(Trigger Warning: Discussions of mentally distressing situations, descriptions of violence.)
Rajlaxmi* (name changed) was sitting on the pavement of her rented shanty in Neharpar, Faridabad. She looked different from the last time I saw her.
Something was amiss.
Her eyes were hollow, her pearly white smile seemed to have fallen into an abyss, her child-like persona absent.
A horrific addition to the list was her uterus. She had recently lost her womb too.
Rajlaxmi was 2 months pregnant when the lockdown was first announced. Her husband, a migrant labourer, lost his job.
Their savings were getting leaner, so they decided to return to their village in Chhatarpur, Madhya Pradesh.
They couldn't afford the baby and took the tumultuous decision to abort it.
But instead of going to a healthcare practitioner, they borrowed a concoction from an ‘elderly lady.’
“The magical kara, guaranteed an easy and painless miscarriage,” she recalls.
But within 24 hours of consuming the concoction, her genitals started bleeding profusely.
Followed by a pungent smell with excruciating pain and cramps. Alarmed by the rise in the stifling odour, her husband rushed her to a private hospital.
The doctors informed them that her uterus was infected and had to be partially removed.
Grim Portrait of Maternal Health
However, Rajlaxami isn't the only woman who is on the receiving end of a failed maternal healthcare system.
1.56 crore abortions were induced annually in India in 2015, Of these, 78 percent or 1.23 crore were conducted outside health facilities, according to a study in The Lancet.
Unsafe abortions are among the most common causes of maternal deaths in India and contributes 8 percent of all such deaths annually.
In India the MTP (Amendment) Act 2021 states that, for abortions up to 20 weeks, one doctor’s approval is needed, for 20-24 weeks of the gestation period, sanction by two medical practitioners is necessary.
Earlier, the law required one doctor for up to 12 weeks and two for between 12 and 20 weeks.
In papers this might seem very liberal, but this law is not devoid of stigma, accessibility and awareness.
Abortion is said to be safe if it is done with a process that has been recommended by the World Health Organization (WHO).
It should be in line with the duration of the pregnancy and the training received by the person providing the abortion.
The WHO classifies abortions as safe, less safe, and least safe. The latter two being unsafe.
Amongst the less safe category falls the usage of the outdated method known as “Sharp curettage”.
It’s an extremely dangerous and old practice where the cervix is dilated and the uterus is scraped off using a sharp metal curettage.
Untrained medical person inducing abortion through drugs like misoprostol is also deemed to be unsafe.The least safe methods are abortions induced by untrained medical person.
These include introducing foreign objects into the uterus or providing life threatening medication. Complications from these practices lead to haemorrhage, collapse of the uterus, internal bleeding and severe infections.
WHO paints a grimmer picture on maternal healthcare across the globe. According to their survey the worldwide estimates from 2010–2014 demonstrate that 45 percent of all induced abortions are unsafe.
Of all unsafe abortions, one third were performed under the least safe conditions, i.e., by untrained persons using dangerous and invasive methods.
Developing countries’ contribution is 97 percent of all unsafe abortions. More than half of all unsafe abortions occur in Asia, most of them in south and Central Asia
Rural India Takes the Brunt
It’s late afternoon now, I look at Rajlaxami as she makes tea for both of us. A 26-year-old, wombless mother of one.
Known for her quicksilver conversations, she seems awfully quiet today. “Why didn't you go to a doctor?” I ask.
She silently stares at the boiling condiments of the pot , as if trying to find answers.
Silence becomes louder, she slowly moves her gaze from the pot to the makeshift temple at the nook of her shack and says, "I didn't have anyone to talk to, I did what my husband said."
"Aisi batte bado ke samne bhi nhi kar sakte,” she added that she was afraid of being reprimanded by her relatives so she stayed mum.
It’s not uncommon for stigma to be associated with abortions. Lack of knowledge, resources and even doctors in the rural parts of India have made this issue a taboo.
The government has introduced several schemes to raise maternal health awareness.
However, according a 2018 report on Sexual Health and reporductive Health rights in India conducted by PLD and SAMA for NHRC, ‘Vulnerable women from marginalised groups and from geographically remote areas continue to be excluded from public health programmes.’
Rural parts of the country have taken most of the brunt.
According to a survey conducted by the Ministry of Health and Family Welfare in 19-20, rural India requires 20732 OB & GY surgeons, however 4957 positions were filled with 8401 vacancies and 15775 shortfall.
Dr Ashish Zarariya, associate professor at GMC hospital Nagpur and an OBGY, says that over the past decade he has seen a decline in the gnarly nature of the cases in rural India but unsafe abortions remained a pressing issue.
“A decade ago I would get patients who would have rods and objects inserted into their private parts by quacks, however now these quacks illegally procure MTP kits and prescribe them.”Dr Ashish Zarariya, associate professor at GMC hospital Nagpur
He adds that taking thse pills without consultation can lead to incomplete abortion. “They keep on bleeding and by the time they reach the hospital they are highly anemic or have severe infections.
Pandemic an unfortunate addition
“If I had known, I would have never done it” Rajlaxami whimpers.
She swirls the the residue of her tea cup and continues, “Agar mahamari nhi hoti toh shayd ye nhi hota."
The COVID pandemic caused a lot of tension to the healthcare system in India. It also strained the maternal healthcare of this country.
The Foundation for Reproductive Health Services India (FRHS), which is affiliate of Marie Stopes International, has estimated that the lockdown could have led to 8, 340, 42 unsafe abortions.
This is due to lack of doctors, contraceptives and basic facilities.
A study by the Lancet in May 2021 also shows a 56 percent increase in hospital admissions from septic abortion during the pandemic period.
“I went against the gods, I angered them. I paid the price with my womb.”Rajlakshmi
As I exited her shanty I couldn’t stop thinking about her culprit, is it the woman who gave her the concoction? Is it the faltering healthcare system?
Or is it the ecosystem that stops women from exerting their reproductive rights?
(On 29 September, the Supreme Court ruled that all women are entitled to safe abortions under the MTP Act 2020, irrespective of their marital status. FIT is republishing this story in light of the historic ruling.)