Why do Indian women need safe abortion services?

Author: Bhuvaneswari Sunil, PhD

If this reading, kindles a spark in you to know more about women undergoing abortion, then you would decide to hear voices of women seeking abortion…But if you simply decide to blame women and abortion, you are at a loss of understanding reality…

For last five years I have worked on the issues related to safe abortion services for women.  I want to share my experiences of working on the issue and a general story of why women undergo abortion and why many women need abortion, especially respectful, safe abortion services at the public health facilities.

In India, currently the number of doctors, bureaucrats, leaders of civil society organisations (working in health sector) and even researchers who believe in women’s autonomy and their unconditional rights over their body and reproductive choices is small. While, they understand about women’s lived in realities and the importance for health services, there are several amongst them who are ambiguous about supporting induced abortion as a woman’s right. Whenever anyone mentions unconditional abortion rights of women, they argue, “What about sex selective abortions and missing girls?”, “Do women not know they will become pregnant and be responsible?”.

Even doctors, who are not totally against women’s right to abortion, often choose to deny services based on their own judgements and moral view of right and wrong about a woman and her pregnancy. This is precisely what happens when third parties are authorised to make decisions for others. It is important for providers and law-makers to understand why women seek abortion, need safe abortion services and their plight in absence of access to these.

While the prominence given to declining sex ratio is well placed, the role of induced abortion alone in the process has been undeservedly stressed and second trimester abortions have been maligned through media and by political forces. Induced abortion has been deemed as a major threat to the demographic composition of the nation and consequentially often perceived as an illegal, irresponsible act by the woman and her family who seek it and the provider who provides it. I do not deny that sex selective abortions are happening. But in my extensive field experience across these five years especially in Tamil Nadu, these as a proportion of overall induced abortions are few.

The women I interacted with were primarily rural, marginalized, married women. None of them intended to have an abortion when they conceived for the first time. It was not surprising as lot of eminence is placed upon motherhood and it is seen by the society as the epitome of achievement of the woman, her purpose in life. Most women wanted to have abortion, when they conceived soon after childbirth. They wanted to space pregnancies. Others who had attained the desired number of children, ‘irrespective of the sex of the living children’ wanted to have an abortion before they could resort to some permanent contraceptive method.

I looked at these occurrences in the context of people’s arguments, “Didn’t these women know they will become pregnant, before engaging in a sexual relationship?”, “Isn’t something called contraception available?”.Yes, they were definitely aware. But have we forgotten how rules and norms of a patriarchal society work for women? How much autonomy did these women have in controlling their sexual lives? Does the societal norms that govern ‘her’, a woman’s responsibility towards her spouse in a marriage, permit her to deny sexual intimacy or use of contraception against her spouse’s wishes? How much control did she have over her reproductive desires, number of children for instance, or use of contraception? Would the available modern contraceptive method of her choice be acceptable to her spouse? If she chooses to have these controls what are the likely consequences in her daily and future life? Unless and until one is prepared to explore the answers to each of these questions, it is unfair to form an opinion and oppose women’s decisions, choices and services they need.

Government’s aim is to promote use of contraception, especially PPIUCDs and PAIUCDs, sterilization and injections to control ‘population explosion’. Doctors in public sector are known to make services conditional on contraception acceptance. Many young women aged 20-35 years I spoke to never wanted to have more than one or two children or at most three children, irrespective of their education and economic status. These women were responsible, committed to their children and families but given that they had no decision-making autonomy either at home or at the service provider’s, they were often helpless and had to resort to unsafe, clandestine methods to meet their needs. These are sometimes known to even cost some of them their health and life.

Women find it difficult to share their private experiences and lack of autonomy in sexual life with doctors. As one of them said, “How can I exactly tell the doctor what happens within the four walls of my house when I say ‘NO’ to my husband for sex….all the bad and abusive words he calls me, the hitting and slapping…the doctors want my husband’s permission to do abortion…with my husband standing next to me what do I tell?”.

I came across a number of life stories where intersection of their personal bodily experience, family circumstances, socio-economic conditions, domestic violence defined their lives and institutional norms and might during service seeking defined their choices. There is a need to change the narrative. To begin with there is a need to spread awareness that abortion is conditionally legal and then we need to sensitize providers, lawmakers to the lived in realities of women. Humane, respectful and empathetic services is all that women are seeking.

Acknowledgement: With support from Dr. Alka Barua, Abortion theme leader and steering committee member CommonHealth

For more information about CommonHealth’s work on Abortion, please visit our website at http://www.commonhealth.in

Published by CommonHealth: Coalition for Maternal-Neonatal Health and Safe Abortion

Constituted in 2006, CommonHealth is a multi-state coalition of organizations and individuals working towards changing this unacceptable situation and advocating for better access to sexual and reproductive health and health care, with a specific focus on maternal health and safe abortion with a rights perspective CommonHealth members are from diverse fields working towards the realisation of reproductive health and rights in different geographies within the country. The coalition advocates for increased access to sexual and reproductive health care and services to improve health conditions of women especially for women from poor, vulnerable and marginalized communities.

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