New Delhi Sep 12 2013(Sailesh Gandhi): Ministry of Health and Family Welfare and Ipas, a non-government organization,jointly organised a national consultation – beyond 40 years of legal abortion: committing to women’s health and rights. This consultation was planned with the purpose of reflecting on the successes as well as challenges in the four decades since the passage of the Medical Termination of Pregnancy Act in 1971 and identifies strategies for the way forward. The expected outcome of the meeting is a joint call to action for women’s health and rights presented to the Secretary Health and Family Welfare, Government of India. 
The fact that the Government of India has taken this initiative to partner with civil society to discuss and deliberate on strategies for strengthening access to safe abortion services is a reinforcement of their commitment to ending the needless deaths and disabilities faced by women as a result of poor access. The meeting was attended by over 100 representatives from government and civil society including senior officials from the MoHFW and representatives from 14 states.
Thursday, September 12, 2013
In India, a woman dies of abortion related causes every two hours. Despite a liberal law governing abortion access in India dating back to 1971, the challenge for Indian women seeking safe abortion services even today is significantly high. Even today, abortion related deaths contribute to 8% of the total maternal mortality. To facilitate faster decline in the overall maternal mortality in India, it is imperative that access to safe abortion is made available so that no woman has to die or suffer disabilities.
Mrs. Anuradha Gupta, Additional Secretary and Mission Director, NRHM, reaffirmed the commitment under NRHM to make abortion as a service imperative like other maternal, newborn, child and adolescent health life cycle approach paradigm. She also highlighted the need for comprehensive awareness initiatives to address the low levels of knowledge about legality and availability of abortion services.
The panel discussion on expanding provider base brought to light international evidence as well as from within the country that nurses as well as practitioners of Indigenous system of medicine (AYUSH) can safely and effectively offer safe abortion services. The priority is to ensure that safe health services are available to women as close to them as possible.
Mrs. Gupta emphasized that there is an urgent need for reviewing the legislations around access to safe abortion in India and facilitate the relevant amendments to make space for task shifting to ensure utilization of the skills of the AYUSH doctors as well as nurses to bring safe and legal abortion services available to women and urged the group to suggest practical recommendations for the same.
Majority of women seek abortion primarily because of lack of access to contraception. Studies on reasons for abortion in the second trimester were distance from facility and poverty. This also reaffirms women’s need for better access to safe abortion services.
Mr. Vinoj Manning, Country Director Ipas said that the problem of unsafe abortion is mammoth and requires dramatically new solutions, which can only be addressed by stakeholders working together in partnership and in tandem to address areas of awareness, service delivery and quality.
Dr. Shireen Jejeebhoy, Population Council shared the findings from the two studies documenting evidences of successful models of implementation of abortion services by nurses and Ayurvedic doctors and said that the evidence for the same exists in India. There is an urgent need to take cognizance of the same and convert evidence to action.
Deliberation on technologies for abortion services highlighted that asignificant gap still exists between the demand and supply of services and to bridge this gap, there is a need to take innovative stepsfor strengthening abortion service delivery with focus on medical methods of abortion (MMA). MMA is globally acknowledged to have a success rate of 95-97% efficacy. While Medical abortion drugs have been approvedto be provided under supervision of a qualified provider by the Drug Controller in India since 2008, as per available data, these drugs are still not readily available in the public sector in the state of Madhya Pradesh. Medical abortion is a very safe method for early abortions under supervision of a qualified provider and has been approved and validated by the WHO. This methodis being used widely as the method of choice in many countries for over 15 years. This method offers privacy, convenience and acceptability of abortion services, without compromising on safety for women.
The discussions on the issue of addressing issues of gender-biased sex selection and access to safe abortion highlighted that while both issues are in the continuum of women’s issues, there is a need to look at them from separate lenses. The two acts – MTP and PCPNDT Act need to be implemented in their element without impinging on the other.
The key recommendations that came up during the day’s deliberation include:
· Expanding provider base to include nurses and AYUSH doctors
o This task shifting requires an amendment to the MTP Act
o Drafting of training and certification guidelines. The training package should be competency based and systems for monitoring to be in place
o Drafting of guidelines for ensuring better access to safe abortion while ensuring that the technology is not misused for sex selection
· Promoting medical methods of abortion across the public and private health system as a means to strengthen women’s autonomy and decision making in choice of technology
· Need for widespread awareness campaigns to increase awareness about safe and legal abortion in India.
· Keeping the issues of safe abortion and sex selection apart
o Need for capacity building and training for the nodal officers in-charge of monitoring the implementation of the MTP And PCPNDT Acts
o Only 2-5% of all abortions are sex selective and therefore all abortions should not be stigmatized
The recommendations from each of the technical panel are being compiled to form a call to action. This collective call to action as a statement of commitment from the Government as well as civil society will be presented to the Secretary Health and Family Welfare on 13th September and will be the guiding framework for the implementation interventions in the years to follow.
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