I work in menstrual health at Boondh and by the nature of my work, I am often associated with Sexual and Reproductive Health. I have had friends and friends of friends who bought the menstrual cup from us and didn’t have to use it for over 6 weeks and when asked, realized they were pregnant.
There is a crowd sourced list of gynecologists we can trust from across India that I often link people to for STDs, infections, pap smear et all anything related to vaginas. So I used the same to help these women who reached out to me for guidelines/ people they could approach to abort their pregnancy.
But it never seems to work.
All of the women who reached out to me were either in their late teens or early twenties and not married. Everyone except barring one case of forced penetration, regularly used some form of contraceptive (read practiced safe sex) and needed to terminate the pregnancy as they were not prepared for a child. Owing to the stigma around pre-marital sex in India, none of them wanted to seek help from family or peers to decide on the procedure for termination. They wanted it done in the most discreet way possible, and hoped it was safe. Yes, discretion was above safety and comfort on their checklist.
For the purpose of this article, I spoke to over a dozen women from India to understand their experience leading to and of abortion as an unmarried woman in India. All of them were from a Tier 1 city in India, had access to higher education and a monthly allowance for expenses. They were involved with boyfriends/ men- some supportive, some not so supportive, and had engaged in consensual sex.
On missing a period, they ran a pregnancy test (available at pharmacies/ on the internet starting at ~INR 100). If and when found positive, most panicked, called their partners and ran a second check. On confirmation, they froze and started to think of people they knew who had undergone abortions as they googled ‘Safe abortions at home’ or along its line. This usually ended in learning that it is safe and common to abort within the first three months. Next they needed to know how to and under whose supervision.
Women who lived with their families decided to look for doctors on phone apps instead of approaching trusted gyneacs they had been consulting for years. They didn’t want to involve doctors who knew their families. They went to localities farther from their own to remain anonymous and untraceable. Some even travelled to another city because of paranoia about family reputation and lack of easy access to hospitals that can offer discretion in service. While hospitals in Pune and Chandigarh were more open to abortions, women in Bangalore met with more success at Fertility Clinics.
Legally, any woman in India can choose to abort a pregnancy in the first 12 weeks of gestation period and has the right to safe abortion at a public or private medical care facility. In the first 8-10 weeks, the abortion can be done via two sets of oral pills that can be bought using a prescription (available online starting at INR ~500). It is suggested that medical supervision is sought. It is mandatory to confirm pregnancy with a ultrasound sonography before adopting any termination methods- pills, DNC or other surgical methods. People I interviewed paid upto INR 8,000 for the pill-induced abortion under supervision. Most of them felt cheated and a few were able to bargain prices. The most inexpensive one cited was at a govt. hospital in Delhi at INR 2,000.
In the event that the pregnancy is over 8 weeks, one must definitely consult doctors to consider options for an in-clinic abortion that might involve a surgical procedure. The procedure is safe, common and legal upto 20 weeks in India. When consulting a doctor and choosing an abortion, an adult woman is not required to consent her spouse or the family. The clinic might request her to sign an undertaking and ask for an identity card. A surgical procedure costed those interviewed INR 10,000- 15000 (data from the years 2011-2018).
For pregnancies over 20 weeks, the court is involved in decision making. It is also suggested that counselling be considered post abortion if and as required.
Saniya (name changed), who is currently working in Rajasthan had two abortions, at ages 22 and 24 in Bombay. She was a post-grad student then and had collected a list of gyneacs from Just Dial. She called many gynecologists and inquired about the cost, duration and procedure before settling on the seventh one to meet. She faced unpleasant reception and remarks from the first six doctors as she told them she was unmarried. The seventh one she spoke to asked her to come over and offered two procedures- medicines for INR 8,000 and a DNC for INR 12,000 both of which she couldn’t afford. She finally availed the service on pills for INR 5,500 and got them wrapped in a paper. The doctor was not transparent about the brand of the medicine or its composition and did not offer any information that she could verify. This was the best she could get from options available to her then.
Her second abortion was a different story where she contacted a doctor from the app Dr. Insta, on searching for ‘abortion related docs.’ The doctor was at the Metropolis hospital and insisted on a sonography but wouldn’t give her a prescription to get the same done. She said the same hospital doesn’t offer these services. Saniya went through many centres that turned her down and eventually got an ultrasound in a dark, dingy lab where she was questioned about marriage, her last period and why she wanted the ultrasound, along with a bunch of other personal questions. (In my own experience, I get ultrasounds done in Chennai every year and have never been asked for a prescription). She felt unsafe and uncomfortable, and got out of there as quick as possible. The doctor at Metropolis wasn’t satisfied with the results from this lab, as it seemed like Saniya had a cyst and that could complicate the MTP. She finally gave a prescription to Saniya mentioning her age, marital status and that she had had an abortion before. This time though, Saniya got an ultrasound in the very same hospital.
She opted for the pills again and the procedure (along with blood test and sonography) cost her INR 6,000 in 2017. She felt comfortable as she was in a hospital and the doctor had given her a sealed kit which she could Google and verify. She also looked up the side effects of sonography and wished she was informed about the same in advance. She said that in both cases the recovery was overwhelming and didn’t know whom to turn to for support. Later that year, when she referred the same doctor to an acquaintance, the acquaintance was charged INR 12,000 for the pill kit and same procedure. They preferred going to this doctor anyway as she offered safety and discretion. No undertaking, contact details or iD card was asked.
Tanushree’s (name changed) experience was different as she looked for a hospital to terminate her pregnancy in Pune in 2011. She was 19 with a the boyfriend who was not supportive and she had to figure everything on her own. She wishes there were more options in India for teenagers with unplanned pregnancies, as abroad. She might have liked to keep the baby, as her friend in USA who delivered the baby, put the baby up for adoption and is still in touch with the child. India has no organizations that facilitate such an option, and family here is rarely ever supportive or expected to understand.
The first doctor she went to was a male at Ruby Hall who made her uncomfortable by inviting pre-med students into the room. He placed Tanushree’s hand to the embryo which was emotionally and mentally overwhelming for her then and sometimes is even today. She left the hospital and two weeks later, she went to Jahangir Hospital where she eventually terminated the pregnancy. This time Tanushree had faked her age as 22 and given a different name. The female doctor at Jahangir tried to convince her multiple times to keep the baby. The doctor insisted on meeting the husband, getting the couple’s confirmation together before proceeding on the matter. This delayed the process by another week.
When it did happen, it was a simple surgery with general anesthesia. After the surgery, Tanushree was alone in the hospital with no friend or boyfriend and the doctor did not meet her during recovery. To add to the stress, she was placed in the maternity ward with sights of and sounds from newborn babies. She was stressed and needed counselling but there was no one to turn to- individual, institutional or organization. The operation costed ~ INR 15,000 and an undertaking was signed.
In the 2.5 months between the start of pregnancy and its termination, Tanushree lost a lot of weight as she could barely eat till the afternoon. She moved to 46kg from 54kg on the weighing scale. For a person who was 5 ft 9 in, she was very weak physically, adding to the emotional stress she was undergoing. She sought counselling after the termination but dropped therapy after two visits. She is now 28 and works in advertising in Bombay and continues to see a physiatrist regularly. She recently discussed her pregnancy termination with her therapist, drawing strings.
Mohini (name changed) from Bombay was a student in Pune who got pregnant in her sophomore year at college. Her supportive boyfriend identified a doctor in Bangalore where he then lived to perform the abortion. They had shortlisted on a Fertility Clinic based on reviews on the app Practo. The doctor was understanding but also insisted that the couple rethink their decision. Mohini had given a fame name and age to this doctor. However, she is certain the doctor understood the situation and yet, judged her for actions and choice, inducing shame. Inspite of declining the offer, the doctor forcefully made her listen to the embryo’s heartbeat, creating a traumatic experience for Mohini.
Karina (name changed), now age 34, mother of two and living in Hyderabad had two abortions, one in Chandigargh and one in London. She remembers her experience in Chandigarh being a traumatizing one as the medical staff at the hospital didn’t tell her what to expect after the pills and she was constantly nervous about doing the same with her parents in the house. Her second abortion in the UK was a better experience as she was better informed about the composition of the pills, its usage, side effects and what she could expect.
Gynecologist Dr. Susheela Rani who practices at a specialty hospital in Bangalore and has been performing vaginal surgeries for 30 years shared that MTP (Medical Termination of Pregnancy) cannot be denied to anybody based on their marital status. She added that however, some hospitals run by religious trusts and institutions might have a blanket rule to offer abortions to nobody. In such a scenario, one must look for an alternative. In the research she shared, she mentioned that 10,000 abortion-related deaths occur each year in India.
It is important for women to know their rights, to care for their bodies, to make informed decisions on abortions, have access to medical advice and safe procedures and be offered counselling after treatment to lead lives undisturbed by the experience.