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Availability and Accessibility to Safe Abortion Methods for Women

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Medical abortion (MA) has emerged as the preferred method of abortion care in India. In fact, about 81% of the 15.6 million annual abortions are performed using MA drugs. MA is viewed as a safe, effective and simpler option for women who may have otherwise faced barriers in accessing safe abortion care.

Considering the importance of them, Pratigya Campaign for Gender Equality and Safe Abortion commissioned a study to understand the availability of MA drugs in the urban markets of four Indian states – Bihar, Maharashtra, Rajasthan and Uttar Pradesh. The study was conducted to assess the availability of MA drugs in the market and to understand the awareness/knowledge levels and attitudes of the chemists stocking and selling MA drugs.

The study concluded that none of the retail chemists reported stocking MA drugs in Rajasthan and a negligible 1.2% in Maharashtra reported stocking. The situation was not as bad in the other states as 66% in Uttar Pradesh and 37.8% in Bihar were stocking and selling MA drugs at the time of the survey.

69.4% of all retail chemists who were not selling cited legal barriers as the main reason and 26.1% reported that ‘requirement of collecting prescriptions’ was a deterrent. 31.1% and 25.6% cited side effects and low demand as reasons for not stocking respectively. In Bihar, the most common reason was low demand (56.4%), while in Maharashtra and Rajasthan, chemists reported legal issues as the primary reason. Most retail chemists in Uttar Pradesh reported legal issues (75.6%), followed by side effects associated with the drug (58.1%) as reasons for not stocking. 58.1% of retail chemists, not stocking MA drugs in Uttar Pradesh attributed it to the frequent visit of drug inspectors to inquire about these drugs.

Apart from this, 43% of the respondents thought abortion is illegal in India, with Rajasthan reporting the highest at 60.7% followed by Bihar at 51.8%. 52% of retail chemists across the four states reported abortion is legal out of which 30% were aware that it is legal only for certain conditions.

Only 26% of chemists were aware that abortion is legal up to 20 weeks gestation in India. 29% of retail chemists reported that abortion can be done only up till 12 weeks gestation. Awareness was lowest at 9.5% in Uttar Pradesh.

The retail chemists across the four states had largely conflicting views on abortion. Half of all retail chemists interviewed believed the availability of MA has increased the number of abortions in India and 15% of the respondents thought MA can be used for sex selective abortions. Significantly, 42.5% of respondents in Maharashtra think that MA drugs can be used for sex-selective abortions in India, a misconception since they are only approved for use up to nine weeks gestation, when sex determination, using the most common and affordable method – Ultra Sonography, is not possible. While 44.6% of retail chemists stated MA is not useful for women, a close 42.6% considered it to be useful for women.

WHO has recently included MA drugs in the Core List of Essential Medicines (previously it was in the Complementary list). The earlier list had advisory stating “that close medical supervision is required for use of mifepristone-misoprostol for medical abortion”. This advisory is not mentioned in WHO’s latest list of essential medicines, which clearly indicates that MA drugs can be used with a minimum level of medical supervision and the risks associated with it are minimal. It is therefore essential that steps are taken immediately to remove unnecessary barriers that have been created in the distribution, stocking and sale of MA drugs to avoid millions of women being denied access to a safe, simple and effective method of terminating an unwanted pregnancy.