Every Two Hours in India, a Woman Dies From an Unsafe Abortion

Each year, 19 million to 20 million women risk their lives to undergo unsafe abortions, conducted in unsanitary conditions by unqualified practitioners or practitioners who resort to traditional but rudimentary means

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NARINDER NANU AFP / Getty Images

Pregnant women wait for a checkup at a government hospital in the Indian city of Amritsar on July 11, 2013

On World Population Day, the first part of TIME’s focus on India — the country with the highest concentration of young people in the world — looked at sex education. This second part examines what happens when the desperate need for contraceptives goes unmet.

Each year, 19 million to 20 million women risk their lives to undergo unsafe abortions, conducted in unsanitary conditions by unqualified practitioners or practitioners who resort to traditional but rudimentary means. Dr. Gilda Sedgh of the Guttmacher Institute, a U.S. sexual-and-reproductive-health-and-advocacy center, believes that “about half of all abortions worldwide are unsafe” — an appalling number when one considers that abortions are simple procedures when done correctly. In India, the problem of unsafe abortions is especially acute. There were 620,472 reported abortions in 2012; experts say the true number of abortions performed in the country could be as high as 7 million, with two-thirds of them taking place outside authorized health facilities. Not all of these are pregnancies out of wedlock. Many unsafe abortions are performed on married women unable to obtain contraception and unable to travel to a registered clinic, who for economic or personal reasons do not wish to have another child.

A woman in India dies every two hours because an abortion goes wrong. That seems like an extraordinary number until one visits the sorts of locations where abortions take place — where it can be seen that the possibility for something to go wrong is high indeed. India’s expenditure on health care is only 3.9% of its gross domestic product, putting it on par with Gabon or the Central African Republic. Rural government clinics are often nothing more than skeletal brick structures with tin roofs and sporadic electricity supply. Women lie on old gurneys or beds if one is available; just as often, they bed down in dark rooms on mud floors scattered with bloody dressings. Less than 20% of these centers provide legitimate abortion facilities, compelling many rural women to seek alternatives.

(MORE: World Population Focus on India, Part 1: Sex Education)

It certainly isn’t tough legislation that’s driving women to backstreet abortionists. Indian abortion laws are liberal — the country is one of only 14 that allow abortion on broad grounds. But misunderstandings about the law and conservative social codes that regard pregnancy out of wedlock as abhorrent mean that many women don’t get help. Aparajita Gogoi, head of the Indian operations of a nonprofit working with women and girls in developing countries, says the “lack of information about services” is particularly debilitating for women and families. Doctors sometimes refuse to perform an abortion on a single woman (as one 22-year-old who was raped and impregnated in Maharashtra discovered), even though that is permissible by law, and girls with unwanted pregnancies can be shunned by their families — sometimes, as in the case of this 17-year-old, with tragic consequences. Fear of social ostracism drives many to take risks. Reflecting a trend seen all over urban India, the city of Gurgaon, near Delhi, is seeing a marked rise in cases of adolescent girls seeking abortions at government hospitals but then vanishing when asked to return with their parents. These are the young women who end up in the backstreet clinics.

Public-health experts promote contraception as protection against unintended pregnancies, but it is not easily available in rural areas, and where it is available, in the towns and cities, young Indians are either embarrassed to ask for it or do not know what to ask for. Because of the lack of sex education, ignorance is rife. A majority of young Indians don’t use protection during their first sexual encounter. One report found that while young men and women knew of contraceptives in general, “knowledge of even one modern non-terminal method such as the condom, the IUD, oral contraceptives and emergency contraception” was reported by far fewer. (Tubectomies for women and, to a much lesser extent, vasectomies for men — both procedures are incentivized by the government — remain India’s preferred modes of contraception.) Along with not knowing, studies have found that even married couples are “shy about seeking sexual and reproductive health services.” At the same time, as with any country that is developing rapidly, sexual patterns are changing and premarital sexual activity is increasing. Add to that a lack of contraceptive information and social sanctions, and “a growing incidence of unintended pregnancy and induced abortion” is the inevitable result, says the Guttmacher Institute’s Sedgh.

(MORE: The Issue That Inflamed India)

Globally, too, women are not getting the contraceptives they need. The number of women with an unmet need for family planning is projected to grow from 900 million three years ago to 962 million by 2015. This increase, researchers have noted, will be driven by most developing countries. Studies have shown that 82% of unintended pregnancies in developing countries occur among women “who have an unmet need for modern contraception.” There are some glimmers of hope. A study last year estimated that 272,000 maternal fatalities around the world were prevented by contraceptive use, and that India accounted for nearly a third of the averted deaths. But the fact remains that India is home to the most maternal deaths in the world and that 50% of those fatalities are in the 19- to 24-year-old age group. With these sorts of numbers, sex education, contraception and greater health-care spending are simply desirable. They are moral imperatives.

MORE: In India, Banking on the ‘Morning After’ Pill

29 comments
HarenJoshi
HarenJoshi

I cannot understand this high mortality. Indian government has liberalized the law for abortion.We run a rural tribal charitable institute . We perform free or for one doller , abortion and no question asked . And we have state of art operating rooms and trained gynecologist . What more a country can do. Dr Haren Joshi

PsyloGetti
PsyloGetti

Well, since we turned it into an our issue instead of theirs (As the article was about), I will chime in with the same respect.  We want to cut out abortions and have more underage and unwed mother's having babies, yet we want to cut welfare and food stamps.  I don't know much about having a child when I was horny at 16 or so as a dude, but I do know that I could not afford to sustain myself much less a child at that age.  Pick one or the other.  There is no in between. 

Gipkik
Gipkik

I think it's high time India stopped being a baby factory for the world, period.  And that is from someone who supports freedom of choice.  

BillCarson
BillCarson

Err, are not all abortions unsafe?  I mean, in the U.S., a child in murdered in almost every one of them, right?

sethton
sethton

Terribly sad...but a more accurate headline would be, "Every time someone gets an abortion in India, someone dies.  Sometimes two people die."

Wisconsinmom
Wisconsinmom

Abortion is always unsafe for the fetus! These women need loving support and better education.

PeterFernandes
PeterFernandes

@HarenJoshi Stand for a ban on abortions Doc. Its legalized murder. Another crime is never an answer for a crime.

PsyloGetti
PsyloGetti

@millionelephants Which babies? US babies, right?  We seem to have no problem with eradicating innocent living or prenatal babies in other countries.  I detest the plead for life when most people have no value of it unless it is their own.  

PsyloGetti
PsyloGetti

@Gipkik India is a big place.  A lot of what you are talking about most likely happens in rural areas in which there is no education and no contraception taught to them.  Perhaps we should teach them what the Red states champion... Abstinence...  It's been working so well for us, we should share it with the world.

Gipkik
Gipkik

@BillCarson 

Child?  You're pretty generous with that word, aren't you, bright eyes?

Raindog63
Raindog63

@sethton So let's just keep forcing people to have children they don't want, can't feed, and who will be a further drain on the environment.

OhMyDog
OhMyDog

@Wisconsinmom They need money,  jobs, food, education, contraception, and a safe place to live. Did you not read the article? I don't think you understand the difficult reality these women face. Easy to sit at your computer in Wisconsin and assume they are living *just* like you, with your first world problems.

You try having yet another mouth to feed when you can't feed the ones you already have. Or give birth to the child fathered by someone who raped you. Or bring another child into a world where your in-laws can set you on fire and kill you for whatever reason...and who will likely never be prosecuted. Google "bride burning" if you want to find out more about what women in this area face.

Raindog63
Raindog63

@Wisconsinmom Or how about easier access to birth control, since they obviously don't want the child.

CadeCummins
CadeCummins

I think million elephants meant ALL, as in all human babies which includes indian humans....

BillCarson
BillCarson

@Gipkik @BillCarson      It's sad to see anyone deny another person's humanity, to deny that they even exist.  Think about changing. 

markprassanna238
markprassanna238

My advice to Detroit (or other down-on-luck blue cities), it should bill itself "Abortion (or pro-Choice city as you liberal call it) City of America",

1.  perform for-profit 'No Question Asked" abortions - even for girls as young as 12 yrs old.
2.  combine the "Abortion Tours" trip with casino coupons on the side to the city-owned casinos,
3.  pot (medical one, of course) or alcohol tours - complete with "How to" classes (grow, bake, roll, smoke, avoid fed, local/state/federal laws, etc..)
4.  underage prostitutions (this one seems to be in many blue cities in the US  but few lame-stream media-outlets would say it - espacially when a democrat is in WH) which will drive up no-question asked abortions (the system looping itself),
5.  provide classes on how to be strippers and pole-dancers (again, the system feeding the loop)
6.  also provide classes on "how to unionize so even a bus driver could retire with 80k salary and collect 60% on pension" - and shafting other honest workers who owned property (and pay taxes).

oh.. wait... my bad.  You already doing a lot of these.  Yet

So, my real advice to my "Blue" brothers is "Worry about children who slept hungry in your blue-cities because their parents do not have jobs to feed them - instead of women who cannot get abortions in red states."

PeterFernandes
PeterFernandes

@Raindog63 @sethton You're so lucky bro, your parents didnt think on the same lines. Btw how many of the poor did you yourself reachout and feed?

SarahConfran
SarahConfran

@Raindog63 @markprassanna238 unions arent the only reason why Massachusetts and Connecticut (and my state of new jersey which is almost always in the top 3 for highest average household income) are richer than a lot of red states. Blue states invest more in education the five states that spent the most per person on education were all blue states (and dc) except for alaska but that is most likely due to very costly transportation to and from school. The five states that spent the least were red states. (http://www.takepart.com/photos/education-rankings-census-per-pupil-spending-state/what-is-education-worth-to-your-state) Spending more on education doesn't automatically mean better schools but shows that local people put education at a premium. The parents in these states also often expect children to go to college (a large factor into average income). It's also about cost of living. In nyc, nj (the most densely populated state) and ct land is at a premium. the cost of living is much higher in these states than in rural areas. 

markprassanna238
markprassanna238

Raindog

You brought up pretty fair and balaned view points.  And a lot of it are valid and so I agreed with many points you made - especially economy in blue/red. 
But let me stay with "THE" topic that startted our discussion - abortion.  Else, it would be pages long.  I agreed that  some types of abortion should be made available to the public - though i still personally oppose them (ie.. refrain from personally using it, or try utmost to not get into using it).  I also agreed that allowance of various types of contraceptives is needed also.

But, I oppose two things that your "Blue" brothers and sisters are doing (1) Late Term Abortion (or IDX as you Blue folks call it), and (2) State/School Bypassing Parents.  I'll discuss only the first one.

1.  Late Term Abortion
======================
I vehemently opposed allowing of late-term abortions where the fetus can survive/live with some care.  In fact, a good majority of Americans (and non-Americans alike) agreed that late-term abortions should be banned.  However, it is some of your "Blue" brothers and sisters that are going against the majority opinion in this particular form of abortion.  So who are the extremists now?

In fact, as you may know, in some of the 'Blue' circles, an idea is floated that a mother (and her doctors) should be legally allowed to end the life of a baby until the baby is up to certain # of days (four when it was initially proposed but I don't know what it is now).  The supporters are claiming that the idea is just an "Academic" discussion.  To me, however, we already have ample proof of this idea being put into practice in some of late-term procedure sessions.  I'm not sure if you believe in God and Devil.  But I do.  I truly believe that this late-term procedure is evil.   As for the said "Academic idea",  it is "undoubtedly" evil if its put into practice.

Now, please allow me to throw an scenario to your way - with a twist on your "Mother Centric" approach.  As your side throw an "Academic" discussion, I shall throw one also. 

Assume that a couple decides to go thru with IDX.  The mother passed away with complication during the procedure.  And the baby came out all the way alive - unintentionally.  Now, the mother is out of the picture, and the father was there in the room.  Should her doctors, now that the mother has passed away, be allowed to continue fulfilling her "Mission"? 

Now, should that father be allowed to do what he pleases with the fetus - as only it is a few minutes old (way less than 4 hours)?  Can he order the doctors to keep the baby alive?  Or continue with original intent of the mother?

Now, replace the father with guardians, grand-parents, parents, state CPS workers, friends, teachers, judges, etc...    Then tell me, who among them should be allowed to decide if that few-minutes old baby (or fetus who is outside the body) stay alive or not?

You can respond to me at MarkPrassanna238@gmail.com.

Raindog63
Raindog63

@markprassanna238 

Hi Mark, (can I call you Mark?) 

You continue to act as if blue cities are somehow unique as far as these social problems are concerned simply because you are biased against them.  Yet, if you want to talk about Meth, it is a huge problem in many poor, rural areas throughout the country, as are many of the other socio-economic problems you point out.  They are more concentrated in some cities because, well, they are cities, and by definition, have lots more people.  Again, the problems are not unique to cities, only magnified.  

Yet it is also obvious that many blue cities have more to offer than a typical small "red" town, which is why so many people from red states go visit places like NYC, San Fran, Boston, etc.  And although you are right that it is typically much more expensive to live in blue cities, and while poverty certainly exists in those cities, it is also true that poverty, not just low wages, is also a huge problem in many red states, even though it is less expensive to live there.  

Again, just look at the rural poverty that still exists in much of the deep south, as well as in the southwest and in the Appalachian hollows that typically vote conservative.  It can be argued that these states and localities are balancing their budgets on the backs of the less fortunate.  Which begs the question, then what are those governments for, and whom do they serve?  This isn't an appeal for what some call "handouts," but it is notable that those red states / towns that don't adequately invest in their people (through public education, for example), are incubating a permanent underclass that will eventually incur future, and otherwise avoidable, increased costs in law enforcement, drug rehab, etc.  Restricting the right of these citizens access to abortion certainly won't have a positive effect on the outcome, but, through child neglect / abuse, for example, it may exacerbate already existing challenges.

Finally, every state and city in America has its own unique economic challenges.  Detroit is not Chicago, San Fran, Boston, or New York.  Nor is it Pickens, SC, or Winchester, VA.  Some will continue to be well-run, and others will fail, whether they are red or blue.  As for asking the Feds for a bailout, well, red states take in more money from the federal govt. than they return to Washington, (Texas leads the way here) so if you took that federal money away, many a red state would be in deep financial trouble.  

As far as abortion is concerned, while it is true that there are many factors other than abortion that affect population growth, it is also true that A) Many of the same people who oppose abortion also oppose any form of family planning or contraception at all (see the Catholic Church's policies in impoverished nations)  and B) Whether or not abortion is illegal, it will continue to exist and persist, but by keeping it illegal, and making it go "underground," we are condemning large numbers of women to unsafe abortions for no other reason than that some people choose to impose their own religious beliefs on others.  ALL forms of family planning should be made available to all women who want it, because to do otherwise is to impose a control over their freedom that is both disrespectful of their ability to make choices for themselves, as well as unnecessarily dangerous to their health and well-being.  

Take care, 

Bill


markprassanna238
markprassanna238

1)  Connecting "Restriction of abortion" with more mouths to feed is not correct argument.  For example, if that argument is true, Bangladesh (a conservative Muslim country) would have increasing # of birth per family, and it is not the case.

"More mouths to feed" depends on a lot of things - not just access to abortion or lack of.

2)  If you don't get what I'm saying about pot and alcohol, I'm not saying "One cannot enjoy" them.  But you cannot make them as a part of your economic and social strategy - to increase tax base and/or to decrease crime. Even the Dutch are NOW restricting access to pots.  You used to hear "The dutch have no problems, or the Portuegse have no problems."  You don't hear that lately now because when they look at the whole picture (or legalization and taxing), it is more trouble than worth.

3) US has the second highest # of underage prostitutes in the world - after India.  And a large chunk of these underage prostitutes are in cities across California, and in cities that are firmly in control of your fellow "Blue" brothers.  Your blue brothers are turning the blind eyes - just giving lip-service. 

4)  http://www.cnbc.com/id/48058145/page/1.  While the income is not good, SC is not also the most expensive place to live.  My sister rents 2-bd room apt near Boston, and the rent is $1450 (about 8 business-days worth of her take-home salary).  Plus she has to pay other fees.  I choose West Virginia or Alabama or S Carolina over living in Boston any day.  So just looking at "Pay" alone is not very accurate.  Please take into consideration other "Quality of Life" items.

5)  Yes, there are many blue cities and towns that are quite good.  But please check their finances and their policies.  Many of these "good" blue towns/cities will have to follow Detroit's steps to get out of their unsustainable life style/commitments.  Just wait and see.  Even your vaunted San Francisco will be in trouble (finance wise) soon.  But of course, you can always ask feds to continue funding your spend-happy Blue brothers and sisters.  I doubt even Obama would agree to bail one out (if he bails one out, he has to bail out many others).

Again, I say for you to worry about feeding children who goes hungry during evenings and weekends - rather than worrying about women who cannot have abortion easily. 

Besides, something illegal does not mean that the products or services are unsafe or unavailable.  You should know - as blue cities are epicenters of good quality meth, coke, pots, underage prostitutes, illegal arms, illegal cigarettes (as in smuggled and tax-unpaid), illegal (but succressful) practice of trading SNAP for cash, etc...;-)

Raindog63
Raindog63

@markprassanna238   

1)  If you restrict abortion rights, you will have even more children who will go to bed hungry because there will be more mouths to feed among people who are least able to feed them.

2)  I know many libertarian Republicans who want to legalize marijuana, all across America (not just in the blue states), and as for alcohol, well, Southerners seem to enjoy their fare share from what I've seen.

3)  Underage prostitution doesn't exist in the red states?  Sure, buddy.  Also, there's a strip-club about eight miles from my home here in Greenville, SC, complete with pole-dancers and strippers, named LUST.  Southerners are so creative.  Oh, and pornography usage is actually higher in the South than it is in the blue states.  

4)  There are no unions down here in this red state in which I live, and, as a result, our household income ranks 41st in the nation.  Meanwhile, up in CT, Mass, and N.Y., where they do have unions, household income is among the highest in the country.  

5)  There are many blue cities and towns where life is quite good, and many hell-holes in the south where life absolutely sucks.  Fortunately, I don't live in one of those hell-holes.

And just for the hell of it, why do conservatives in red states go on and on about the evils of government intruding itself into people's lives, restricting our freedoms and our liberties, then pass legislation restricting women's reproductive choices?  Are women not citizens, too?  Do they need to be protected from themselves by a paternalistic government that knows what's best for them?  Do you even see the hypocrisy within your conservative ideology?  

Raindog63
Raindog63

@PeterFernandes @Raindog63 @sethton If they hadn't had me, I'd never know the difference.  Also, I've volunteered in soup kitchens, given money to Catholic Charities, and would like to see a greater portion of my tax dollars go to those who need it most, vs. Exxon and the Pentagon.