is the termination of pregnancy at any time before the foetus has
attained the stage of viability. This has been fixed administratively
at 28 weeks, which corresponds to a foetal weight of 1000 gms. With
expert neonatal care, this limit has been brought down to 20 weeks
of pregnancy, corresponding to foetal weight of 500 grams in developed
Abortions may be spontaneous or induced. Induced abortions are
deliberately carried out and these may be legal or illegal. Spontaneous
abortions can be further categorized into threatened, inevitable,
incomplete, complete, missed and septic abortions.
Unsafe abortions are those which are performed by untrained persons
and/or in improperly-equipped institutions, and are more likely
to result in maternal morbidity and/or mortality. Spontaneous abortion
if not properly managed can also be unsafe and induced abortions
carried out illegally are generally unsafe. Occasionally, an illegal
abortion may not be unsafe when carried out by a qualified person
in a wellequipped place (though not certified – safe illegal
Various studies show the proportion of abortions ranges from 9-15%
of total pregnancies. In some countries (e.g. Hungary), legal abortions
exceed live births. The actual incidence of abortions worldwide
is not known but estimates range from 40-60 million a year of which
at least half are unsafe. Nearly 40-50 per 1000 women of reproductive
age have abortions annually with an abortion ratio of 260-450 per
1000 live births.
In India, it is estimated that about 6 million abortions take place
every year, of which 2 million arespontaneous and 4 million are
induced. Of the induced abortions, nearly 5-6 lakhs are legal and
the rest are estimated to be illegal abortions.
Spontaneous abortion rates are influenced by age at menarche and
smoking rate. Higher gravidity / parity of woman and history of
previous abortions, genetic factors, maternal infections, uterine
abnormalities or hormonal defects lead to most spontaneous abortions.
In India, abortions were illegal and amounted to homicide till
1971 (as per provisions under IPC 1860 and CPC 1898). MTP Act was
passed in 1971 and came into force with effect from 1st April, 1972.
Under the MTP Act, the following are strictly specified:
• Maternal/ Fetal conditions under which MTP can be done
• Place where it can be done
• Persons who can do it
MTP was introduced in India as a maternal health measure and NOT
as a birth control measure. Unsafe abortions account for nearly
200,000 maternal deaths in developing countries annually. Treating
women who had illegal abortions drain health systems and the women
face long term morbidity and social disability.
Abortion will continue to exist as long as women face unwanted
pregnancies, and unwanted pregnancies will continue to occur until
women gain the power to determine their sex behaviour. Though abortion
is legalized, illegal abortions abound. It is estimated that 90%
of India’s 6 million annual abortions are carried out in unhygienic
conditions and hence are unsafe.
Women who seek abortion at unauthorized facilities or from unskilled
persons put not only their health but also their lives at risk.
Although unsafe abortion is a public health problem at all ages,
it is particularly so among young women. These young women often
havea poor access to family planning and are less likely than older
women to have the contacts and money to obtain a safe abortion.
Abortion-related morbidity and mortality are much higher in the
second trimester of pregnancy. Women abort later as they have neglected
As with all other data on illegal abortions, information on the
social and demographic characteristics of women resorting to illegal
abortions is fragmentary and biased. A variety of factors, including
reproductive behaviour, accessibility and use of effective contraception,
socio-economic conditions and cultural mores, influence the behaviour
of women seeking illegal abortions.
The profile of safe abortion-seekers and unsafe abortion seekers
Profile of abortion Seekers
|Safe Abortion Profile
||Unsafe Abortion Profile
|• women in age group 20 and early 30
• usually multiparous with 2 or 3 children
coming from all socio economic strata
• not much of
a rural urban bias
• in places where services are
|• teenage girls or women in late 30 and early 40
• many times unmarried or widowed
of lower socio economic status
• illiterate and of
• timing of abortions is late-first or
• mostly in un-recognised places
The profile of people providing abortion has, perhaps, undergone
some change during the last 50 years. Earlier, the providers of
abortion used to be Dais, barber-women or traditional-healers and
the methods adopted used to be pastes, herbal products, sticks,
etc. Currently, however, some studies have shown that, in a fairly
sizeable proportion of cases, abortions are being provided by healthcare
professionals-both of modern system of medicine as well as ISM and
Homeopathy but majority without the requisite qualifications, skill
and experience. The method used is surgical dilatation and evacuation
of the uterus.
Morbidity and mortality from illegal unsafe abortions vary according
to conditions under which the abortion is erformed, the procedure
adopted, the skill of the person performing it, the stage of gestation
and age, health and parity of the woman. Where abortions are legal
and statistics are accurate, the mortality ratio ranges form 1 to
3.5 per 100,000 abortions in the developed countries. In India,
the mortality is reported to be 7.8 per 1000 random abortions, most
of which are illegal. Studies indicate that risk of death is 7 times
higher for women who wait until the second trimester
for termination of pregnancy.
Unfortunately, data on morbidity are very limited and fragmentary.
Illegal abortions are a frequent cause of severe short-term complications
and long-term sequelae. The most common early complications are
excessive blood loss, pelvic infection, uterine perforation, cervical
injury, thromboembolism, anaesthetic complications and shock. The
late sequelae include infertility, ectopic pregnancy, increased
risk of spontaneous abortion etc.
There is an urgent need to correct anomaly of safe versus illegal
abortions. Some of the steps are:
• awareness of availability of legal and safe abortion facility
as a maternal health measure.
• increase access to and the choice of methods available for
safe abortion services.
• ensure appropriate referral facilities.
There is a challenge to provide safe abortion services to all those
in need of abortion and to fully meet the unmet needs for contraception
so as to reduce the need for abortion. Providing appropriate contraceptive
care at the time of MTP will prevent these women from the risk of
yet another unwanted pregnancy and induced abortion. All these will
go a long way in achieving substantial reduction in morbidity and
mortality associated with induced abortions.
An unsafe abortion is "a procedure for terminating
an unwanted pregnancy either by persons lacking the necessary skills
or in an environment lacking the minimal medical standards, or both"