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Abortion stigma is a powerful deterrent to accessing abortion services. It can arise from lack of information or awareness about abortion being a relatively simple medical procedure, cultural superstitions and myths, and patriarchal beliefs that feel the need to control what women do with their bodies and reproductive choices.

For a woman or a trans person to access abortion services therefore, can be a huge hurdle. For many, it is a secret endeavour, away from the prying eyes of their family or partner. The Indian law too, grants adult women the agency to make decisions about their abortion rights (to a certain extent) by decreeing that a woman’s parents’ or spouse do not have to grant consent in order to avail an abortion. However, the final decision to get an abortion does not lie with the pregnant woman.

The Medical Termination of Pregnancy Act states that the pregnant woman has to get the consent of one medical practitioner if the pregnancy is less than 12 weeks old, and two medical practitioners if the pregnancy is between 12-20 weeks old. Therefore, medical service providers make the final decision on abortion in their hands.

Also read: Your Handy Guide To Understanding And Getting An Abortion

Now, what if doctors themselves hold regressive views on abortion? When a woman is denied an abortion service by her doctor, it is extremely likely that she will perform the abortion anyway – using unsafe methods. Despite the legality of abortion in India, a survey that studied abortion services in 9 of its biggest states found that 67% of abortions performed in these states were unsafe and illegal abortions.

The quotes below were taken from a study conducted by Asia Safe Abortion Partnership and a local partner as a follow up to a previous study that was published in the journal Reproductive Health Matters.

“The doctor told me that an abortion would be risky because I had recently had a family planning operation. She told me to continue the pregnancy. I was only 8 weeks pregnant.” – Abortions can be safely carried out in the aftermath of family planning procedures (like the insertion of IUDs and other contraception) after taking appropriate measures.
The doctor said that he needed my husband’s signature on the abortion form. He called my husband and started asking him questions about me – my husband disconnected the call. After that, the doctor refused to perform my abortion, saying that, “I think your husband is not ready for your abortion. If I do it, I might face problems from your husband.” – The MTP Act specifies that women don’t need consent from their parents or spouse to obtain an abortion. Informing them can put the pregnant woman at risk of violence.
This is what the doctor told me – “Two months are complete. Why are you doing this now? It is a sin to kill your child in the womb. In our religion we do not even kill an ant and you want to kill your child? Abortion is a big sin. If you don’t want a child, you should have thought of it earlier. I will not commit this sin.” – Should religious considerations come in the way of a doctor performing a professional duty?
“After the denial of abortion, I decided to continue the pregnancy. I felt very bad when doctor said I am killing my child but I didn’t want to have another child. I suffered from weakness and vomiting throughout the pregnancy. Also I was very disturbed but I could not do anything to get out of this situation.” – Is it right to force a woman to continue her pregnancy against her will? When the onus of bearing and raising a child falls on the woman, should it not be her decision to have a child or not?
“The doctor refused to give me tablets. I visited 3 hospitals and paid Rs 500 each time as visiting fees. Finally, my husband found the tablets from his friend’s pharmacy. He charged us Rs 2500. I paid that amount from my own savings. The last time I had an abortion, the doctor charged us only Rs 500 for the tablets, but this time I had to pay so much extra just because the doctor would not give me abortion pills.” – Medical abortion pills are a safe and non-invasive abortion procedure. They can even be safely self-administered by following correct dosage and instructions. However, why are doctors limiting their usage when it is legal and safe to use them?
“I felt very sad when doctor refused to perform an abortion. After that I ate the tablets, but nothing happened. Now I am worried that if the baby will born with a disability, who will take responsibility for it?” – When women are denied safe abortions, they will attempt abortions under any circumstance. Safe abortion is imperative to women’s health.
“I wanted to have an abortion but did not want a surgical procedure because my family members were not aware about it. I went to many doctors but everyone said no. I think they wanted to take money from me and that’s why did not give me abortion pills. I was very angry with them.” – Medical abortion pills are a simple and non-invasive abortion procedure that can be used to induce abortion. They are a good alternative to surgical abortion. 
“I asked doctor to give me abortion pills because I found them easy. But he said that he had stopped providing tablets for abortion as they were banned by the government. I went to two more doctors after that but they also refused to give me the medical abortion pills.” – Medical abortion pills are a simple and non-invasive abortion procedure. They are not banned by the government.

It is imperative that medical service providers are told to provide non judgmental and stigma free healthcare, especially for an issue that holds so much social taboo as abortion.

In India, another problem arises because abortion, which is legalised through the Medical Termination of Pregnancy Act, is frequently conflated with sex determination, which is penalised through the Pre-Conception and Pre-Natal Diagnostic Techniques Act. Therefore, abortion is often conflated with sex determination, even though they are two completely different procedures. The pressure to stop gender biased sex selection leads to many medical practitioners often denying life-saving abortion services to women.

Dr Suchitra Dalvie from Asia Safe Abortion Partnership writes, “In many places, pharmacists now refuse to stock or sell morning-after pills for fear of harassment. Doctors turn detectives and refuse women who seek 2nd trimester abortions – suspicious that the abortion follows the results of prenatal sex determination – and civil society turns vigilante, undertaking sting operations that use pregnant women as decoys to flush out suspects. As a result, it has become even more difficult to get a “regular” abortion from a qualified and registered doctor, thus turning women towards more-unsafe options.”

The quotes below were taken from doctors in a study conducted by SAMYAK, an NGO. In these, doctors provide justifications for not providing legal abortion services to women, citing the fear of getting caught for performing sex selective abortions. In order to curb sex determination, government authorities often target abortion services, leading to safe abortion services for women being denied to them. When this happens, the gap is filled by unqualified persons and quacks that offer illegal and unsafe abortions that put women’s health at risk.

“It does not make any difference to my practice if I say no to provide an abortion, but it makes a great difference to my practice if I do an abortion and it turns out to be a female fetus. The PCPNDT machinery wants us to report every single abortion and its result. So I asked the family to get a permission letter from Taluka (Block) Medical Officer, which he refused to provide, so I denied abortion service to this woman.” – The pressure to stop gender biased sex selection leads to many medical practitioners often denying life-saving abortion services to women.
“Pregnancy in unmarried girls may be due to certain illegal things. It can create problems for that girl and her family. My opinion is that we should inform the police while dealing with these types of cases because there are chances of medico-legal problems after MTP. So it is better to inform police. I generally do not do MTPs of unmarried girls in my hospital. I advise them I will do it in the institute (privately) because it is easy to deal with these types of cases there. We can also protect the privacy of that patient.” – In this case, the doctor employed personal prejudices about ‘unmarried girls’ to deny life-saving abortion treatment to them.
“Though I am authorised to do MTP up to 20 weeks in our hospital, still we are not doing abortions after 10 weeks. We make sure that women do not abort at our hospital in the second trimester. Because we don’t know if it is sex selective abortion or not, it is better to keep ourselves away from it.” – The pressure to stop gender biased sex selection leads to many medical practitioners often denying life-saving abortion services to women.
“I don’t do second trimester abortions because record keeping is very difficult and moreover if unluckily the aborted fetus is female, then it will be more problematic. Nowadays it is very easy to catch a gynaecologist for sex determination and sex selective abortions.” – The pressure to stop gender biased sex selection leads to many medical practitioners often denying life-saving abortion services to women.

It is in this climate that we must wonder whether it is right for doctors to deny treatment to women in need of abortion services, due to personal prejudices, stigma or for the mythical goal of “saving the girl child”.

Also read: We Need To Stop Restricting Abortion Access In The Name of Women’s Rights

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