Indian Chemists Are Not Stocking Medical Abortion Pills Anymore, Putting Millions of Women at Risk
Chemists are increasingly choosing not to stock Medical Abortion (MA) pills, with more than 40% incorrectly believing that abortions are illegal in India, according to a new study by Pratigya Campaign for Gender Equality and Safe Abortion.
The Campaign — consisting of individuals and organizations working towards protecting and advancing women’s access to safe abortion care — conducted the study with two aims. First, to assess the availability of MA pills — Mifepristone and Misoprostol, which taken in combination, end a pregnancy; and second, to understand the awareness levels and attitudes of chemists stocking and selling these pills. To this end, one-on-one interviews were conducted last year with 1008 retail chemists and 42 wholesalers in four states: Bihar, Maharashtra, Rajasthan, and Uttar Pradesh.
No chemists — that’s right, not one out of 252 — reported stocking MA pills in Rajasthan, and only 1.2% of chemists in Maharashtra reported stocking them. 66% in Uttar Pradesh and 37.8% in Bihar reported stocking and selling the pills. “The reported availability of MA pills was strikingly low in Maharashtra and Rajasthan, where the respondents were hesitant to provide information on MA and mostly refused when asked if they were dealing with abortion pills. In Maharashtra, only three retail chemists said they sell MA pills while not even a single chemist in Rajasthan admitted to stocking and selling them,” the study found.
The hesitation and fear among chemists are not unfounded. Nearly 70% of all chemists who were not stocking the pills cited legal and regulatory issues as the reason. In Maharashtra, Rajasthan and Uttar Pradesh, this number was found to be especially high where chemists reported drug authorities regulating the sales of MA pills in a bid to end sex selection — through verbal orders not to sell them and regular inspections. Bihar was the only exception, where low demand was cited as a reason for not stocking.
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That MA pills are or can be used for sex-selective abortions is a misconception. Here are the facts: In India, it is legal to get an abortion up to 20 weeks of pregnancy under the Medical Termination of Pregnancy (MTP) Act. It has a provision for MA up to seven weeks of pregnancy, after which abortion involves surgery. In 2008, the government approved the prescription of a combination pack (200 mg Mifepristone and 800 mcg Misoprostol) for up to 9 weeks of gestation. But, “the commonly used and affordable technology to identify the sex of the fetus, Ultra Sonography, can detect the sex only around 13 to 14 weeks gestation,” Dr. Kalpana Apte, secretary-general of the Family Planning Association of India, said in a press release by Pratigya. For this reason, it’s simply not possible to commit the crime of having a sex-selective abortion by using MA pills — the gestational timelines don’t match. This misconception is resulting in the overregulation of the pills, according to Dr. Apte, “significantly affecting [the] availability of a safe, simple and affordable method of safely terminating a pregnancy, compromising the health, wellbeing and reproductive rights of women in India.”
Yet, “chemists have been informally asked not to sell MA pills and there have been MA-specific visits by regulatory authorities …. As high as 56% [of] chemists reported that MA pills are overregulated as compared to other schedule-H drugs,” according to the statement. In fact, just last month, the deeply rooted misconception and a misogynist bias that young women misuse the drug made matters worse when the government instructed state drug controllers to impose a complete restriction on the sale of MA drugs at pharmacies; a pan-India advisory will soon follow, allowing only MTP-registered centers to sell the drugs, reports LiveMint.
Additionally, nearly 15% of chemists reported pill authorities asking them to keep prescription copies or maintain a database with names of clients who buy MA pills. This grossly violates the client-confidentiality provided by the MTP Act, under which the name of the client seeking an abortion cannot be revealed to anyone unless ordered by the judiciary. To avoid this excessive scrutiny by drug authorities, chemists are increasingly choosing not to stock the pills at all.
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But the blame doesn’t solely lie with the drug-control authorities — the study also found a lack of awareness and bias in attitudes about abortion among the chemists. 43% of them thought abortions were illegal; 15% felt that the availability of combi-pack MA pills contributes to gender-biased sex selection, with more than half thinking MA pills have increased the number of abortions. In Bihar, one in five chemists said they won’t provide the pills to a woman if she’s unmarried. 82% of the chemists considered bleeding as a side effect, when in fact is a part of the MA process. More than half could not remember the order in which the pills had to be taken. This significant and dangerous knowledge gap only hinders the MA process for women, since chemists are usually their first point of contact, especially in smaller cities. The potential consequences of the study’s findings, in addition to the government’s latest decision to ban the sale of MA drugs via chemist shops entirely, are staggering.
According to a recent report published in The Lancet, MA was the preferred method for early abortions (up to seven weeks of pregnancy) in India with an estimated 81% of the 15.6 million annual abortions in India performed using MA pills. The non-availability of these pills can undo all the progress we’ve made in reducing the number of unsafe abortions over the past few years. Even today, the number isn’t one to be proud of — on average, 10 women die in India every day due to unsafe abortions, which is the third leading cause of maternal mortality in India. Restricting access to MA pills would result in millions of women being denied life-saving drugs, and agency over their bodies and lives — millions of women who, as history would confirm, will find another way to have an abortion, even if it kills them.