FYI 16th October, 2020

How Nurses And Midwives Make Abortions Safer In India.

India, the second most populated country globally with a 1,300,000,000 population and 18.2 births/1000 population, has been a country where abortion has been legal under certain conditions for almost the last five decades.

Abortion is a complicated term in Indian society. It is entirely challenging for women to seek abortion for various reasons: lack of knowledge, stereotypical thinking, judgmental culture, personal beliefs, and criticism. The question: ‘what will people sayis the driving force behind the stigma.  

But even those who seek abortion after overcoming all the challenges and difficulties find secure and affordable abortion to be an elusive prospect. India’s maternal mortality rate is declining at a double pace compared to the global rate, and the Indian government aims to bring it low by the end of 2020.

Unsafe abortions are the third leading cause of maternal deaths in India. This death rate contributes to 8% of all such deaths annually

Abortion Cases in India – Insights

According to Ipas Development Foundation, India has an estimated 15.6 million abortions every year. The actual number is likely higher than the mentioned number, and this is due to several reasons.

There is a significant pregnancy occurrence rate in India, which is 48.1 million pregnancies, and out of that almost half are unintended pregnancies. Unsafe abortions are the third largest reason for maternal morbidity leading to a death rate of 10 women per day. 

There is a problem in developing countries, and that is the legal status of abortion. In most countries, abortion is restricted by law and due to that people find alternate ways to abort the child, which make the whole process complicated and results in unsafe abortions and maternal deaths. 

Another problem is the unsafe abortions of women living in rural areas. We estimate that around three-fourths of the total population of Indian women live in rural areas. But the majority of hospitals and healthcare sectors are in urban areas. 

That is why women in rural areas undergo great risks while aborting the child or even while giving birth, due to the lack of training of medical personnel treating them.

Inadequate & Unsafe Healthcare System  

The main problem is that the Indian healthcare sector faces an acute shortage of healthcare workers and the healthcare network is inadequate all over the country.  

The developed hospitals are limited to cities, making it challenging to cater to the needs of women living in rural areas. Women in rural areas have to rely on PHCs (Primary Health Centers) but these centers have only one doctor per center, which makes it next to impossible to meet every person’s needs. These primary health centers are also filled with untrained nurses and midwives who do not have the hands-on experience and adequate knowledge to administer safe abortion.

According to the Ministry of Health and Family Welfare, Government of India, 87% of the abortions are performed in the first trimester. It is mandatory for such abortions to happen under medical supervision. But, in most cases, these protocols are not followed, which results in unsafe abortions. The WHO has stated that healthcare workers’ role in providing safe abortion care, and post-abortion contraception is paramount. Furthermore, making safe abortions is an increasingly important public health strategy. 

Practices of Abortion in India by Nurses and Midwives 

According to The Hindu, 25% of pregnancies are unwanted – it may be unintentional or lack of awareness, causing teenage pregnancy. Certain families do not consider facility centers as safe for abortions as there are high chances of maternal deaths. This is a point of view from the family’s perspective. 

But the recent developments and steps taken by nurses and midwives have altered the scenarios to a great level. Human life is of great importance for nurses and midwives.

Nurses and midwives in India are trying their level best to ensure safe abortions for women with post-abortion care. With the timely actions taken by great, well-versed, and adequate nurses, safe abortions are sure to be conducted. 

  • Nurses and midwives are often seen providing services at a lower cost to make it affordable to all backgrounds.  
  • They are practiced and have technical expertise, which ensures abortion with great extensive and intensive care.
  • They do not compromise on the quality and level of provided service. 
  • Nurses and midwives in different parts of the world, including India, can carry abortions in the first three months considering the health safety and other measures. 
  • In India, nurses and midwives can safely conduct abortion using vacuum aspiration, i.e., (VA) or other medical methods.
  • The best practice conducted is to examine the patient and health status. After examining, the uses of methods are determined. 
  • Taking pills in the early pregnancy to abort the unborn child is not recommended or practiced by these nurses and midwives. Drugs can only be accepted if recommended by the doctor.
  • They are keen on providing effective support, supervision, and proper oversight. 
  • All the mid-level nurses and midwives provide abortion facilities aligned with national standards and guidelines.

Ensure that Mother is the Decision Making Authority

There are tons of cases in which mothers are forced to undergo abortion and give-up their child just because of some vain perceptions. 

For example, the father did not want the child, so the mother must abort the child. Sometimes, the lust and desire for another boy are drivers to the decision to abort, or some people prefer giving up the girl and undergo an abortion, etc. and in many cases, to hide the malicious act by two committed in the past, mothers have to abort the child to save the family’s honor. 

But not anymore, the mother’s decision is paramount, and it is a mother who will give birth to the child, and for that, her decision is crucial. But no woman can be forced to abort the child if she hasn’t contended.  

In India, some laws and provisions must be followed. According to the Medical Termination of Pregnancies Act 1971, Section 3 (2) {i & ii}, the unborn child can be aborted within 20 weeks. However, it could be done after 20 weeks only if there is some serious injury or mental health problem with the child. All this must be done with the mother’s consent.

New Human Centric Abortion Law in India 

Laws and legislations have been in action since 1971. But in January 2020, the Union Cabinet amended the 1971 Medical Termination of Pregnancy (MTP) Act, which allowed women to undergo and have abortions as part of reproductive rights and gender injustice.

This amendment in the law was also made to give strength to women’s decisions. The amendment is the 1971 (MTP) Act, which has raised the limit for abortion from 20-24 weeks for surviving women, including rape survivors, differently-abled, minors, and domestic violence victims.  

Future of Maternal Healthcare System in India

The process of abortion in India has been made secure for the last two decades. Technologies have been advanced in every walk of life. The same goes for the advancements in abortion processes.

There have been technologies developed like vacuum aspiration and medical abortion, which ensures maternal mortality. According to Vinoj Manning, the Country Director of the Ipas Development Foundation (IDF) India, the developments and advancements are being made to match the world’s standardized structures and patterns.

With proper training and top-quality instruments, abortion can be carried out safely in India, as happening in other developed nations. The training is quite useful in other countries as well. 

For example, Nepal is a neighboring country with almost the same conditions, such as social and economic grounds and the same healthcare infrastructure providing extensive training to nurses and midwives of abortion services. 

Considering the increasing demand for healthcare, the nurses are encouraged to pursue higher education so that they can be promoted to more prominent roles. For this reason, many nursing students are opting for Master Thesis UK services to fulfill their job duties while continuing advanced education. 

Final Thoughts

Abortion has to be less strenuous, followed with a lot of encouragement and motivation. The taboo created around the word must be eliminated, and there must be laws to support those who wish to avail abortion safely.  

Nurses and midwives are applying all the safety measures in order to carry out abortion safely. Newly recruited nurses must be trained and practiced so that no life goes in jeopardy.



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