Fading Medical Abortion Pills From Markets: A Threat To Safe Abortion Care – Pratigya Campaign Study

Globally more than 20 million women, vast majority of them being in poor countries, resort to unsafe abortion each year. An estimated 47,000 women die in the process and five million need urgent medical attention.

Pratigya Campaign for Gender Equality and Safe Abortion was launched in India in January 2013. The campaign – an association of individuals and organisations working towards protecting and advancing women’s rights and their access to safe abortion care in India. The campaign advocates with governments, organisations and media at the national and state levels on issues of women’s empowerment and women’s access to healthcare services. The concept of ‘Population First’ is engaged in the campaign.

The focus of the Campaign is on key areas such as:

a) Extending support to the providers to ensure they continue to provide abortion services

b) Ensuring continued availability of Medical Abortion drugs in the markets and support to women using Medical Abortion (MA) drugs out of facility

c) Understanding and engaging with the legal landscape, particularly the jurisprudence in abortion related cases

d) Building strong alliances with organisations and individuals to sharpen the collective voice of the Campaign.

Recently, Pratigya Campaign conducted a study and found that Medical Abortion (MA) drugs are rapidly vanishing. Legal/regulatory barriers was cited by chemists to be the major reason for non-stocking of MA drugs. Non-availability of MA drugs is threatening women's access to safe abortion, considering the situation where even today an estimated 10 women die in India due to unsafe abortions, the third leading cause of maternal mortality in the country.

Availability of safe, effective and accessible abortion services including MA Drugs is indispensable for promoting women’s health and reproductive rights. MA is considered as the most preferred method of abortion care in India.

There are certain requirements put forth by the Medical Termination of Pregnancy Act, 1971 (MTP) for legal and safe abortion services in India. It lays out the qualifications for providers who wish to offer abortion services and also facility requirements for clinics that wish to be eligible for approval to offer abortion services in the first and second trimesters. According to a survey, an estimated 81% of the 15.6 million annual abortions in India are carried out using MA drugs.

A study conducted found out that there have been MA specific visits by regulatory authorities and chemists have been informally asked not to sell MA drugs. As high as 56% chemists reported that MA drugs are overregulated as compared to other schedule H drugs.

According to Mr. V.S Chandrashekar, Pratigya Campaign Advisory Group member and Chief Executive Officer, Foundation for Reproductive Health Services India, the availability of MA drugs has been instrumental in the decline of unsafe abortions. He further noted that the country has achieved great success in improving access to safe abortions, owing to the proactive steps taken by the Ministry of Health and Family Welfare over the past decade and a half. However, the non-availability of MA drugs could potentially reverse the gains made over the past few years.

The study attempted to capture chemists’ awareness, knowledge and attitudes about abortions and MA drugs. According to 43% of chemists, abortions were illegal; and only 26% were aware of the fact that abortion is legal up to 20 weeks gestation.

Dr. Kalpana Apte, Pratigya Campaign Advisory Group member and Secretary General, Family Planning Association of India said that the perception is because of the fact that combipacks are indicated only for use up to nine weeks gestation and the commonly used and affordable technology to identify the sex of the fetus i.e. Ultra Sonography can detect the sex only around 13-14 weeks gestation. Such misconception seemed to be resulting in overregulation of MA drugs, significantly affecting availability of a safe, simple and affordable method of safely terminating a pregnancy, compromising the health, wellbeing and reproductive rights of women in India.

Further, the study findings showed that 50% of buyers of MA drugs went to the Chemists with prescriptions as against a common perception that a majority of MA drugs are purchased without prescriptions. According to V.S. Chandrashekar, allowing all allopathic doctors to prescribe MA drugs will definitely increase prescription and medical support for women seeking MA. As law and rules stand now, only Obstetrician and Gynaecologists and allopathic doctors who are approved abortion provider under the MTP Act can prescribe MA drugs. In a country as big as ours, estimatedly, only 60-70,000 doctors, especially in urban areas, can prescribe MA drugs in India which is woefully inadequate.

MA drugs are considered safe and even if incorrectly used, they are unlikely to create an emergency situation or seriously impact the health of a woman. The World Health Organization (WHO) has moved MA combipack to the core list. The previous list had an asterisk (*) against MA drugs indicative of the fact that MA drugs required close medical supervision. According to Dr. Apte, the removal of the asterisk implies that MA combipacks can be used even without close medical supervision and the risks it poses are minimal.

The study has indicated that MA drugs are under greater scrutiny by drug control authorities and their non-availability in retail chemist shops is a major cause of concern especially in Maharashtra and Rajasthan. To ensure that MA drugs are easily accessible Pratigya Campaign recommends that the Ministry of Health and Family Welfare and the Drug Controller General of India should send an advisory/guidance to all State Drug Controllers clarifying that cracking down on combipack does not help in curbing sex selection and that MA drugs should be subjected to the same standards/scrutiny as other schedule H drugs.

The MTP rules and the Drug Controller General of India (DCGI) approval are inconsistent regarding the gestation up to which MA can be used. It is recommended that the MTP rules should be amended to allow all allopathic doctors to prescribe MA drugs thereby increasing the number of doctors who can prescribe MA drugs. This would enable women to seek medical support while using MA. Further the knowledge of retail chemists on abortion and MA ought to be improved by the Government in partnership with MA drug marketing companies and Chemists and Druggists association enabling them to provide correct information.

Women in large numbers find MA drugs effective, affordable and convenient in terminating unwanted pregnancies. Greater scrutiny resulting in MA drugs disappearing from shelves of chemists would result in millions of women being denied access to lifesaving drugs and compromise their ability to exercise their sexual and reproductive rights. The access to safe abortion services will enable women to take control over their own bodies and life, critical to promoting reproductive health rights and gender quality.