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Abortion Policy Landscape-India2

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First Second Post-Abortion Trimester Trimester Care Specialists (ob gyns) WHO Non-specialists (general physicians) Medical abortion ** *** (using mifepristone (Up to 9 weeks) & misoprostol combination) Surgical abortion HOW (vacuum aspiration) Surgical abortion (dilatation & evacuation) All public-sector Secondary and tertiary public- Where facilities and All public and approved private sector facilities private sector facilities/ and approved facilities clinics**** private facilities *Qualiication and training criteria apply. **The Drug Controller General of India limits the use of MA drugs upto nine weeks. However, the national CAC guidelines10 include drug protocol for second trimester abortions in accordance with WHO Guidelines 2014, for reference. *** Misoprostol only. **** MA upto seven weeks can also be prescribed from an outpatient clinic with an established referral access to MTP-approved facility. REFERENCES 1 United Nations, Department of Economic and Social Aairs, Population Division (2019). World Population Prospects 2019, Online Edition. Rev. 1 https://population.un.org/wpp/Download/Standard/Population/ 2 Census of India 2011 http://www.censusindia.gov.in/2011census/population_enumeration.html 3 Sample Registration System 201416 http://www.censusindia.gov.in/vital_statistics/ SRS_Bulletins/MMR%20Bulletin-201416.pdf 4 National Family Health Survey 4 (201516) http://rchiips.org/nhs/pdf/NFHS4/India.pdf 5 Maternal Mortality Ratio: India, EAG & Assam, Southern States and Other States https://www.niti.gov.in/content/maternal-mortality-ratio-mmr-100000-live-births ABORTION 6 National Family Health Survey 1 (199293) http://rchiips.org/nhs/india1.shtml 7 Sample Registration Survey. Maternal Mortality in India: 19972003. Trends, Causes and Risk Factors. Registrar General. India http://www.cghr.org/wordpress/wp-content/uploads/RGICGHRMaternal-Mortality-in- India-1997%E2%80%932003.pdf POLICY LANDSCAPE 8 Banerjee et al. BMC Public Health 2012, 12:175 http://www.biomedcentral.com/14712458/12/175 9 The Medical Termination of Pregnancy Act, 1971 http://www.egazette.nic.in/WriteReadData/1971/E13831971003461647.pdf India 10 CAC Training & Service Delivery Guidelines 2018 https://nhm.gov.in/New_Updates_2018/NHM_Components/RMNCHA/MH/Guidelines/CAC_Training_and_Service_ Delivery_Guideline.pdf 11. Special Bulletin on Maternal Mortality in India 201517 Bulletin http://www.censusindia.gov.in/vital_statistics/SRS_Bulletins/MMR_Bulletin-201517.pdf BACKGROUND CONSENT FOR ABORTION PROVISION OF CAC AND POSTABORTION CARE India is the seventh largest country by area and the second-most populous country in the world. The The MTP Act requires only the consent of the woman for an abortion (if she is of sound mind and CAC services in India can be provided by ob-gyns (specialists) and MBBS doctors (non-specialist total population of India is estimated1 to be 1.3 billion of which 656.3 million are women not a minor). Spousal or any other consent is not required. physicians), also referred to as a registered medical practitioner who fulill training qualiications approximately 336 million in the reproductive age (15 – 49 years). The sex ratio of India is 943 as speciied in the MTP Act and Rules. females per 1000 males. However, in case of a minor who has not completed the age of 18 years or a mentally ill woman, the consent of the guardian is required. Table 1: Key reproductive health indicators POLICY PROGRESS AND GAPS Table 2: Key abortion-related indicators Indicator Status The national CAC guidelines were revised in 2018 and aligned with Maternal mortality ratio 122/100 00011 live births Induced abortion rate (as% of all pregnancies) 3.1%7 1 recommendations of the latest WHO safe abortion technical and policy Spontaneous abortion/miscarriage rate (as% of all pregnancies) 6.4%7 guidance for health systems. Proportion of women who were aware that abortion is legal in India 35.5%8 Number of maternal deaths 32 000 Proportion of women who knew at least one source of accessing abortion services 46.2%8 Medical abortion drugs are included in the essential drugs list, and equipment (manual vacuum aspirator) and essential drugs for MVA are Median age at irst marriage 2 18.6 years weeks registered and available in public sector facilities. ll 20 d ti tte mi er p Median age at irst birth 21 years ns Integration of CAC with post-abortion contraception with key guidance io it Rape/ d documents by the national government, including a technical update n o Incest 3 C and operational guidelines on post-abortion contraception. Total fertility rate 2.2%3 Mental Contraceptive prevalence rate Fetal Handbook by GoI for community awareness on safe abortion to be health* (all methods) 53.5% impairment 4 used by peripheral health workers in dierent languages. Unmet need for family planning 12.9% The Drug Controller General of India limits the use of MA drugs upto 5 nine weeks of gestation. India has signiicantly improved its maternal health indicators over the years – MMR reduced from Economic/ 254 in 2004 – 2006 to 130 in 2014 – 20165; TFR reduced from 3.4 in 1992 – 19936 to 2.2 in 2015 – Physical social 2016; and CPR increased from 40.6% in 1992935 to 53.5% in 201516. The use of modern methods health reasons The MTP Act permits only allopathic doctors to provide abortion services, of contraception increased from 36% to 48% during the same period. 6 excluding a range of other potential providers of complementary systems of medicine, nurses and auxiliary nurse midwives. Abortion related complications are the third largest cause of maternal deaths and account for about 8% of the country’s MMR7. Save On woman’s request ABORTION LAWS AND POLICIES life Abortion in India is legal as per the Medical Termination of Pregnancy (MTP) Act, which was passed in 1971. The Act allows termination of pregnancy upto 20 weeks for a broad range of indications. Conditions not permitted The MTP Act was amended in December 2002, and the Rules, in June 2003. *This includes injury to mental health caused due to failure of any device or method used by a married woman or her husband for the purpose of limiting the number of children Figure 1: Conditions and gestation limit for which abortion is permitted in India.
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