THE CONUNDRUM WITH “DO IT YOURSELF” ABORTION PILLS

Every individual has the right to freely and responsibly decide the highest standard of sexual and reproductive health. Despite legalization of abortion, over the counter illegal sale and unsupervised self-administration of abortion pills has shown a rapid spurt in recent time in spite of the legal ban on over-the-counter sale. “DIY” abortion is when a person performs their own abortion outside of a medical setting. This rising phenomenon endangers the woman’s life. Medical abortion is a safe method of termination of pregnancy when performed as per guidelines.

Legalization of abortions was done with the aim of reducing maternal death but its very alarming that each year between 4.7% – 13.2% of maternal deaths can be attributed to unsafe abortion. Out of 46 million abortions performed annually, 19 million are estimated to be unsafe. As far as the reason for self-administration of abortion pill is concerned, lack of awareness about the legality of medical abortion is the primary factor. 1 in 2 females and 1 in 6 males believe that abortion is illegal. Most of these women are young, illiterate, poor and belong to rural areas. Lack of access to safe abortion facility is another important determinant that puts these women in a vulnerable position. As per statistics available through official sources, contraceptive failure is the most common cause for termination of pregnancy.

That next-door chemist gives you this MTP kit that contains two drugs mifepristone and misoprostol, these are schedule H drugs and schedule H drugs can only be prescribed by a registered medical professional. The fact that the chemists, who have limited knowledge about medical abortion, are already the main service providers as far as over the counter sale of schedule H abortion pill is concerned, and this should not be ignored. The reasons for this rampant misuse are easy accessibility, cost effectiveness and convenience. The knowledge regarding medical abortion is largely limited in both the provider and consumer. Most of the chemists believe that over the counter sale of abortion pills is legal, only 46% know the administration protocol and this turns out to be disastrous at times with women landing up with excessive hemorrhage, shock and sepsis. WHO recommends that the person or facility prescribing abortion pills should have a backup healthcare facility for surgical evacuation in case of failed or incomplete abortion. Therefore, abortion pills must only be prescribed by Registered medical practitioners.

The current scenario calls for interventions which increase awareness among masses regarding medical abortion, administration protocol, recommended gestational age limits which can be achieved through various campaigns, public forums, posters and media coverage. The women should be encouraged to break the social taboo and seek for safe abortion facility which is their legal right

HOW CAN THESE UNSAFE ABORTIONS BE PREVENTED:

First, by promoting comprehensive sexual education, parents and schools should jointly breed safe interactive and non-judgmental spaces for our children. Age appropriate, gender based and culturally compatible knowledge should be provided. The aim of sexuality education is two-fold, it will reduce potential negative consequences of sexual behavior like unwanted pregnancies, sexually transmitted infections and child sexual abuse. It will also increase wellbeing by enhancing the quality of life and relationship of young adults. This does not give them green signal to experiment rather this positions them better to make responsible and safer choices for themselves.

Second, by use of effective contraception, appropriate awareness about condoms, pills, injections, intrauterine contraceptive devices and other emergency contraceptive methods can be available via healthcare providers about its availability, safety and use. This intervention will definitely decrease the number of unwanted pregnancies thereby decreasing abortion rates.

Third is provision of safe and legal abortion, access to safe health facilities should be the priority. Pre abortive counselling and proper investigation like ultrasound is necessary to rule out ectopic pregnancy. It will decrease the burden of unnecessary hospital visit, provide a better scope for decision making and safe abortion based on protocol and gestational age, with different gestational age there is difference in termination protocol starting from medical abortion to surgical.

Improving access to safe health facilities should be the high priority for the government. This can be achieved by strengthening the PHC and CHC in terms of trained manpower and infrastructure so that drugs can be easily provided under supervision to reduce maternal mortality and morbidity and urgent restriction is required on pharmacists to stop unsafe use to MTP kit.

Further amendment in MTP Act is required especially in term of service provide. Eliminating over the counter sale of abortion pills completely seems impossible considering various socioeconomic factors. It is emphasized that self-administration of abortion pill can be safe provided the women have accurate information about medical abortion, have undergone proper investigations and have easy access to health facility if need arises; otherwise, these pills may backfire.