There is now universal agreement that public health is a basic need for all developing societies. So much has been written about the need for clean water and air, vaccination, and the control of killer diseases like malaria.
But there is one public health issue which peole are scarcely aware of. This is illegal abortion. India legalised abortion way back in 1969. Yet two researchers, Rami Chhabra and Sheel Nuna, estimate that around 6 million illegal abortions are performed every year, ten times as many as the six lakh legal ones.
According to the annual report of the. ministry of health and -family welfare, there are two million cases of malaria causing upto 1000 deaths per year. (This sounds an underestimate). These numbers pale in comparison with 6 million illegal abortions which cause an estimated 15, 000 to 20, 000 deaths a year. This constitutes an enormous toll on the health and lives of women, yet is scarcely recognised as such.
Why do women go for illegal abortions when these have been legalised? There are only 8, 000 approved institutions for a population of 900 million people. Although the government wants all 20, 000 primary health centres in rural areas to have MTP facilities, less than 2, 000 do. There is a shortage of equipment and authorised physicians.
There is so much paperwork involved in an official MTP. and such lethargy in book-keeping in institutions, that the actual number of MTPs may be twice as high as officially recorded. Many government doctors tell patients to come for private operations, for which they charge illegal fees. The saving grace in such cases is that patients get proper medical attention.
In the west, abortions are sought mainly by unmarried teenagers. In India they are sought over-whelmingly by married women who do not want another child. Many are seriously traumatised by unwanted pregnancy. The overwhelming majority of rural women go to untrained dais (village midwives), or quacks, undergoing risks, damage and death.
What can be done? First, we should train dais and paramedics in abortion and change the law to authorise them to perform MTPs, at least for early pregnancies. This also implies a huge increase in equipment and medicines to all villages. Paperwork for legal abortions must be slashed to the bone.
An abortion pill called RU 486 has been legalised in many countries but not yet in India. It has side-effects like bleeding, and is supposed to be administered under medical supervision, so critics say it is unsuitable for rural India. However, the dangers of illegal abortion are surely much greater than those of RU 486.
Abortion is also a gender issue. Yet the right of a woman over her body, in regard to sex within marriage as well as pregnancy, is rarely debated. However, the first step must be to educate the public on a health hazard whose dimensions most Indians are scarcely aware of.
Foreign aid agencies are today anxious to increase aid for public health, but most of them refuse to give a penny for abortions, because of the objections of the Catholic Church and right-wing religious groups in the US.
The biggest problem of all is data. When there is an epidemic of malaria or anything else, the newspapers carry figures of those affected and killed. But abortion takes place secretly, with no published data. This makes it difficult to build up public opinion. Yet the task must be done.