Marking 49 years since the creation of the Medical Termination of Pregnancy (MTP) Act 1971a new study published on August 10, 2020 assessed the availability of medical abortion (MA) drugs in six Indian states to understand awareness levels and perceptions of chemists stocking and selling MA pills.
Despite the passage of MTP Bill (amendment) in March 2020 which extended the upper limit for allowing abortion to 24 weeks from 20 weeks, the non-availability of MA drugs, which are approved for use up to nine weeks of pregnancy in India, is seen as a “threat ” for women’s access to safe abortion and appropriate reproductive health care.
According to the quantitative cross-sectional study conducted between January and March 2020 by the Foundation for Reproductive Health Services India (FRHSI), among 1,500 retail pharmacists in six states, there is an “overwhelming shortage (of AD drugs) in five surveyed states in storage in Madhya Pradesh (6.5%), Punjab (1.0%), Tamil Nadu (2.0%), Haryana (2.0%) and New Delhi (34.0%). The only state that seems to do better is Assam with 69.6%.
These MA combipacks are a single package containing both the drugs – 1,200 mg of mifepristone and 4,200 mcg of misoprostol – to terminate a pregnancy up to nine weeks gestation. With the maximum retail price set by the National Pharmaceutical Pricing Authority, MA drugs are affordable.
However, according to the study, the non-stocking of MA drugs appears to be linked to over-regulation by drug control authorities. He said about 79 percent of chemists no longer stock MA drugs to avoid legal issues and excessive documentation requirements. The study noted that 54.8% of pharmacists also reported that MA drugs are over-regulated compared to other Schedule H drugs (prescription drugs that cannot be purchased over-the-counter without a prescription from a qualified physician).
Interestingly, even in Assam, which has the highest storage percentage, 58% of chemists reported excessive regulation of AD drugs. State-level regulatory/legal barriers continue to be the main reason for not stocking AM drugs, with 63% of pharmacies in Haryana, 40% in Madhya Pradesh, 74% in Punjab and 79 % in Tamil Nadu. “In the last quarter of 2018, we carried out a similar study in the states of Bihar, Maharashtra, Rajasthan and Uttar Pradesh. Since most of the states surveyed were in the north and west of the country, we chose to include Assam and Tamil Nadu,” said VS Chandrashekar, Managing Director, FRHS India and CAG Member, Pratigya campaign for gender equality and safe abortion.
In a 2015 Guttmacher Institute study “The Incidence of Abortion and Unwanted Pregnancy in India,” it was estimated that 81% of all abortions in the country were performed using medication. MY. He said that if MAID drugs are not available from pharmacies, one can assume that access to MAID — “a safe and effective method of terminating a pregnancy is no longer an option for many women”.
It was inferred that access to and choice of safe abortion care could likely force many people to seek unsafe abortion services, risking their health and their lives. “I must mention here that abortion in India is still not a right of women, it is a conditional right, and she can access it if the provider is of the opinion that she fulfills the conditions mentioned in the law. MTP. Unfortunately, the MTP (Amendment) Bill 2020 does not change this situation. To begin the process of making the MTP Bill rights-based legislation, we recommend that at least first trimester abortion (up to 12 weeks gestation) be available on demand and not dependent on the opinion of a provider,” Chandrashekhar said. indianexpress.com in an email interview.
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Chandrashekhar informed that according to government records, there are 25,931 health facilities in the public sector that provide abortion services. “However, each year, only about 7,00,000 abortions, or 4.5% of the estimated 1,56,00,000 abortions in the country, are performed in the public sector, with the rest performed by the private sector. When read in the context of how “about half of pregnancies in the country were unintended” according to a 2015-Lancet Global Health study, access to safe abortion must be a priority, said he declared.
“Only 43% of all pregnancies in India are planned. Unplanned pregnancies and unwanted births can be devastating and life changing for women and families. Apart from the impact on health and the economy, this prevents women from living their lives to the full. This violates their right to life and liberty. Unfortunately, women’s interests do not receive the required attention from policy makers and the general public. This has to change,” he said.
It was in 2019 that WMA drugs were included in its Master List of Essential Medicines, removing an earlier advisory that required medical supervision when taking the drugs. Interestingly, according to the study, about 82.3% of chemists in the six states said they had never sold AD drugs without a prescription. About 10 percent said they would not sell MA drugs to a single woman and would refuse to fulfill demand if the single woman was under 18. Only 3.5% of pharmacists in Delhi said they would provide AD drugs to these women.
Canceling the perception how easy availability of MA drugs could lead women to take pills that could be harmful to them, the study noted that 93% of clients seem to have achieved the desired result with MAID medications, and pharmacists reported that 77% of their clients come with a prescription. Chandrashekhar mentioned that if MA drugs are not available, the “only option women will have is surgical abortion,” which can only be done in a facility, again putting them at risk of abortion. at risk.
While some of the amendments of the MTP Amendment Bill 2020 like – failure of contraceptive used by women or their partner is grounds for seeking abortion (it was previously limited to married women); advice from a doctor for 12-20 weeks instead of two doctors; the removal of the upper gestation limit for fetal anomalies and the extension of the upper gestation limit from 20 to 24 weeks for “certain categories of women” are welcome, the amendments did not go far enough to make access to safe abortions a reality for women, Chandrashekhar said, and urged the Ministry of Health and Family Welfare to clarify that MAID drugs cannot be used for selective termination of pregnancy by sex.
According to Chandrashekhar, since MA drugs are only approved for use up to nine weeks gestation and sex determination through the most common and affordable method of ultrasound, can only detect the fetus at 13-14 weeks of gestation, so sex-selective abortions cannot increase due to the availability of AD drugs, which 35.5% of chemists/respondents in Tamil Nadu reported.
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