Sex workers in Chennai give a thumps up to India’s liberalised abortion law. Many sex workers are living with HIV and face discrimination and stigma in accessing safe abortions. Credit: Stella Paul/IPS
By Stella Paul
NEW DEHLI, Apr 14 2020 (IPS)
Arti Zodpe is from the Tamasha (folk dance-drama) theatre in Sangli, in India’s Maharashtra state. After evening performances, some of the singers and dancers offer sex work services to the audience.
“We [Tamasha sex workers] live outside of the city as people feel disturbed by the sound of our ghunghroo [anklet bracelets with bells] and music. When we go to the city, especially to a sex health clinic, the staff say, ‘so you have come to spread your filth here’. If we get an abortion, they make us clean the floor afterwards,” she had said at a recent gathering of doctors and abortion rights experts.
Zodpe’s life narrates the difficulties vulnerable women like her face to get an abortion, and explains in painful detail the layers of social discrimination and stigma marginalised women face in orthodox Indian society.
Safe abortion still a dream for many
Abortion has been free in India since 1971, yet millions of women still fail to access safe abortions.
According to the Lancet Global Health report 2019, 15.6 million abortions occurred here in 2015, of which 78 percent were conducted outside of health facilities. Most of these abortions were also by women obtaining medical abortion drugs from chemists and informal vendors without prescriptions.
According to the Office of the United Nations High Commissioner for Human Rights (OHCHR), unsafe abortions are estimated to account for 9 to 20 percent of all maternal deaths in the country.
A more recent study by Mahila Sarvangeen Utkarsh Mandal (MASUM), a Pune-based NGO, and Asia Safe Abortion Partnership (ASAP) conducted in seven of India’s 29 states revealed that 80 percent of women were unaware of the existing law and, as a result, feared seeking safe abortion services.
The study, released last month, interviewed 200 participants and found that all had had an abortion at some point, while some had as many as six. Yet none of the women had revealed this to their family or friends, primarily for fear of social stigma.
According to Hemlata Pisal, the project coordinator at MASUM, there were various gaps and discrepancies when it came to abortion services in public health centres (PHC):
- Medical abortion pills were largely unavailable, and even when they were available (through private clinics or mostly pharmacies), there was a variation in the dosages and types of pills prescribed.
- The out-dated D & C (dilation and curettage) method was still being used in many health centres across India and there was no standard protocol followed for both surgical and non-surgical methods.
- But above all there was a high level of stigma practiced by the staff.
“Women we interviewed reported that when they approached PHC for abortion they were often refused or subjected to extreme humiliation and abuse,” Pisal told IPS.
Liberalising the law
On Mar. 17, a week before the country went into a nationwide lockdown to stop the spread of the coronavirus disease or COVID-19, the Indian parliament voted for an amended version of the old abortion law, the Medical Termination of Pregnancy (MTP) Act, 1971, making it more liberal and accommodative.
- One of the salient features of the amended MTP law was increasing the upper limit for abortion from 20 to 24 weeks. However, the new law will only favour “special categories of women”, which include rape survivors, victims of incest, those who are differently-abled and minors.
- It also gives a woman the opportunity to terminate her pregnancy if foetal abnormalities are detected within 24 weeks of her pregnancy. In recent years, several law suits were filed that demanded a raise in the upper limit for foetal abnormalities.
Speaking at parliament on the occasion, the India’s health minister Harsh Vardhan said that the new law was very progressive and it promised to ensure the safety of women.
Medical practitioners and health exerts also welcomed the amendment.
Dr. Noor Fathima, a senior public health official and Bangalore-based gynaecologist, told IPS that it would make abortion “less cumbersome to service providers”.
“The [amended] MTP Act is particularly a boon to women who are facing emotionally draining and stigmatising pregnancy conditions,” Fathima told IPS.
Lack of accountability fuels discrimination
However, many said that continued social stigma posed a serious threat to the effectiveness of the new law, which also grants a woman the right to complete privacy.
But vulnerable groups of women rarely enjoy this right to privacy, said Kousalya Periasamy, the head of Positive Women’s Network (PWN), a Chennai-based group advocating equal rights for HIV positive women across India.
“Staff at any abortion centre would frequently ask us ‘why were you sleeping with your partner when you have HIV’? We are also asked to submit identity documents and consent letters from male family members. Often we are denied an abortion even without a reason. And after the abortion, we must clean up the room,” Periasamy told IPS.
The reason behind such humiliation, says Mumbai-based gynaecologist and coordinator at ASAP, Dr. Suchitra Dalvie, is that presently there is no accountability for quality of abortion care or for refusals.
“Women are still dying of septic abortions and/or enduring immense pain, public-shaming and judgemental-abusive attitudes. Unless we are plugging these holes, the situation will not change dramatically because 80 percent of women are unaware on the law to begin with,” she told IPS.
Stigma – a global challenge
Katja Iversen, chief executive officer of Women Deliver — the New York-based global advocacy group — agrees that stigma is a serious obstacle to availing abortion services worldwide.
“Abortion is a basic healthcare need for millions of girls and women, and safe, legal pregnancy termination saves women’s lives every day. Unfortunately, abortion has been stigmatised to keep people from talking about it and to maintain control over women’s bodies, and that silence leads to political pushback and dangerous myths,” Iversen told IPS.
The study by MASUM also found some of these myths and unfounded beliefs which existed among women across the country. Some of these are:
- The medical termination of a pregnancy is illegal.
- Abortion is legal only up to 12 weeks.
- Abortion is not allowed for first pregnancy.
- Abortion causes permanent infertility.
- One’s husband’s signature is mandatory for an abortion.
“These beliefs ultimately block the ways of society to view and discuss abortion as a normal health issue and discuss in a transparent manner,” says Pisal.
Safe abortion for a better life
According to Iversen, free and regular access to reproductive health, including abortion care, can lead to overall improved living conditions of women and a more gender-equal world.
“When girls and women have access to reproductive health services, including abortion, they are more likely to stay in school, join and stay in the workforce, become economically independent, and live their full potential. It is a virtuous cycle and benefits individuals, communities, and countries,” she said.
The United Nations Sustainable Development Goal (SDG) 3 to ensure healthy lives and promote the well-being of all also confirms this. Target 3.7 of SDG 3 specifically aims to ensure “universal access to sexual and reproductive health-care services”.
In India, however, achieving this target might need more than a change in the law.
Dr. Ravi Duggal, a senior health consultant based in Mumbai, suggests strengthening the public health system, which he believes will ensure cost regulation and access to services as a matter of right; timely and regular stocking of medicine; and sensitisation of service providers, including doctors and nurses.
“A stronger public health system is a need of the hour. If the staff is non-judgemental, confidential, respecting privacy and (generate) prompt response will go a long way to shift women from seeking abortion care at unqualified facilities to approved facilities.”
But as India extended its three-week COVID-19 lockdown until May 3 with just over 10,000 cases recorded, it’s the poor who have been the hardest hit by the countrywide closures.
This includes women in need of abortions as all hospitals and clinics have closed their free, outdoor, non-coronavirus treatment services.
And in Sangli, Zodpe’s home district, the area has been declared a COVID-19 hotspot. For poor, marginalised women like herself this means a great struggle for survival as they are unable to work and earn a living and also remain unable to access sexual and reproductive health care.
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