How Stigma, Lack Of Awareness Endanger Women Seeking Abortions

So Kruti went to Sanjay Gandhi Memorial Hospital, a Delhi-government-run hospital in North West Delhi. “When I met the doctor and told her I wanted an abortion, she shouted at me: ‘How many kids will you produce? Don't you ever think about the future?’ Badtameezi se baat karte hai. (They speak very rudely),” said Kruti, whose name has been changed to protect her privacy. Her voice trailed off as she could not bear to mention everything the doctor said.

Kruti said she was given a run-around in the busy, crowded hospital for four days over a couple of weeks. She spent days undergoing blood tests, an ultrasound test, and collecting the reports, for which she came to the hospital several times. She said that it was hard to leave her young kids at home and come to the hospital constantly, as there is nobody to take care of them.

She was already two-and-a-half months pregnant, and felt that she was running out of time. “Not once did I get an assurance from the doctor that I will get an abortion,” Kruti said.

The Medical Termination of Pregnancy Act, 2021 allows abortion up to 20 weeks of pregnancy for most women--that is about five months--and till 24 weeks of pregnancy for certain categories of women such as those whose marital status has changed, rape victims, disabled women, or minors, among a few others.

This correspondent heard stories of denial of services, active discouragement, or prohibitively steep abortion fees from women and stakeholders from four states, including parts of Uttar Pradesh, Delhi, Chhattisgarh and Rajasthan. This results in women going from doctor to doctor. This is the first in a four-part series on abortion access in the country.

Conversations about abortion in the public sphere, especially in the Supreme Court, miss the nuances of what women go through while looking for abortion services--often placing the responsibility squarely on the women for seeking “late abortion”. In one of the cases of “later abortion of 26 weeks of pregnancy”, the former Chief Justice of India D.Y. Chandrachud asked what the major, married woman who already had two children was doing for 26 weeks.

We spoke briefly to Vandana Bagga, Director of Delhi government’s Directorate of Family Welfare, who said that there are regular training sessions with both public and private doctors about respectful maternal care and comprehensive abortion care, and that the government has a “no refusal” policy for any service.

Kruti’s experience compelled her to seek private doctors. But her husband found out that it would cost them at least Rs 15,000, which was unaffordable for them. Then she contacted Gayatri, an ASHA worker in her area who took her to Parivar Seva Sanstha clinic in Rohini.

Parivar Seva Sanstha is a non-profit which provides safe reproductive health services at affordable cost--this includes abortion, contraception, as well as sterilisation services. Organisations such as Parivar Seva Sangh have also roped in these ASHA workers to tell the community about their facilities.

Kruti got her abortion towards the end of February and got a sterilisation surgery done in the same clinic in March.

Respectful, non-judgemental abortion care

As per the Comprehensive Abortion Care Training and Service guidelines, service providers are advised to counsel the women seeking abortion while maintaining their privacy and confidentiality, and being respectful and non judgemental. It says that doctors should assure these women that they will not be refused abortion services.

However, multiple visits to the hospital act as a deterrent for the woman seeking abortion. It does not inspire confidence that they can get abortion done. Gayatri, the Delhi ASHA worker, said that women have to go through several rounds to these hospitals, which only very poor women endure. Gayatri said that she has seen doctors and other staff in public hospitals hurl the choicest abuses at women seeking abortion.

“I have seen the hospital staff slapping these women and asking, ‘You were having fun at the time, now why do you have pain while we place an instrument inside you?’ I have seen even sweepers talk like this to women. The women (seeking abortion) women are so helpless as they do not have money,” said Gayatri.

She has herself undergone abortion at Parivar Seva Sanstha more than a decade ago. Even though she is an ASHA worker with some understanding of how public hospitals function, she said she would not dream of going for abortion in one.

“I cannot even think about going to a public hospital for abortion. Ek roti kam kha lungi par waha nahi karvaungi (I will eat less [to save money for private care], but will not get the procedure there),” said Gayatri.

Source: Comprehensive Abortion Care Training and Service guidelines

This reporter reached out to a senior gynaecologist from Sanjay Gandhi Memorial Hospital. She did not want to be on the record, but answered my queries. The gynaecologist said that the biggest problem in the hospital is that there is a severe shortage of doctors, and the patient burden is very high: Doctors perform about 50-60 deliveries per day. She said, “Being a government hospital has its limitations.” She explained that since abortion is not an “emergency procedure” (unless a woman has post-abortion complications of heavy bleeding) they may have deferred abortion in some cases due to heavy workload. She admitted that staff may lack “soft skills”, owing to the heavy case burden.

Soft skills in medicine refers to an ability to communicate with patients in respectful, non-threatening, non-judgemental, empathetic manner. The doctor said that the fact that each doctor in her hospital is attending to nearly 300 patients per day, makes it difficult to give enough time to each patient.

Abortion is legal, but awareness is low

When Saraswati Sahu wanted to get an abortion around 2003, she did not dare to go to a hospital for it.

“I used to think abortion is illegal. That is why I was secretly taking abortion pills from chemists,” said Sahu, who is a leader with Chhattisgarh Mahila Mukti Morcha that works for the rights of women workers. One major reason why she felt abortions are illegal is because of the bombardment of advertisements and posters related to brun hatya (foeticide) being a sin. She had two girls, and felt that she would be particularly accused for sex selection if she went through an abortion at a public health insitution.

Sahu, who is 40 years old now, took abortion pills four times, before her husband underwent sterilisation procedure in 2017.

“People still think abortion is illegal. And that it's a sin. People are living in this confusion. The government also does not publicise about abortion--that women can seek abortion legally,” Sahu said.

Studies conducted in Bihar, Jharkhand, Assam and Madhya Pradesh show that less than 40% of women are aware about abortion and its legality.

Social conservatism about abortion

Considering that stigma is a barrier for abortion, IPAS did a large survey exploring opinions and attitudes about abortion. A survey released in September 2024 showed that while a majority (approximately 70%) of 13,000 people surveyed supported abortion, the support dipped when it came to unmarried women, especially among young people between 18-24 years to 61%. Only 29% of people felt that women should have bodily autonomy.

Manning said that they did not expect that young people would be less liberal than older people.

“People (as per the survey) are saying we want abortion only if the men or the doctors decide, but not women. And interestingly, in India, law allows women to make the decision, but society doesn't seem to be ready to let women make the decisions,” said Manning.

Sahu said that the government has little incentive to provide abortions, as they will be a greater burden on their public health system and that is why the health systems hold back on offering women more freedoms.

“If women come for abortion openly, there will be crowds in the government hospitals. If abortion is available freely then women will know that they can have sex freely. In a caste society, women will remain oppressed and subjugated. It is about controlling the freedom of women,” said Sahu.

This story was supported by the Pulitzer Center.

We welcome feedback. Please write to respond@indiaspend.org. We reserve the right to edit responses for language and grammar.