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A killer pill, twice over

An increasing number of young women is resorting to self-medication to abort unwanted children. Due to various reasons, they avoid taking advice from registered medical practitioners. But what they do not realise is that such drugs may result in infertility, and sometimes even death

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Sitting on a wooden bed covered with a dirty sheet in a 6x6ft shady room, which serves as a 'surgical ward' in the Nangloi area of west Delhi, Santosh Dai waits to perform what she calls 'safai' — i.e., getting rid of an unwanted child. From teenage girls to young married women, there are many who line up for such abortions.

However, in recent years, more and more women who visit her complain of 'septic' or failed abortions induced by Misoprostol and Mifepristone — tablets commonly used for abortion. Popping the pill to abort the child can lead to complications, and in some cases, even death.

Rani, 19, has been in an emergency ward of a hospital in west Delhi for four days now. Her husband Manoj brought her to the hospital after she complained of severe abdominal pain and experienced profuse vaginal bleeding in her ninth week of pregnancy. Although this is Rani's primy (first) pregnancy, the couple has decided to abort. Rani bought an MTP (Medical Termination of Pregnancy) kit from a local pharmacy without a prescription and took the pills on the directions of the 'pharmacist', thereby risking future prospects of getting pregnant and even her life.


—Thinkstock

The incomplete abortion caused by the tablets had to be extracted through dilation.

"Abortion is not a method of contraception," says Dr Mani Mrinalini, HoD, Obstetrics and Gynaecology, Guru Gobind Singh Hospital."This is a very serious problem. A doctor takes many factors into consideration before prescribing a specific drug to his/her patient. A wrong step can be life-threatening," he adds.

The rising number of such failed abortions due to the MTP tablets — which need quick surgery — have alarmed the authorities concerned. In a letter to the drug controller of the Drugs Control Department (government of NCT, Delhi), dated May 26, 2016, the state programme officers and the MTP team (Directorate of Family Welfare) urged for a regulation of all MMAs (Medicine for Medical Abortion) as they are being misused as a contraceptive drug, apart from being taken for sex selective abortions.

Despite the alert, nothing has changed and the drug continues to be sold over the counters without prescriptions.

And it's not just the illegal clinics which come across such cases, even hospitals have reported a rise in MTP abortions. Officials say, on an average, 3 out of 10 abortion cases are due to wrong intake of such drugs.

In 2016, west Delhi recorded the highest number of abortion cases, according to the Family and Welfare Department. In November last year, around 637 cases were reported in west Delhi alone, out of which 537 were due to failure of contraceptives. Only 34 abortions were because of life-threatening complications during pregnancy. In 282 cases out of the 637 reported, the patient had already taken the MTP tablet without any medical supervision before going to a hospital.

In 2002, Mifepristone was approved for use in India but it was not until 2009 that it was commonly sold at the local pharmacies. As per the MTP guidelines, due to its serious side-effects, a MTP kit can not be sold without a prescription. And although selling or buying the kit without a prescription is a criminal offence under the Medical Termination of Pregnancy (MTP) Act, 2002, the kit is easily available at every local pharmacy.

In a report sent to the drug controller, the MTP department says that MTPs are Schedule H drugs, and can be prescribed only by a Registered Medical Practitioner (RMP) — which means any medical practitioner who possesses a recognised medical qualification, experience and training in gynaecology & obstetrics — can prescribe these drugs. Also, all pharmacists are instructed to retain a copy of the prescription for cross verification of all such medicines dispensed under the MTP Act.

"MTP tablets should only be taken in the first 7 weeks of pregnancy. If taken after that the mother is at a risk of an incomplete abortion or a deformed fetus," says Dr Shashi Maheshwari, specialist obstetrician and gynaecologist, Deen Dayal Upadhyay hospital.

"Even in the first seven weeks, it cannot be given in cases of ectopic pregnancies (pregnancy other than in uterine cavity) and thus requires a medical supervision. We receive 2-3 incomplete abortion cases every day and the patients usually come after taking the MTPs," she added.

Any use of medicines after the ninth week of pregnancy may rupture the uterus wall, and cause infertility or serious disabilities to the unborn.

Janaki, 24, was admitted to a hospital with severe complications. Twelve days after she took a MTP dose, she had noticed an unhealthy clot discharge from her body. She was five weeks and five days pregnant when she decided to take the dosage without any medical supervision. As it turned out, hers was an ectopic pregnancy. The fetus was in the placental tube and not in her uterus, and her abdomen had to be opened to 'clean' the remains.

"We don't advise first pregnancy termination unless there is some serious problem," says Dr Shashi. "But in cases where there is a dire need, we assure women of confidentiality. I advise and request every woman to get her pregnancy terminated from a recognised doctor. We also help if the basic criteria of a safe abortion is fulfilled."

MTP Act, 2002

No termination of pregnancy shall be made in accordance with this Act at any place other than
(a) a hospital established or maintained by government, or
(b) a place for the time being approved for the purpose of this Act by government or a District Level Committee constituted by that government with the Chief Medical Officer or District Health Officer as the chairperson of the said Committee:

Provided that the District Level Committee shall consist of not less than three and not more than five members including the chairperson, as the government may specify from time to time:

In section 5 of the principal Act, for sub-section (2) and the explanation thereto, the following shall be substituted, namely-

Notwithstanding anything contained in the Indian Penal Code, the termination of pregnancy by a person who is not a registered medical practitioner shall be an offence punishable with rigorous imprisonment for a term which shall not be less than two years but which may extend to seven years

Whoever terminates any pregnancy in a place other than that mentioned in section 4, shall be punishable with rigorous imprisonment for a term which shall not be less than two years but which may extend to seven years

Any person being owner of a place which is not approved shall be punishable with rigorous imprisonment for a term which shall not be less than two years but which may extend to seven years

Quacks

Neighbours say that Santosh 'Dai' has been conducting 'safai' for women for decade and a half now. The Dai Maa says her rates can vary anywhere between Rs 5,000 to 20,000, depending on the week and urgency of the pregnancy. Among her clients are young, single girls who are afraid to go to a hospital, she claims.

In September 2016, forceful abortion of a young rape survivor in Bulandshahr district of Uttar Pradesh, shocked the entire nation. It is also brought into light the problem of increasing number of quacks in India. The survivor's belly was pressed down for more than eight hours to 'clean' it by an unqualified doctor and her team.

In 2014, a Delhi University girl visited a quack in the Nangloi area of the national Capital after she found out that she was pregnant. The process from the clinic left her infertile for life.

Lack of knowledge

Uma Devi, 47, wants Phoolan, her daughter-in-law, to get rid of the Copper-T she got two years ago, after successfully delivering two healthy babies. She believes that the IUD (Intrauterine Device) makes Phoolan lethargic. Taking recourse to medicines or a 'Dai Maa' are much simpler means of abortion, she says.

Excessive vaginal bleeding and immense abdominal pain are some of the common side-effects, but some implications can be far more serious. Improper dosage of the drug can lead to deformation in babies, while incomplete termination can block the placental tube and can lead to haemorrhagic disorders in cases of ectopic pregnancies. It is yet unknown if the effects of Mifepristone can be reversed and therefore requires intensive follow-up care in case of usage.

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