Legal Factors Mediating Women’s Access To Safe Abortion
Author: LawSphereX
Category: General Law
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LEGAL FACTORS MEDIATING WOMEN’S ACCESS TO
SAFE ABORTION Deepali Sinha, Research Scholar, CNLU This paper addresses the factors that influence Registered Medical Practitioners' decisions to assist in or withhold abortion care. We outline the circumstances in which the practitioners exercise decision-making authority with reference to abortions conferred on them by law, as well as the manner in which they exercise this authority. DECISION-MAKING BY REGISTERED MEDICAL PRACTITIONERS Section 3(2) of the MTP Act recognizes "danger to the pregnant woman's life or serious injury to her bodily or mental health" as a reason to terminate her pregnancy. 1 Additionally, the MTP Act specifies that "in assessing whether the continuation of a pregnancy would pose such a risk to the pregnant woman's health as described in sub-section 2, consideration may be given to the pregnant woman's actual or reasonably foreseeable environment.
"2 As a result, the Act recognizes that the decision to terminate a pregnancy is not solely a medical one, but also involves a variety of additional social, economic, family, and other circumstances unique to the woman seeking abortion. Despite this acknowledgement, the MTP Act vests the authority to terminate a pregnancy with a registered medical practitioner (RMP) and not the pregnant woman. Thus, when a woman seeks termination of a pregnancy from an RMP, the RMP retains the option to do so. Women's access to safe abortion is contingent upon the RMP's interpretation of the Act's Section 3 grounds.
We discover that this discretion is frequently exercised in ways that have little to do with concerns about the woman's health and well-being, her right to make her own reproductive choices, or even with the MTP Act's legal provisions; and has a great deal to do with providers' fear of personal consequences, their views on the morality of abortion, and their beliefs about women's role and place in society.
1 MTP Act, s 3(2).
2 MTP Act, s 3(3).
A. FEAR OF THE LEGAL PROCESS
The law does not recognize a woman's unalienable right to abort a pregnancy. Her decision is punishable not only criminally, but also civilly, including divorce on the grounds that the abortion was performed without her husband's knowledge or consent. Doctors may be sued by the spouse for damages,3 or they may be called as witnesses in divorce procedures. 4Women's access to safe abortion is hampered by providers' perpetual fear of coming into contact with the criminal, or even civil, legal system. This concern has a chilling impact on the willingness of service providers to provide abortion services. Additionally, given the IPC's overall criminal law framework for abortion, as well as the stigma associated with abortion, there is widespread (mis)perception among service providers that everything related to abortion may be illegal, leading in fear of the legal procedure.
5 Given the legal system's reputation for being prohibitively expensive, time-consuming, and inconvenient, the majority of providers want to avoid any contact with the law or its enforcers. As discussed throughout this research, this includes denying abortion services to women, particularly those under the age of 18, those in their second trimester, and those who have previously had more than one female child. When abortion is delivered, physicians frequently make women jump through unnecessary hurdles, such as obtaining increased permission, documentation, and third-party authorizations, in order to avoid legal liability. Apart from this, when women seek abortion after the 20-week gestation period, RMPs are hesitant to invoke Section 5 of the Act, despite the fact that RMPs' conduct in good faith are protected under the Act.
For example, in a government hospital in Mumbai, any "suspect" abortion case is reported to the local police station via an Emergency Police Report ("EPR"). When we enquired about the definition of "suspicious," we were informed that EPRs are not required for married couples or in cases of foetal abnormalities. EPRs are filed in cases where an unmarried woman wants abortion on the grounds that medical officials consider such sexual intercourse outside marriage is "illegal," or the woman may later file a case alleging assault. According to them, the EPR was compelled to document the abortion. Notably, the law does not require RMPs to make a police report before to or following an abortion unless there is an allegation of rape or the lady requesting abortion is under the age of
18. The filing of EPRs appears to be a proactive and misguided attempt to comply with the
mandatory reporting requirement under Section 357C of the CrPC, which requires that if a
3 Dr Mangla Dogra v Anil Kumar Sharma, ILR (2012) 2 P&H 446.
4 Samar Ghosh v Jaya Ghosh (2007) 4 SCC 511.
5 IPC, sub-section 312-316.
woman alleges rape, all hospitals must provide necessary therapeutic care and "shall immediately notify the police of such incident. "6 Anecdotal evidence of legal action against service providers abounds, increasing providers' hesitancy to provide abortion services. Medical practitioners facing legal implications or becoming enmeshed in the legal process as witnesses are frequently cited in any discussion about abortion. For example, we were told of a situation in which an unmarried pregnant woman had a termination, but the pregnancy was ectopic (a pregnancy in which a fertilized egg attaches outside the uterus), necessitating the removal of a fallopian tube. Her parents, on the other hand, desired to conceal the reality of her pregnancy and requested that the doctor record the treatment as the removal of a cyst. Later in life, after marriage, the woman was unable to conceive.
Her in-laws and husband referred her to another physician, who discovered one of her tubes had been removed. Her in-laws and husband brought suit against the first doctor, and the case is now presumably before the Supreme Court. These types of accounts, which circulate widely among the medical profession but are difficult to substantiate, exacerbate service providers' concerns about delivering abortion treatment. This is not to argue that all of these tales are untrue. Newspaper accounts indicate that numerous doctors have been arrested for performing abortions, particularly when the abortion is discovered through another investigation. In Chennai, women seeking abortion services after 12-14 weeks of pregnancy are frequently referred to government facilities, and/or another signatory is required as a witness.
According to the MTP Act, no additional witness/signatory is required for an abortion performed on an adult woman who is not "mentally ill. " However, providers assert that late first trimester and second trimester abortion seekers are predominantly unmarried women who arrive alone, and providers fear that the law may not support them in these instances. While the woman's signature is sufficient to have an abortion, a member of the Obstetric and Gynecological Society of Southern India ("OGSSI") stated that the husband's signature is always required to avoid "problems. " When a foetal defect is discovered during ultrasound/blood tests at a New Delhi Municipal Corporation hospital in Delhi, abortion is not provided to avoid potential legal liability; instead, women are sent to the Central Government-run All India Institute of Medical Sciences.
7 A 6 Aparna Chandra Mrinal Satish Shreya Shree Mini Saxena, “Legal Barriers to Accessing Safe Abortion Services in India: A Fact-Finding Study”, CENTER FOR REPRODUCTIVE RIGHTS, ISBN: 978-93-91111-05-2.
7 Ibid.
private practitioner in Pune eloquently summarized this fear of any involvement with the legal system. He recounted an encounter with a married woman seeking an abortion. A year later, a police inspector informed him that the woman had filed for divorce and had said throughout the divorce processes that she had been coerced into having an abortion. The hospital's Head of Department (who also happened to be the practitioner's mother) was summoned to the Dhulia police station, about 800 kilometres from their place of operation. According to the practitioner, under such situations, doctors usually become easy targets for bribes. This generates a "panic-inducing atmosphere" and makes people feel unsafe. 100 RMPs employ a variety of protective manoeuvres in response to this "environment of terror.
" They may either refuse abortion services outright or require the pregnant woman to comply with a variety of extra-legal requirements, such as counselling the woman to continue the pregnancy, imposing cooling-off periods or waiting periods, obtaining additional consent and third-party authorizations, and requesting a variety of documentation. This report discusses these tactics in detail. B. ABORTION STIGMA AND PATRIARCHAL VALUES Women's access to abortion is further limited by abortion stigma and patriarchal preconceptions about women's sexual, reproductive, and decision-making capacities. Due to the fact that the law permits service providers to act as gatekeepers for abortion access, their beliefs on abortion's morality influence women's access to safe abortion services.
RMPs' moral judgments on abortion are influenced by a variety of factors, including widespread abortion stigma, RMPs' own religious beliefs, and their perspective of women's status and role in society. For instance, a renowned gynaecologist in Chennai informed us that abortions are "ethically imprudent. " According to a private practitioner in Pune, no woman has the right to choose abortion because the foetus is not her "property. " Such perspectives on the morality of abortion and on women's rights to their bodies influence how RMPs exercise discretion. Certain RMPs attempt to dissuade women from having abortions by informing them that abortion is sinful and that the pregnancy should be carried to term, that God is watching, and that they would suffer for the rest of their life if they obtain an abortion.
8 When women, particularly unmarried women, seek abortion services, they are frequently
8 Supra 14.
humiliated for their sexual behaviour. Even RMPs who are willing to provide abortions frequently make their own determinations about whether women's reasons for obtaining an abortion are sound, in addition to what the MTP Act mandates. For example, women seeking abortions to space their children's births, or women seeking abortions beyond the second trimester for reasons that the RMP does not deem acceptable, are frequently discouraged from proceeding with the abortion. Numerous RMPs believe the MTP Act is overly liberal and the grounds are very broad. For example, while failure of contraceptive is recognized as a basis for terminating pregnancies in married women, many service providers object to the broad interpretation of this ground, especially given the absence of a necessity to produce proof of contraception failure.
Similarly, several providers raised worry about the broad interpretation of the health grounds for abortion, given that the Act has no description of physical or mental anguish and no indication of the level of distress required to satisfy the Act's standards. Mental health, in particular, is viewed as being impossible to quantify and demonstrate, and thus as being so broad that "everything can fall under it. " Gynaecologists at a government hospital in Ranchi claimed that this phrase may potentially apply to 75% of their cases due to its "breadth and vagueness. " Personal objections to abortion by RMPs are frequently couched in terms of medical research and/or public health concerns, but are actually motivated by their own views on abortion and women's place in society.
For example, a top government official in Tamil Nadu voiced concern that allowing women to obtain abortions in complete privacy might encourage promiscuity and multiple partners, so increasing the spread of STDs and diseases. Occasionally, such arguments are couched in ostensibly neutral health terms, but the underlying rationale remains moral. For example, women who are pregnant for the first time are frequently discouraged from abortion on the grounds that difficulties may occur later, despite the fact that there is no scientific evidence to support this assumption, as detailed below. Previous instances of abortion resulting in problems or inability to conceive are frequently discussed to dissuade women from abortion.
Apart from the widespread stigma associated with abortion, one cause for rejecting abortion care on these grounds is a lack of proper training for providers of safe abortion services. RMPs' beliefs on the morality of abortion influence their decision to both deny and give abortion care. REASONS FOR DENYING ABORTION SERVICES A. FIRST PREGNANCY Married women who become pregnant for the first time are frequently questioned if the pair plans to have additional children in the future. If the response is affirmative, the couple or woman, as the case may be, is strongly "advised" to continue the pregnancy. The lack of desire for children at that time is viewed as a "superficial" reason, without regard for the woman/personal couple's wishes and circumstances.
An alleged health rationale for this denial is that abortion may result in subsequent issues such as infertility, fibrosis, tube blockage, infections, or cervical stenosis, and the woman may be unable to conceive again or may have difficulty doing so. There is little evidence, however, that induced abortion for the first pregnancy is associated with later difficulties such as ectopic pregnancy or infertility. In such circumstances, denial of abortion services fully undermines a woman's reproductive autonomy. B. REPEATED ABORTION(s) AS A SUBSTITUTE FOR CONTRACEPTION Contraception failure is a frequently cited reason for married women seeking abortion. However, many service providers believe that women use the ground repeatedly, despite the fact that it is (in their opinion) physically impossible for contraception to fail numerous times.
Additionally, many assert that the ground is frequently invoked not when contraception fails, but when no form of contraception was utilised at all. Additionally, healthcare providers expressed fear that if abortion on request is authorised, women will use abortion as a substitute for contraception. This is deemed unhealthy from a health standpoint. Resident doctors at a Ranchi hospital advocated for a numerical limit on the number of abortions a woman can undergo. Women are frequently advised against repeated abortions and are required to take contraception to avoid pregnancy. Once again, this denial of services ostensibly for health reasons limits reproductive liberty completely. Additionally, India has a substantial unmet need for contraception. 12. 9% of married women between the ages of 15 and 49 who seek to avoid pregnancy lack access to contraception. In this age range, just 53.
5 percent of married women utilise some form of contraception. Given this lack of access to contraception and contraceptive choice, restricting women's access to abortion simply serves to disadvantage them; the solution must be to improve access to contraception rather than to restrict access to safe abortion. Even when women have a safe abortion, it may be subject to certain conditions. For example, women visiting a government hospital in Ranchi are only permitted to receive an abortion if they agree to use contraception in the future; hence, women without contraception are unable to obtain an abortion. This is related to providers' concerns about repeated abortions and the use of abortion as a contraceptive method. Conditions associated with abortion care provision are also affected by women's socioeconomic position.
Doctors at a Ranchi hospital informed us that repeated abortion is used as contraception by a "certain class of patients" (suggesting women from economically disadvantaged backgrounds), necessitating the use of contraceptive methods that prevent further conception, such as intrauterine contraceptive devices. 130 While the doctors acknowledge that the majority of women do not consent to having an Intrauterine Device implanted or to undergo ligation, they believe that abortion should be available in conjunction with contraception. Residents at a hospital in Ranchi advised us that when a lady seeking abortion declines contraception, "we counsel her so strongly that she accepts it. " Women are informed that repeated abortions will result in physical difficulties, which will cause their husbands to marry another woman.
While providers indicated that the possibility of complications did not appear to affect women, the argument about their husbands abandoning them does. Additionally, physicians recommend permanent methods of contraception when a woman's family is deemed "complete," which occurs after two or three children. Government programmes such as "hum do, hamare do" help service providers define what constitutes a full family. Additionally, many clinicians believe there is a government/legal limitation on performing abortion without using some type of contraception. Making abortion available to women contingent on contraception is a blatant infringement of women's right to access contraception and contraceptive choice, which has been judged to be within the right to privacy.
Additionally, this study emphasises the importance of proper and enough training for service providers focused on providing rights-based and compassionate abortion services. C. LATE DETECTION Many women are denied abortions if the pregnancy is discovered late — typically in the second trimester or later. This relates to concerns about the PCPDNT Act and the possibility that the abortion sought is for sex-selection grounds. For example, while failure of contraception is a legal basis for abortion, if a married woman seeks an abortion later in the pregnancy due to contraception failure, some providers refuse, both out of concern for sex-selection and because they believe that if the unwanted pregnancy was indeed the result of contraception failure, it should have been recognised earlier.
However, there are other circumstances that could result in a late pregnancy detection, such as lactational amenorrhea, or rape in the case of adolescents who are either unaware of their pregnancy or conceal it until the pregnancy becomes obvious (due to fear of the stigma and shame associated with rape in the family and community).
Women are also denied second-term abortions on the grounds that the increased health risks associated with abortion rise with advanced gestational age. According to the WHO, abortions are safe regardless of gestational age if they are performed using procedures appropriate for the gestational age and performed by a skilled provider or supporter. D. HIERARCHY OF REASONS FOR PROVIDING ABORTION CARE While there is widespread stigma associated with abortion and a reluctance on the part of service providers to provide abortion care, morality, sympathy, and societal considerations can sometimes work in favour of women seeking abortions when the reasons for seeking abortion align with heteropatriarchal and ableist social constructs.
Gayle Rubin argued in her essay, Thinking Sex, that society establishes a hierarchy of sex acts, with "good," "normal," and "natural" sexuality being heterosexual, married, monogamous, reproductive, and noncommercial, and any sex act that violates these rules, such as homosexual, unmarried, promiscuous, non-procreative, or commercial, being "bad," "abnormal," and "unnatural. " A similar hierarchy is seen in how care providers evaluate the reasons for abortion sought by women. Service providers always scrutinise women's motives for seeking abortion and evaluate them according to a hierarchical structure based on societal standards dictating sexual behaviour and gender roles, as well as ableist conceptions. While abortion is often stigmatised, it is most likely to be considered "legitimate" for pregnancies coming from heterosexual marital relations. 9 I.
FOETAL ABNORMALITY Pregnancies resulting from heterosexual, marital, reproductive intercourse are prioritised for termination due to foetal anomalies, even at advanced gestational ages. Additionally, courts are more likely to legalise abortion on the basis of foetal abnormalities than on any other basis. Apart from being at the top of the hierarchy of "acceptable" sex acts, this argument is ableist in that it views foetal abnormality as the most justifiable reason for seeking an abortion. After all, the MTP Act self-avowedly pursued "eugenic" goals by allowing abortion "when there is a high chance that the child, if born, will suffer from malformations and disorders. " Apart from that, this logic is predicated on women's "natural" position in society as loving, caring mothers. As discussed below, women who wish to fulfil their maternal obligations through an intended
9 Supra 14.
pregnancy that is later discovered to have foetal defects are considered to be the most "deserving" of abortion. While many abnormalities are identified late, unlike late requests for abortions in other instances, such as late pregnancy detection or reporting failure of contraception at a later stage, the majority of women can get abortions in cases of late diagnosis of foetal malformations. When foetal anomalies are detected after 20 weeks, service providers either seek judicial authorization for abortion or, in some cases, perform the procedure without it because abortion on these grounds is considered legitimate and providers view carrying such a pregnancy to term as pointless if the future child will live in discomfort.
10 This is particularly remarkable because Section 5 of the MTP Act11 authorises RMPs to terminate a pregnancy after 20 weeks only if it is immediately essential to preserve the pregnant woman's life, not only on the basis of foetal abnormalities. This overwhelming acceptance of abortions on the basis of foetal abnormalities is based on the cultural notion, as well as the providers' personal beliefs, that a child deemed "odd" can be aborted, as well as their sympathy for the mother bearing such a foetus. In general, as a Chakardharpur youth volunteer who provides support services to women seeking abortion explained, "if a lady is recommended abortion due to foetal anomaly, the doctors perform it quickly; there is no trouble at all. " They do so at any stage of pregnancy, regardless of gestational age. The issue arises only when the lady expresses her desire to abort the kid.
Then there is an additional issue if she decides for herself. If the doctor recommends it due to an abnormality or because it is impacting her physical or mental health, it is acceptable. It becomes a problem only when she decides for herself. " RMPs have expressed concern about the MTP Act's Section 3's12 interpretation of the term "substantial risk" of incapacity. Providers are unsure whether the mere presence of medical treatment for the relevant defect suffices to determine that it is not significant, or whether the availability of treatments with a poor prognosis disqualifies a foetus with malformations from abortion. For instance, in a case before the Bombay High Court, a woman sought termination of her pregnancy after 20 weeks due to the discovery of a significant heart defect in the foetus.
The court referred the matter to a prestigious government hospital in Mumbai and directed the establishment of a medical board to consider the termination request. The board included a heart surgeon, who stated in the medical report that in instances involving this type of defect, the child's chances of survival are quite poor, even after surgery; the infant may die or may live
10 Supra 14.
11 MTP Act, s 5.
12 MTP Act, s 3.
for one or two years but with tremendous difficulty. The other experts on the board, on the other hand, stated that if treatment for the anomaly is available, it should be pursued; termination cannot be recommended. Indeed, the report noted that demanding abortion in these circumstances constitutes "reproductive materialism. " The pregnant woman's preferences in this subject were disregarded. On the other side, there are concerns based on disability rights about the broad acceptance of this reason for providing abortion, given the possibility of utilising this ground for eugenic purposes. In the absence of a precise definition of which types of defects are covered by the section, concerns have been made that the basis may be used even in cases of cleft lip or nose, organ loss, visual or hearing problems, or other less severe and treatable disabilities.
These concerns are legitimate, but they arise because the law requires women to express their reasons for seeking abortion under one of the MTP Act's limited grounds, rather than enabling them to decide for themselves whether to continue the pregnancy regardless of their reasons. By limiting abortion to a few narrow grounds, the law itself establishes a hierarchy of valid reasons for abortion, one of which is foetal abnormality. Thus, this exceptions-based system of allowing abortions only in limited instances creates a conflict between women's rights to reproductive autonomy and the rights of persons with disabilities to not be stigmatised as leading less deserving lives. At the same time, the notion that women abort foetuses even when they have easily correctable defects is unsupported by research.
These concerns about women's decision-making contribute to the policing of women's bodies along a hierarchical scale of what constitutes a normal body and what does not, imposing judgement on women and undermining their ability to make informed decisions. II. MAREGEALIBILITY
1. Rape
Abortions sought by unmarried women whose "marriageability" will be jeopardised by giving birth outside of marriage are next in the hierarchy. This is especially true for rape survivors, who are not regarded "at fault" for having children outside of marriage and hence elicit pity for having their future (i.e., prospects of marrying) wrecked. RMPs are mandated to quickly notify the police in cases of rape under Section 357 C of the Criminal Procedure Code and Section
19 of the POCSO Act (irrespective of the choice of the woman)13. This is why many women
and service providers are hesitant to use this basis (especially when one of the other grounds
13 Protection of Children from Sexual Offences Act, s 19.
is available), as women are not always eager to report rape. Certain providers seek to circumvent this provision in order to terminate the pregnancy without subjecting the pregnant woman to the criminal court system. According to a prominent private practitioner in Pune, when a woman approaches him seeking an abortion on the grounds of rape, he not only provides the service, but also counsels her and obtains her signature and consent on a statement indicating that he counselled her and she has indicated that she does not wish to report the matter to the police. He then informs the police station that he is performing an abortion on a woman who is a victim of rape but wishes to remain anonymous. He requests that they file a First Information Report ("FIR") but withhold the victim's name.
While he was dubious whether this was a legally valid method of abortion provision, he felt that his technique provided him with some amount of protection while maintaining the pregnant woman's secrecy. However, the majority of practitioners and the law itself do not let the woman to choose whether or not to disclose the rape. Minors' access to safe abortion has been severely restricted as a result of the POCSO Act, which forbids all sexual behaviour under the age of 18 and requires mandatory reporting. Numerous providers also believe that court authorization is required when a woman requests an abortion due to rape at any stage of gestation, despite the fact that courts have frequently stated that this is not the case.
Additionally, we discovered that a very widespread belief among care providers is that the shame and stigma associated with rape can be overcome if the woman marries a suitable guy (either her rapist or another man), in which case the pregnancy does not need to be terminated. For instance, we were informed that in tribal parts of Jharkhand, such as Chaibasa, the village panchayat (assembly) may affect a "compromise" by marrying the lady off to the rapist or his partner, or to another man. According to the care providers we questioned, such pregnancies should not be aborted. 14
2. Consensual Sexual Intercourse before Marriage
Women who choose to have sex outside of marriage and become pregnant are at the bottom of the list of legitimate grounds for seeking abortion. Women's unmarried status frequently works against them when it comes to abortion availability, in part because of the shame associated with sexual conduct outside of marriage. Surprisingly, but frequently shared among service providers, is the belief that sex outside of marriage is unlawful. This viewpoint was most eloquently expressed during our interactions with providers of contraception for unmarried
14 Supra 14.
women. Numerous providers asserted that contraception is not designed for unmarried women, as it would eliminate dread of pregnancy and result in a drop in marriages, and therefore would send the wrong social message. According to nurses at a renowned government hospital in Ranchi, contraception advice is not intended for unmarried women because their family is incomplete. We discover that many service providers operate under an established classification system that classifies sex prior to marriage as 'illegal' and sex within marriage as 'legal. ' Forensic medicine textbooks used in medical school feature similar (wrong) categorizations, thereby entrenching the stigma associated with premarital sex and accompanying reproductive demands.
As a result, unmarried women are frequently denied abortions because their pregnancy is perceived to be "illegal," necessitating interaction with the legal system, such as reporting to the police or filing a complaint. The stigma associated with premarital sex also influences how service providers interact with unmarried women seeking abortion services. Women are constantly chastised, reprimanded, and belittled for their sexual behaviour. This is especially true in the public healthcare system, which contributes to women's avoidance of such institutions. As youth leaders who support women seeking abortions informed us, "[Doctors and nurses] will terrify and threaten you. " When they visit the hospital for check-ups, the nurses reprimand the girls, and their behaviour is inappropriate.
When a pregnant unmarried girl arrives, the counsellors, doctors, nurses, and other personnel take an entirely different perspective. They claim you roam freely, are unable to take care of yourself, do things in any location, and then come here and claim it was coerced. The women then declare they will not seek treatment from a doctor and turn to traditional medicine solutions. They assert that they will employ their own ways and consult with someone they know the quacks who sit in villages and administer traditional treatments. '" This apparent "illegality" of unmarried women having sex sometimes creates the perception that abortion cannot be performed in a government facility and that the lady must be referred elsewhere. According to a doctor at an NDMC hospital in Delhi, unmarried women do not seek abortion at the facility because it is a government-run facility.
However, in some cases, concern for an unmarried pregnant woman's reputation and future marriage prospects outweighs the shame associated with pre-marital sex and allows them to seek abortions. Additionally, service providers in tertiary medical facilities, which are frequently viewed as a last resort due to the distances involved in travelling to them, are occasionally of the opinion that if abortion is not provided there, the woman will resort to unsafe and illegal methods to obtain the abortion. 15
15 Supra 14.
Transgender and sex workers seeking abortions are virtually entirely missing from the public health debate surrounding abortion. When these identities are included into the narrative, prejudices about them shape providers' views and decisions. For example, providers may dismiss sex workers seeking abortion on the grounds of rape, reasoning that sex workers "cry rape" only when they are not paid. III. ABORTION FOR LIMITING FAMILY SIZE AND SPACING When women in Maharashtra, Gujarat, Andhra Pradesh, and Tamil Nadu were asked to name the circumstances under which they would seek abortion or have sought abortion, the majority indicated this as the primary reason. Similarly, a very brief inter-conception gap was mentioned as a rationale for abortion. Some women become pregnant without realising it during postpartum amenorrhoea and while breastfeeding the child.
To avoid having another kid in a short period of time, women consider abortion as a realistic choice. In a study conducted in Tamil Nadu, younger women saw frequent childbirth as embarrassing and resorted to abortion to increase the inter-birth gap. Another reason for abortion related to contraception that surfaced in Tamil Nadu, Andhra Pradesh, Gujarat, and Maharashtra research was conception shortly after marriage. While a premium is normally put on proof of fertility and elders wish for the young bride to birth a child within a reasonable time following marriage, pregnancy very immediately after marriage was cited as a reason for abortion by a few women in each of the four states. Interestingly, a Gujarat study revealed that when girls married to Non-Resident Indians (NRIs) fell pregnant shortly after marriage, they chose abortion.
Fear that pregnant women would not be granted an immigration visa, preventing them from joining their husbands overseas within a reasonable time following marriage, was stated as the primary cause. IV. ABORTION FOR DESIRED SEX COMPOSITION OF CHILDREN According to certain studies, couples and their extended family members choose abortion not only to reduce family size but also to achieve preferred child sex composition. Internalization of son desire was pervasive enough that Barua, Radkar, Anadhi, and Visaria all reported that couples sought female selective abortions following a sex determination test. Sons were chosen for a variety of reasons, including help in old age, continuity of the family line (as stated in a Maharashtra study: providing heir is a primary obligation of women), and conducting death rites.
Women discussed the accessibility of ultrasonic facilities in practically every place. Additionally, they were aware that sex selective abortion was banned and admitted to visiting multiple institutions to determine the fetus's gender and to have an abortion. Women and service providers were considerably more knowledgeable about the new PNDT Act than they were about the specifics of the MTP Act. When sex selection was debated in groups, conversations generally became fairly heated. Despite the fact that they were aware that sex selective abortion was illegal, women voiced helplessness since their family standing and, in some cases, the life of their marriage hinged on their capacity to have sons. Although the majority of the research discussed attitudes, Radkar's study in Maharashtra found that 8 out of every 70 recorded abortions, or 11%, were sex selective.
Additionally, she noted that women who undergo sex determination also undergo abortion of the female foetus. Everyone seems to be aware of at least one woman who has committed this actî. According to Barua's study in Gujarat, 10% of abortions (16%) were conducted following a sex determination test and confirmation of a female foetus. Additionally, a Maharashtra study of Morankar indicated that when only female infants were born or conceived, the family approved of the need for abortion and the community supported it. Thus, there was no societal shame connected with sex selective abortion for a mother of numerous girls. Women from Gujarat and Haryana also said that, while they were opposed to abortion in general, they approved it when it was done for the sake of family honour (not a son-less family).
In the RUWSEC study in Tamil Nadu, abortion was used in only two occasions to avert a female birth: once to avoid giving birth to another daughter and once to escape violence associated with delivering a female child. On the other hand, Anandhi, who was also doing research in a comparable area in the same state, observed that the preference for male children, and hence for sex selective abortion, was quite widespread. Simultaneously, rather than relying on new technology to determine the sex of the embryo, women appeared to rely on prevailing myths. For instance, it was believed that if a girl was born with two circle marks on her bottom, her subsequent kid would likewise be a girl. Even though women recognised that the predictive efficacy of such beliefs was dubious, many relied on them to have abortions.
16 Additionally, ladies preferred sterilisation only after the birth of a male child. Additionally, if the male child was still young and the wife became pregnant again, she would not hesitate to abort the second child in order to devote extra care and attention to the male child already born. While the studies by Barua, Radkar, and Prakasamma indicated that abortions were performed for medical reasons such as when a woman's life is threatened or when there is concern about the foetus being abnormal, a study by Barua noted a discrepancy between the reasons cited by women and abortion service
16 Supra 10.
providers. The providers indicated that they do abortions for medical reasons, such as the mother's poor health; an abnormally formed foetus was a rare reason for an abortion. While some respondents indicated that they sought abortion on medical advice, It is irrelevant whether the women's phrase is a euphemism for sex selective abortion. This could also be a means of justifying the abortion decision and shifting the burden of proof to the provider. V. FINANICAL CONDITIONS, POVERTY AND WORK The two Tamil Nadu studies and the Karnataka study all identified poverty as a motivation for seeking abortion.
Anandi's study of pharmaceutical sector workers in Tamil Nadu indicated that practically all units employing young women insisted on a contract that explicitly stated that females could neither marry or become pregnant during their contract period if they were unmarried at the time of employment. What is interesting about the increase in abortion among unmarried young women is that it occurs concurrently with their increased employment in the industrial sector and appears to be a conscious reproductive decision arising from their role as family providers. Regrettably, it serves only as a vehicle for contesting the disempowering conditions of their employment and production ties. For other married women, the obligations of childcare and the financial responsibilities of family support were key reasons for seeking abortion.
As the author observes, while women's job in the informal sector, such as in the pharmaceutical industry, may have elevated their standing within the family as primary revenue earners or providers, it has not empowered them as reproductive and sexuality decisionmakers. In these circumstances, a woman's decision to abort does not imply autonomy or the ability to choose freely. It is a form of strategic accommodation or a synthesis of complicity and resistance. Although the Karnataka study questioned women who worked in Beedi rolling or agricultural work and were classified as low socioeconomic, the authors discovered that younger and more literate respondents underwent induced abortions to a greater extent than illiterate or older women. The younger and more literate are likely to be more exposed to mass media and metropolitan influences, which in turn influence their behaviour.
On the other side, the RUWSEC study found that poverty and the necessity to earn money to make ends meet drove some younger women to seek abortion. Concurrently, some women stated that they lacked social support during and after pregnancy. As one respondent stated, "I aborted two pregnancies, my third and fifth. " At the time, my family's economic position was dire, and I was also struggling. " Similarly, as another responder stated, her husband decided to terminate the pregnancy "because I would be unable to stand all day in the business throughout my pregnancy, which would negatively affect sales and income. " VI. PHYSICAL AND PSYCHOLOGICAL VIOLENCE Several studies found that women reported being pressured into having abortions by their spouses or other conjugal family members.
Pregnancy may exacerbate both physical and verbal aggression if the husband does not desire the child (for example, a later order birth or a female child) or suspects the pregnancy is the result of his wife's infidelity. Violence is a technique for him to demonstrate his dominance over her. According to Anadhi's research, several women indicated that abortion was their only option for escaping the cycle of spousal violence that another pregnancy would entail. As one 38-year-old lady explained, after three girl children, I was fearful that my fourth would be a girl. Even yet, it was nothing compared to my husband's filthy comments regarding my sexuality. As a result, each time I became pregnant, I attempted suicide. However, this time, I chose to abort the pregnancy. However, the doctor recommended me against abortion, stating that it was too late.
As a result, I threatened the doctor that if she did not perform the abortion, I would commit suicide right there in the hospital. She agreed and aborted the foetus only then. 17 However, it was discovered to be a male child. Still, there was joy in the abortion, as my spouse was unaware of the child and myself at the time. Women have also claimed utilising abortion to resolve marital disputes or to exact revenge on their husbands or conjugal families. According to one respondent in Barua's study, "my mother-inlaw and husband have been harassing and hitting me since our marriage. " When I was approximately four months pregnant, my husband, who was intoxicated at the time, beat me up. I immediately chose to abort the baby. The doctor performed sonography on his own and determined that the foetus was male and that I might wish to prolong the pregnancy.
However, I was crystal clear in my thoughts. I obtained an abortion without informing anyone save a close friend. " Non-consensual sex violence also contributes to women being pregnant in the first place. Threats of violence, charges of adultery and lax sexual morals, as well as actual physical abuse, are frequently used to maintain marital sexual contacts, even when they are against the women's wishes, and contraception use is unlikely in the majority of such sexual encounters. According to some women in the RUWSEC research, their husbands pressured them to have sex by stating that they would pay for the abortion if there was a pregnancy.
17 Supra 8.