India is a developing country that is full of contrasts that become obvious through socioeconomic and cultural disparities. Currently, the country is in the state of transition because, on the one hand, the prevalence of poverty and number of people living in poverty, struggling to survive is horrific, and, on the other hand, the country currently experiences significant economic development and progress (Narain, 2016). Therefore, people face the following challenges that are directly associated with health care. Income disparity and inequality between the representatives of the different socioeconomic classes are correlated with the adverse health outcomes for those who have no money to pay for health care. Besides, the unprecedented demographic growth will soon result in the enormous increase of the Indian workforce, but that workforce is likely to be less efficient than the current one because of the diseases and undernutrition of mother during pregnancy are likely to bring the workforce down in its health status. Finally, there is a huge challenge with the infant mortality and maternal mortality, comprising up to 40 incidents per 1,000 live births (Narain, 2016), meaning that India lacks appropriate conditions, experts, and services to ensure an adequate level of patient safety.
One of the biggest challenges for India is with abortions because a large percentile of them is provided outside the healthcare facility, suggesting that up to 32% of all abortions are completed in the health facilities (Singh et al., 2018). The risk factors and causes of the growing number of abortions, especially the growth of the illegal abortions, are associated with the prevalence of poverty, lack of housing and nutrition, and inability to support the child from the first minutes of birth. Besides, couples have no funds for contraception, meaning that women frequently get pregnant and have to risk their lives by undergoing an abortion at the informal-sector providers (Singh et al., 2018). The consequences of such health choices are the insufficient patient safety during and after the abortion procedure completed with the medical methods of abortion (MMA), incomplete or unsuccessful MMA abortion due to the lack of efficient and correct administration of medication for the abortion procedure. Finally, the consequences of abortion can be fatal for the woman, or it might also result in her inability to have children.
Based on the analysis of the data that came from the 6 out of the 29 states of India, the prevalence of the non-healthcare facility MMA abortions is within the range of 63-83% out of 100% of all abortions made by the Indian females (Singh et al., 2018). Besides, based on the statistical data from across India, the combination of misoprostol and mifepristone for MMA is used in 4 out of 5 abortions, making MMA equal 81% as a distribution method, whereas surgical abortions are for 14% only, and 5% of abortions are done in some other way (Guttmacher Institute, 2017). The prevalence of non-facility abortions is explained by the high out-of-pocket payments, the rates for which are within the 85.6% highest expenditures across the globe (Narain, 2016).
Pregnant women in India, especially those who represent the poor parts of Indian population unable to pay for their medical coverage and out-of-pocket expenses, have to get more adequate and accessible induced abortions with consideration of all correlated circumstances. Within the next 10 years, I expect to see the changes in legal regulations as for the judicial authorization for abortion for the rape victims, especially if they are under 18 years old (Center for Reproductive Rights, 2019), and enhanced accessibility of abortions in medical facilities due to the payment rates reduced by 30-50%. The identified changes in legal regulations should occur within 1 year, whereas the modification of price rates should occur in 2 years.
- Center for Reproductive Rights. (2019, Apr. 18). It’s time to end judicial authorization for abortion in India. Retrieved from https://reproductiverights.org/story/time-to-end-judicial-authorization-for-abortion-in-india
- Guttmacher Institute. (2017). National estimate of abortion in India released. Retrieved from https://www.guttmacher.org/news-release/2017/national-estimate-abortion-india-released
- Narain, J. P. (2016). Public health challenges in India: Seizing the opportunities. Indian Journal of Community Medicine, 41(2), 85-88. doi: 10.4103/0970-0218.177507
- Singh, S., Hussain, R., Shekhar, C., Acharya, R., Moore, A. M., Stillman, M., Frost, J. J., … Ball, H. (2018). Abortion and unintended pregnancy in six Indian states: findings and implications for policies and programs. Guttmacher Institute. Retrieved from https://www.guttmacher.org/report/abortion-unintended-pregnancy-six-states-india