POLICY LANDSCAPE

1 United Nations, Department of Economic and Social Affairs, Population Division (2019). World Population Prospects 2019, Online Edition. Rev. 1 https://population.un.org/wpp/Download/Standard/Population/

2 Census of India 2011 http://www.censusindia.gov.in/2011census/population_enumeration.html 3 Sample Registration System 2014-16

http://www.censusindia.gov.in/vital_statistics/ SRS_Bulletins/MMR%20Bulletin-2014-16.pdf 4 National Family Health Survey 4 (2015-16) http://rchiips.org/nfhs/pdf/NFHS4/India.pdf 5 Maternal Mortality Ratio: India, EAG & Assam, Southern States and Other States https://www.niti.gov.in/content/maternal-mortality-ratio-mmr-100000-live-births 6 National Family Health Survey 1 (1992-93) http://rchiips.org/nfhs/india1.shtml

7 Sample Registration Survey. Maternal Mortality in India: 1997-2003. Trends, Causes and Risk Factors. Registrar General. India http://www.cghr.org/wordpress/wp-content/uploads/RGI-CGHR-Maternal-Mortality-in-

India-1997%E2%80%932003.pdf

8 Banerjee et al. BMC Public Health 2012, 12:175 http://www.biomedcentral.com/1471-2458/12/175 9 The Medical Termination of Pregnancy Act, 1971

http://www.egazette.nic.in/WriteReadData/1971/E-1383-1971-0034-61647.pdf 10 CAC Training & Service Delivery Guidelines 2018

https://nhm.gov.in/New_Updates_2018/NHM_Components/RMNCHA/MH/Guidelines/CAC_Training_and_Service_

Delivery_Guideline.pdf

11. Special Bulletin on Maternal Mortality in India 2015-17 Bulletin

http://www.censusindia.gov.in/vital_statistics/SRS_Bulletins/MMR_Bulletin-2015-17.pdf

REFERENCES

WHO

HOW

Where

Specialists (ob gyns) Non-specialists (general physicians)

(Up to 9 weeks)

All public-sector facilities and approved private

facilities/

clinics****

Secondary and tertiary public- sector facilities and approved private facilities

All public and private sector

facilities Medical abortion

(using mifepristone

& misoprostol combination) Surgical abortion (vacuum aspiration) Surgical abortion (dilatation &

evacuation)

** ***

First

Trimester Second

Trimester Post-Abortion Care

*Qualification and training criteria apply.

**The Drug Controller General of India limits the use of MA drugs upto nine weeks.

However, the national CAC guidelines10 include drug protocol for second trimester abortions in accordance with WHO Guidelines 2014, for reference.

*** Misoprostol only.

**** MA upto seven weeks can also be prescribed from an outpatient clinic with an established referral access to MTP-approved facility.

ABORTION

POLICY LANDSCAPE

India

The MTP Act requires only the consent of the woman for an abortion (if she is of sound mind and not a minor). Spousal or any other consent is not required.

However, in case of a minor who has not completed the age of 18 years or a mentally ill woman, the consent of the guardian is required.

CONSENT FOR ABORTION

CAC services in India can be provided by ob-gyns (specialists) and MBBS doctors (non-specialist physicians), also referred to as a registered medical practitioner who fulfill training qualifications as specified in the MTP Act and Rules.

PROVISION OF CAC AND POST-ABORTION CARE

Figure 1: Conditions and gestation limit for which abortion is permitted in India

122/100 000

¹¹

live births

Maternal mortality ratio

32 000

Number of maternal deaths

18.6 years4 21 years3 2.2%

³

53.5%3

Median age at first marriage

Median age at first birth

Total fertility rate

Contraceptive prevalence rate (all methods)

12.9%3

Unmet need for family planning

BACKGROUND

India is the seventh largest country by area and the second-most populous country in the world. The total population of India is estimated1 to be 1.3 billion of which 656.3 million are women approximately 336 million in the reproductive age (15 – 49 years). The sex ratio of India is 943 females per 1000 males2.

India has significantly improved its maternal health indicators over the years – MMR reduced from 254 in 2004 – 2006 to 130 in 2014 – 20165; TFR reduced from 3.4 in 1992 – 19936 to 2.2 in 2015 – 2016; and CPR increased from 40.6% in 1992-935 to 53.5% in 2015-16. The use of modern methods of contraception increased from 36% to 48% during the same period.

Abortion related complications are the third largest cause of maternal deaths and account for about 8% of the country’s MMR7.

POLICY PROGRESS AND GAPS 1

2 3 4 5

The national CAC guidelines were revised in 2018 and aligned with recommendations of the latest WHO safe abortion technical and policy guidance for health systems.

Medical abortion drugs are included in the essential drugs list, and equipment (manual vacuum aspirator) and essential drugs for MVA are registered and available in public sector facilities.

Integration of CAC with post-abortion contraception with key guidance documents by the national government, including a technical update and operational guidelines on post-abortion contraception.

Handbook by GoI for community awareness on safe abortion to be used by peripheral health workers in different languages.

The Drug Controller General of India limits the use of MA drugs upto nine weeks of gestation.

6

The MTP Act permits only allopathic doctors to provide abortion services, excluding a range of other potential providers of complementary systems of medicine, nurses and auxiliary nurse midwives.

ABORTION LAWS AND POLICIES

Abortion in India is legal as per the Medical Termination of Pregnancy (MTP) Act, which was passed in 19719. The Act allows termination of pregnancy upto 20 weeks for a broad range of indications.

The MTP Act was amended in December 2002, and the Rules, in June 2003.

Indicator

Status

Induced abortion rate (as% of all pregnancies) 3.1%7 Spontaneous abortion/miscarriage rate (as% of all pregnancies) 6.4%7 Proportion of women who were aware that abortion is legal in India 35.5%8 Proportion of women who knew at least one source of accessing

abortion services 46.2%8

Table 2: Key abortion-related indicators Table 1: Key reproductive health indicators

*This includes injury to mental health caused due to failure of any device or method used by a married woman or her husband for the purpose of limiting the number of children

Conditions permitted till 20 weeks

Save woman’s life

Physical health

Mental health*

Rape/

Incest

Fetal

impairment

Economic/

social reasons

request On

Conditions not permitted