In her hospital, which acts as a referral centre, 40% of women who have had abortions have had complications after taking abortion pills without a prescription. These women were then taken for emergency treatment including surgical abortion.
A study conducted by a postgraduate student found that these women bought prescription pills over the counter for anything between Rs 500 and 700 from medical stores. After talking to the women, the study found that some of them were unaware that their pregnancy was ectopic (outside the womb) and some took the pills too late. A few women skipped them in the wrong order or at the wrong intervals.
For 10 years, Tamil Nadu has imposed restrictions that have made morning after pills virtually unavailable, forcing women to resort to abortion pills without a prescription or medical advice.
This, doctors say, leads to complications and death. Doctors at Sri Ramachandra Medical University have taken seriously a student-led study that found many women experienced complications after taking over-the-counter prescription pills.
Doctors at other hospitals said they do not have statistics because most women do not disclose that they have taken abortion pills and report complications from spontaneous abortion. “It is difficult to know whether the women took these pills. We don’t have time to waste on that either,” said gynecologist Dr Uma Ram of Seethapathy Nursing Home.
Several medical bodies such as the Federation of Obstetrics and Gynecological Societies of India and the state branch of the Indian Medical Association have urged the state to tighten the sale of abortion pills and loosen the rules on the morning after pill. In the absence of contraceptives, doctors say the morning after pill is the best alternative for a woman to avoid the compulsion of an abortion.
The drug was pulled from the state by several manufacturers because they felt it was nearly impossible to meet state restrictions. “So some women are waiting to be pregnant. When they do, they get the abortion pills from their local pharmacy,” says Senior Obstetrician Dr Jayashree Gajaraj.
The abortion pill, unlike the morning after pill, is a Schedule H drug that should only be administered under medical supervision. Doctors say there is a reason. Although doctors consider medical termination of pregnancy (pills) the first choice for abortion, they warn that not all women can take them. It cannot be given to women who have a pregnancy outside the womb (ectopic). It is most effective when given to women who are less than six weeks pregnant. At the end of the course, doctors perform a CT scan to make sure the uterus is empty.
In fact, doctors at public hospitals say the protocol is so cumbersome that they prefer surgical abortion. In 2015, some 30,000 of the 46,000 abortions performed in public hospitals were surgical abortions where doctors use a vacuum to aspirate the fetus. “We are concerned that the women will not come for a follow-up examination. Instead of risking unsupervised medical termination, we prefer surgery,” said gynecologist Dr Usha Rani at Government Women and Children Hospital, Egmore.
Some private doctors, however, say it’s all in the advice. Dr. Nazira Sadique, who sees patients from different economic backgrounds, instructs women to take every pill under medical supervision. “We give them the first pill and ask them to come back for the second dose. We only send them once we know they don’t have serious bleeding or other side effects. Each patient is followed by a CT scan,” she said.
In states like Kerala, abortion pills are only sold to patients who hold a double prescription. The pharmacist must hold a copy of the prescription and submit a record of the purchase and sale of each drug to the National Directorate of Drug Control. In the absence of such rules, local pharmacies sell the pills over-the-counter like all prescription drugs, including antibiotics. Drug Control Directorate officials said they had not received any complaints about the sale of the drugs. “We have never received a complaint from any doctor or medical organization so far,” he said.