We feel greatly honoured by the presence of our Hon’ble Health Minister, Smt. Sushma Swaraj, and other dignitaries for the inauguration of this important consortium on National Consensus for Medical Abortion. As far as we have been able to analyse, a major contributory factor to the burgeoning population and women’s suffering in our country is occurrence of unwanted pregnancies. Our focus is, therefore, to minimize such cases by the use of effective contraception. The first death that I witnessed in my medical career as a third year student was of a young woman dying of uterine perforation, bowel injury and septic shock following a criminal abortion. It left a deep scar on my psyche that something must be done to save these suffering women. Of course, the first step to minimize such cases is by avoiding unwanted pregnancies by effective contraception.

In some cases, failure of contraception, or failure to use one, may occur where emergency contraception can come to her rescue. We had, therefore, organized a consortium on National Consensus for Emergency Contraception in India in January, 2001, following which the Government approved its use in the country and included it in the National Family Welfare Programme.

Still, contraceptive coverage continues to be poor in our country, child-bearing starts at a very early age and women continue to have unintended pregnancies. Unwanted pregnancy is a major public health problem with potentially serious consequences for the health of women. Despite the availability of several contraceptive methods, the need for abortion continues. World population surveys have shown that 210 million pregnancies take place annually but only 63% of these result in live births, 15% miscarry spontaneously and 22% end their pregnancies by induced abortion. In our country, current ratio of abortion is 452 per 1000 live births and more than 50% of these abortions are unsafe. Approximately 20,000 women die annually due to unsafe abortions in India, and many more suffer from permanent or temporary disability. Abortion-related deaths contribute to 17.6 % of all maternal deaths in India.

For many decades, the traditional method of termination of pregnancy has been surgical evacuation of uterus performed under general/local anaesthesia or sedation. Though safe in hands of experts, the surgical abortion if performed by untrained providers under unhygienic conditions is associated with high procedural morbidity and mortality. Worldwide, research has been on for safer, simpler and effective methods of termination of pregnancy. In the last two decades, extensive research has gone in for termination of pregnancy by using drugs (medical abortion methods) which are found safe and effective when used under proper supervision and appropriate counseling.

These medical methods are an alternative to surgical abortion, requiring less training skills and expertise to perform. The objective of the Consortium on National Consensus for Medical Abortion in India is to recognize the potential role of medical abortion in the National health policy of India, and formulate strategies for safe usage of these methods.

Today, there will be an Open Forum, which everyone interested in the reproductive health of women is welcome to join. The experts in medical abortion have been invited from all over the country and from countries with experience of medical abortion including technical experts, policy-makers, drug controller and experts from WHO, ICMR, MOHFW, NIHFW, FOGSI, Population Council and PSS, who will be sharing their experiences in the respective area.

The next two days, i.e. tomorrow and the day after, during the Expert Forum, the experts will be considering several issues related to safe usage of medical abortion methods for termination of pregnancy and availability of medical abortion technology in India including pre and post-abortion care, training and monitoring of program. On the concluding day of this consortium, the recommendations formulated thereat will be submitted to the Government of India.

This consortium will lead to a greater understanding of, and more informed action on Medical Abortion, for improving women’s reproductive healthcare in India. Abortion in India is not against the law, but it should be safe. The women should have access to quality services for the management of complications of abortion. Post-abortion counseling, education and family planning services should be offered promptly, which will also help to avoid repeat abortions. We need to ask whether we can afford to allow unsafe abortions to continue to threaten the health and survival of women and their families. Abortion is a social and health issue of urgency to all – women, their families and the nation.

I hope that the deliberations of Consortium on National Consensus for Medical Abortion in India, will lead to useful conclusions for better healthcare of women in the country. I reiterate that a child should be born only when it is wanted and not when it cannot be prevented.