According to the WHO, approximately 100 million people make love daily, resulting in one million conceptions, and 150,000 abortions. The world population increases by 100 million every year: 17 million in Africa, 10 million in Latin America and 55 million in Asia; in India, 44 babies are born every minute. Sadly, many pregnancies are unwanted, accidental, the result of rape and incest, or wanted but not affordable. Others are a risk to maternal health. According to WHO, about one-third of the 150,000 abortionsworldwide are unsafe; and a woman dies every seven minutes as a consequence. Annually, as many as 600,000 women die through lack of contraception which leads to pregnancy.

In India, after the introduction of Medical Termination of Pregnancy (MTP) Act in 1972 legalizing abortion, reported MTP cases have been on the increase. According to available statistics, the number of approved institutions providing MTP facilities has increased from 1877 in 1976 to 7121 in 1991. Similarly, the number of MTP cases from a mere 25 reported in the year 1972-73, has gone up to in 632526 in 1991-92. However, these figures are only the tip of the iceberg as it is estimated that, in India, every year, an additional 5-6 million abortions are conducted by private practitioners. Majority of these cases are done in rural areas having inadequate facilities and hence done in an unhygienic and unscientific way.

Despite the fact that MTP has been legally approved in India for more than three decades, its services are not easily accessible to majority of the women, particularly in the rural areas. At the departmental level, MTP has remained a neglected area. At the time of allocation of resources, it receives the lowest priority. Since 1991-92, it is fixed at Rs.150 lakhs (US$ 435,000 approx.) annually which is totally inadequate. The donor agencies that have contributed significantly in expanding health and family welfare facilities in the country have also not shown any interest in supporting MTP program.

Consequences of unwanted pregnancy can be quite severe. Every year, 11 million abortions take place and at least half are unsafe. Nearly all deaths and serious morbidity resulting from unwanted pregnancies occur in developing countries. In India 20,000 deaths occur every year due to abortion. Surgical abortion may be undesirable to some women, requires skill and may be unsafe and potentially lethal in unskilled hands. Medical abortion using drugs – mifepristone and misoprostol can be delivered in a manner that is safe, effective and acceptable to women.

Medical abortion has the potential to improve women’s health and advance their reproductive rights. Medical abortion can be used safely in even the most basic-setting (non-physician worker) as long as back-up care is available to treat women who experience complications or failure. It is highly effective in early pregnancy, but we need to regulate the sale of drug and formulate country specific guidelines, taking into consideration a large number of ISM
providers in our country.

There is an urgent need to have a dedicated centre for reproductive healthcare to provide leadership in women’s healthcare all over the country. With these words, I thank the organisers for inviting me and sharing my views on the subject and wish all the success for the consortium.