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Rampant use of abortion pills

Text by: Ankita Jain

Gynecologist Dr Jyoti Agrawal shares information on status of abortion, misuse of emergency contraceptive pills, and lack of information and use of contraception especially amongst teenagers.

A few weeks earlier, a 20 year old college student arrived at Dr Jyoti Agrawal’s clinic with severe bleeding. After a medical examination it was revealed that she had an incomplete abortion which led to severe infection. Upon further investigation it was discovered that she took two types of abortion drugs. Though these are common drugs used in medical termination of pregnancy (MTP), they can’t be sold without authorised prescription. The girl got them from a chemist who had failed to evaluate her accurate gestational stage and not warned her about the complications that could arise thereafter. “Due to the higher gestational age and despite consuming the drugs, she had had an incomplete abortion. The remains in her uterus caused the severe infection,” says Dr. Jyoti who has more than two decades of experience working in this field. When the doctors asked her about the source of the pills, she referred a nearby medical store. “This is not uncommon at all. I get many such patients with complications arising after consuming MTP pills without consulting a qualified doctor,” she adds. Dr Jyoti  is uncomfortable with the easy availability of abortion drugs. “These are available as easy as a chocolate,” she states.

While prescriptions are mandatory for abortion medication, the ground reality may present a different picture. “Access to safe, legal abortion services sums up to be expensive, so women now commonly obtain medication to induce abortion from pharmacists, chemists and informal vendors. Further, the information they receive on how to use the drugs and on recommended gestational limits is often inaccurate or absent,” she states.

Despite many surgical and non-surgical options available at hospitals and clinics, many women go for ‘illegal and unsafe options’ fearing that their family will learn about it, added the doctor. She emphasises that many abortions are happening without prescriptions and outside of facilities via chemists and informal vendors which suggests the need to improve facility-based services.

She said it is unfortunate that till date a large majority of women, even in urban Nepal, are unaware of their rights regarding abortion and continue to resort to unsafe and medically non-substantiated methods of abortions which at times can prove fatal. A qualified doctor will carry out a sonography to understand the gestational age and whether the pregnancy is ectopic. “In ectopic pregnancies, where the foetus grows outside the uterus in a tube, there is always a risk of the tube rupturing and causing a haemorrhage due to the MTP pill,” says Dr Jyoti who has seen many patients with such complications.

She also talks about how college girls these days are living on emergency contraceptive pills. “I am completely against emergency contraceptive pills. These pills are not 100 % safe and should be taken once in a lifetime. College girls in the capital are highly engaged in unsafe sex and later consume such pills,” she says. Referring to the number of college girls she sees, she says, “These pills have greater impact. It causes irregular period. Also, many a times the pill doesn’t work and the girl is still pregnant.” In one such incident a 20 week pregnant woman from Bhaktapur visited her clinic and wanted to undergo an abortion. “Apparently she was a mother of three and didn’t want more children. Upon asking why she turned up late, the woman replied that she had taken emergency contraceptive pill and was assuming that she wasn’t pregnant anymore,” recalls Dr Jyoti who does not conduct abortion post 13 weeks.

A major problem she faces while dealing with such cases is that most women try to hide their history. “If they provide us with details truthfully especially about the use of emergency contraceptive or abortion drugs, things can be simpler to deal with. Despite trying to dig in for information, proper clarity is never shared,” she explains.

An evident, unmet need of contraception is the key reason for unintended pregnancies, many of which result in abortions. She highlights that half of the pregnancies she consulted in the year 2018 were unintended. “Unintended pregnancies are a strong indicator of the need for improvements in contraceptive services,” she says. Other factors that might contribute to both an unintended pregnancy and abortion include contraceptive failure from incorrect and inconsistent use, sexual activity among unmarried women, and a woman’s and couples strength of resolve to have small families.

“One cannot ignore the fact that the burden of family planning continues to be on women. Unless this mindset changes, the figures for abortions will continue to remain high,” she says.

“We are yet to aware the young generation on the side effects of abortion drugs without consultation and the misuse of emergency pills. We are a long way from reaching the masses and generating the kind of awareness required on the ground level,” she concludes.