perception that medical abortions are

extremely safe even in the hands of untrained

personnel can be misleading and potentially

dangerous. While medical abortions using

mifepristone and misoprostol have been proven to be

safe and effective when used appropriately and under

medical supervision, it is crucial to emphasize the

importance of proper training and supervision in the

administration of these medications.[10,11]

The recommendation by the Federation of

Obstetrics and Gynaecological Societies of India

(FOGSI) for close monitoring of the distribution of

drugs used for medical abortion reflects the need to

ensure that these medications are accessed and used

responsibly. The medical profession and pharma-

ceutical industry should exercise due diligence in

promoting and advocating for the safe usage of these

drugs.[12]

Unsupervised terminations and the over-the-

counter dispensing of medication abortion pills can

lead to potentially life-threatening complications.

Without proper medical supervision, individuals may

not receive appropriate counselling, information, or

follow-up care, increasing the risk of incomplete

abortions, unrecognized complications, or inadequate

management of side effects.

It is essential to address the societal perception

that medical abortions can be safely undertaken

without medical supervision. This can be achieved

through comprehensive education and awareness

programs that provide accurate information about the

risks, benefits, and proper usage of medication

abortion. Healthcare providers and organizations

should play a pivotal role in disseminating accurate

information and promoting responsible use of these

medications.

Regulatory measures, such as strict guidelines

on the distribution and dispensing of medication

abortion pills, can also help ensure that these

medications are accessed only through appropriate

Kalra R. Unsupervised Medical Abortions: A Concern

People’s Journal of Scientific Research / Volume 16 / Issue 1 / Jan-June 2023

channels and under medical supervision. These

regulations should strike a balance between ensuring

access to safe abortion care and mitigating the risks

associated with unsupervised medical abortions.[13,14]

By emphasizing the importance of trained

personnel, medical supervision, and responsible usage,

it is possible to address the perception that medical

abortions can be safely undertaken without proper

guidance. This approach promotes the well-being and

safety of individuals seeking abortions while ensuring

that they receive the necessary support, information,

and healthcare services throughout the process.[15,16,17]

Additionally, it is essential to assess the extent

to which healthcare providers are trained according to

the World Health Organization (WHO) guidelines on

medical abortion procedures and whether these

guidelines are being implemented in practice.

Understanding the current training practices and

identifying any gaps can help improve the quality of

care provided by healthcare professionals.

CONCLUSION:

Overall, awareness is needed to address these

important aspects and call for action from the

government, medical, paramedical personnel, and

NGOs to fill the existing knowledge gaps. One of the

key steps would be the formation and implementation

of strict guidelines on the distribution and dispensing

of medication abortion pills, this will help optimize the

provision of medical abortion, ensure patient safety,

and enhance access to the safe reproductive healthcare

option.

Financial Support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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