Every time a woman becomes pregnant, she risks a sudden and unpredictable complication that could result in death of, or injury to herself or her infant. Every year, on an average, about 210 million women become pregnant throughout the world. Approximately, one-third of these, or 75 million pregnancies are unwanted. About 40-50 million of these women resort to abortion, 30 million abortions being performed in the developing countries. At least 20 million of the total abortions are thought to be unsafe i.e. carried out by an untrained person or in a setting lacking the minimal medical standards, or both. Everyday, 55,000 unsafe abortions take place globally.

Nearly 90% of these unsafe abortions are performed in developing countries where around 80,000 women die annually due to abortion-related complications and a further 5 million women suffer disability. Unsafe abortions account for 12% i.e. one in eight of all maternal deaths worldwide, or approximately 200 deaths per day. In India, 11 million abortions take place annually and around 20,000 women die every year due to abortion related complications.

We have a liberal abortion law which makes abortion available on request for social, ethical or eugenic reasons. Most common reason why women resort to unsafe abortion is an unintended pregnancy. The common causes of unintended pregnancies are lack of access to, or failure to use, a contraceptive method and sometimes failure of the contraceptive method itself. Other reasons may be a pregnancy occurring as a result of sexual coercion or rape and a variety of socio-economic reasons.

Several surgical and medical methods are available to induce abortion. Between 10- 50% of women who undergo unsafe surgical abortions need medical care for complications. The most common complications are incomplete abortion, infection (sepsis), haemorrhage and injury to internal organs such as perforation of the uterus. Long-term health problems include chronic pain, pelvic inflammatory disease and infertility.

Medical abortion offers a novel approach to pregnancy termination by non-invasive methods, with minimal side-effects and efficacy as high as 95%. Several agents are used for early medical abortion; the common ones include Mifepristone and Misoprostol and their combination regimens. Methods that have been used for second trimester abortion include oxytocin infusion, intra-amniotic instillation of hypertonic saline or urea, extra amniotic ethacridine lactate, prostaglandins by intra or extra-amniotic route, intramuscular injection or vaginal insertion.

WHO Collaborative Centre for Research in Human Reproduction at AIIMS has completed three decades of fruitful collaboration with WHO Special programme for Research and Development in Human reproduction. One of the major areas of WHOCCR research activities is Post-ovulatory Methods of Fertility Regulation. In the Consortium on National Consensus for Medical Abortion, WHO-CCR, in collaboration with a group of experts from MOH FW, ICMR and WHO, has deliberated on different issues involved in the introduction and safe usage of medical abortion in India.

The methodology followed for building consensus included one-day OPEN FORUM in which experts presented their view-points, followed by another two-day EXPERT FORUM whereat the experts deliberated on different issues related to safe medical abortion services in India. The issues included pre-abortion decision-making, technology of medical abortion, access to medical abortion facilities, post-abortion care, training of health care providers for medical abortion and monitoring of medical abortion prograrmme. The experts reached a consensus after exhaustive deliberations. The proceedings that follow record an important event in the annals of women’s health in India.

The recommendations lay emphasis on the government and nongovernmental agencies to enhance knowledge and intervention strategies for providing safe medical abortion ervices.The co-ordination of this project has been a monumental task for which I am grateful to our patrons, advisors, resource persons, participants, dedicated experts and the members of the organizing committee for their time, effort and support at every stage. The recommendations included in the proceedings were presented to Shri JVR Prasada Rao, Secretary to the Govt. of India MOHFW, Department of Family Welfare and have his approval.