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Seeking Reproductive Health Services: Must it be Clandestine?

Anamika [name changed] is a 19-year old girl from Jharkhand who, like many girls of her age, fell in love with a boy in her acquaintance. And like most young people in their teens, they began exploring the idea of physical intimacy and soon enough, Anamika noticed that she had missed her periods. After ignoring it for some time, she took a pregnancy test only to find that she was pregnant, and her boyfriend refused to take responsibility. For an unmarried girl from an underprivileged background and living in rural India, this situation was nothing short of a catastrophe – one that could potentially ruin her life given the socio-economic conditions her family lived in. While she was contemplating suicide, she considered speaking to the local health counsellor who frequented the village. On the counsellor’s advice, Anamika agreed to undergo an abortion but wanted it done at a distant facility that would ensure confidentiality. A few years since then, she is happily married today.

 

There is nothing unique about this story. It is an experience perhaps lived by numerous women across the country – both married and unmarried – who are compelled to jump through several hoops and overcome challenges to seek safe abortion services. Young, unmarried women are often found to be more vulnerable in such situations. Taboo around pre-marital sex, gender stereotypes, sexual and gender-based violence, myths and misconceptions, and glorification of motherhood are some of the societal factors that enhance the vulnerability of young women. Further, with poor women getting poor quality of care, it leads to double marginalization. Women are at times forcefully delayed even after seeking early abortions due to the paucity of access in the second trimester and high out-of-pocket expenditure involved. Many women continue to be hesitant to approach public health centres (PHCs) since the women here are looked down upon and subject to judgment and ridicule, whether they intend to access information, services or the facilities. The latent bias and prejudice among providers is also observed in metro cities. Young, especially unmarried, women face challenges in accessing safe abortion services as their fear prevents from the pregnancy presenting itself until the second trimester, and they are mostly unwilling to reveal their identities. Fear of being ostracized by the family and community, and the fear of not being able to get married are some causes for the hesitation. Dependency on counsellors for the choice of contraception and reluctance towards follow-ups pose as additional barriers as they feel discouraged to access any information or service that could stigmatize them. Some amount of fear also presents itself among safe abortion service providers about legalities and law enforcement agencies along with families of young, unmarried women seeking abortion services, and this situation needs to be urgently addressed. Many unmarried young women are not aware of abortion being legal, let alone possess the courage to go and seek it at a facility near them.

 

The need for abortion can be felt by any woman at any time regardless of socio-cultural background, financial status, marital status, educational qualifications, etc. Whether abortion is legal or not, when a woman needs an abortion, historical evidence will testify that she will find a way to seek it. While a wanted pregnancy is one that is shared by both the woman and her partner, the burden of an unwanted pregnancy is borne by the woman alone. The question is – how can we ensure the availability of safe and legal abortion services for women.

 

With a burgeoning population comprising the largest youth demographic in the country, India must introduce and amplify conversations around sexual and reproductive health and rights in the early stages of every individual’s life across the country, including in vulnerable and underprivileged communities. Awareness and sensitization among educators, law enforcement officials and providers; comprehensive sexuality programmes in educational institutions and communities for out-of-school children / youth; and making schools, colleges and health facilities more youth-friendly are critical to meet this end. At the district and village levels, to ensure easy access for women without compelling them to travel far, it is fundamental to leverage the backbone of the country’s public health system – the frontline workers including Accredited Social Health Activists (ASHAs) and Auxiliary Nurse Midwives (ANMs). They need to be equipped to not just deliver critical maternal health services but also leverage the power they may wield in the communities to address some of the persisting societal stigmas that continue to hinder access to healthcare services. PHCs need to be upgraded with manpower and infrastructure in line with the developed technologies that have made abortion a fairly easy and safe procedure.

 

At the recently held CAC (Comprehensive Abortion Care) Conclave 2018 in New Delhi, it was discussed that the focus in the abortion debate has shifted significantly in the recent past as earlier, there was a call for enhancing access and today in the face of the changing contexts, the debate is about preserving access. Internationally, access to safe abortions is becoming more challenging by the day and India, having been one of the first few countries to legalize abortion has the tremendous opportunity to lead with example by preserving and advancing women’s right to comprehensive abortion care. It was also discussed suggests that deaths among unmarried women due to unsafe abortions will never be recorded under maternal mortality, proving that maternal mortality numbers cannot be completely representative of unsafe abortions. There are thousands of young women like Anamika across the country who come from varied socio-economic backgrounds and have one thing in common – the need for safe health services, and the lack of information on where and when to find them. Living in denial about the possibility of young, even unmarried, women requiring reproductive health services in the country is unlikely to have positive outcomes. An abortion is a deeply personal choice a woman makes that affects her alone, beseeching the right to bodily autonomy. Let us not turn a blind eye towards these countless women counting on us. The time to act is now.

 

The CAC Conclave provides an important platform for experts, professionals, researchers and even the common folk to exchange ideas, learnings and experiences in the reproductive health and rights space. This is the second CAC Conclave I have attended, and I found it rather insightful and engaging, particularly with the group exercises. Discussions were informative and inspiring. Going forward, the organizers must consider roping in organizations working across women’s rights issues to add a broader perspective to the conversation on safe abortions. Government participation would also be a good way to open up the policymakers to different perspectives on what is happening on ground in the women’s reproductive rights space.

Bhavani Giddu

CEO, Footprint Global Communication

Bhavani is a senior communications professional with experience spanning over 17 years in Public Relations and strategic Media Relations, having extensive work experience with leading multinationals and some of the world’s largest communications agencies in senior leadership roles.

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