Rural India's criminal abortionist

Rural India's criminal abortionist
Dr Shyam Ashtekar

We could not have recognised it if we had not seen it so often in our hospital -- a small stick jutting out of the woman's uterus. The woman is still alive, but bleeding and miserable. This is just one case from the horrific archives of criminal abortions in rural India. The woman had had this abortion (better-termed as MTP or medical termination of pregnancy) three days earlier and it was performed by a practising homoeopath. She limps back home a week later.

During my internship as a doctor in a Pune village in 1978, the private practitioner next door once told me that he had just scooped out a foetus with a spoon, even scraping the vagina was enough since ``nobody knows''. Only last year, a lady homoeopath actually killed a mother of two during an abortion. But a death or two do not deter such practitioners, who once having tasted blood carry on with complete nonchalance. Criminal abortions of this kind take place in several nursing homes all over the country. Yet the government has legalised some of these centres, under the guise of recognising the system of ``visiting gynaecologists''.

But why don't Primary Health Centers (PHCs) and Community Health Centers (CHCs) provide legal and free abortions? To answer the question, I met the district health officer. I know him as a serious professional. After the usual pleasantries, I deliver my bouncer: Aren't most government doctors not trained for Medical Termination of Pregnancy? Are the rural institutes not recognised? It transpires that neither is the case. Officially, not even one MTP is reported. I laugh and tell him that these must be taking place but only clandestinely (or at private clinics). So what was the remedy for this? The only way out, it seemed, was to put up notices outside all PHCs and CHCs, stating that ``free MTP services'' were available. The figures should then be monitored on a monthly basis. Nothing of the kind happened, of course. As for the health officer, he got transferred and I am yet to meet his replacement.

Despite being legal, MTPs are not available at government rural centers. Even registered private MTP clinics are rare. In the entire block of 1,50,000 population where I am located, there was no legal MTP centre until we got our hospital certified in 1997. (That took three years of paperwork despite the fact that we knew most of the officers). Yet several fly-by-night ``doctors'' perform abortions or arrange for surgeon's services without bothering about legalities.

Why should we make the situation so difficult for abortion-seekers? The economics behind the process might provide some answers. Many of us might have read the advertisement of a certain medical centre in Mumbai in the '90s, that offered abortions at Rs 70. I know of doctors who do it for Rs 300 without a general anesthesia. With anaesthesia, it may cost even Rs 1,000. The prize catch for all those in the business of illegal abortions is the hapless mother of a teenaged daughter hiding her tummy. Recently, a rural doctor took a whopping Rs 10,000 for one such procedure. Extramarital abortions cost a little less than premarital ones. The more the ``sin'' and ``secrecy'', the higher the fees! There are economy packages for sex pre-selection procedures.

Providing a service like safe abortions is not enough then. It is necessary to educate people on how to avoid them all together. Any abortion can be unsafe. It can cause sterility, serious infections and even death. It is a necessity but an evil necessity. Good doctors -- and they are a rare breed -- try and convince couples and forego fees in many cases. Most abortionists take the opposite route and earn quick money. Since money is the incentive, no one is interested in health education.

And now the punch line. The facts I have cited here come from a district that was represented by three health ministers spanning 15 years of health administration in Maharashtra, two of them are qualified doctors. No less important is the fact that World Bank's pilot project for Reproductive Health has been operating in this district for the last three years.

The writer is presently running a hospital in Nasik, Maharashtra, and is a public health activist