Although the 1971 Medical Termination of Pregnancy Act (MTP), allows abortion access with some regulations, there are still many misconceptions, taboos, and various socio-cultural concerns shrouding abortion in India. The lack of bodily autonomy and the taboo around premarital sex are some hindrances that prevent many abortion seekers from accessing safe abortion facilities. Fear of judgment, lack of confidentiality from service providers, and lack of clarity on the law influence young abortion seekers to opt for unsafe methods of abortion, which often involve fatal health risks and high costs.
We already knew anecdotally that young people are being turned away from abortion services.
Unmarried young women are particularly at risk of judgement from service providers and risk getting outcasted due to the ‘shame’ they bring onto their families. The existing challenges especially for people belonging to marginalised and underserved communities are manifold. Knowing the prevailing situation in the abortion landscape in India, the Safe Abortion For Everyone (SAFE) Fellowship led by The YP Foundation was conceptualised to equip young people with evidence-based and factually accurate information on safe abortion.
10 young people from different social locations, across seven states, were selected for the fellowship. An immersive fellowship model was designed where fellows initially undertook an online course to get a rights-based and factual understanding of the abortion discourse in India. After the training workshops, the fellows engaged in evidence generation that is grounded in their lived experiences. They identified and assessed gaps in service delivery, providers’ attitudes, and accessibility of abortion services through a social audit of abortion facilities in their respective districts.
To actually gauge the experience of young abortion seekers, the Mystery Client Methodology was used – a form of participatory research that is used to assess service delivery in health facilities. Here, some fellows posed as married individuals, others as unmarried, either alone or accompanied by a male or female companion. They used varied combinations to assess provider bias in different situations.
Our audit showed that young people are still facing prejudice when they seek abortion care in India.
Based on the evidence generated through the audits in their respective districts across seven states, the 10 young fellows arrived at some key observations:
- Service providers and staff engaged in unethical practices in some facilities. For example, a private hospital referred one of the auditors to an unregistered facility that offered to perform an abortion using vacuum aspiration in secrecy for an exorbitant amount.
- Abortion services had no regulated pricing, and the cost be up to INR 12,000 (which is approximately $150 USD).
- Service providers imposed value judgments on pre-marital sex and had moralistic perspectives on abortion. For instance, in a private facility, the service provider tried to conduct a two-finger test – which was banned by the Supreme Court of India in 2013 – on an unmarried researcher. In another case, the service provider insisted on parental consent for performing the abortion on an adult.
- There was a clear gender-based disparity based on whether the abortion seeker was accompanied by a male spouse or boyfriend or by a sister or female friend. If the companion was the abortion seeker’s romantic partner, service providers and supporting staff were cordial, but in some cases also morally policed the couple to be “responsible adults”. In the latter case however, it was felt that the staff were likely to be inhospitable, intimidating, and unsympathetic.
- Confidentiality and privacy was breached, mostly in government hospitals where two separate patients were made to come into the consultation room together.
- One auditor posing from a marginalised caste and class location was denied the service on the grounds of inability to provide a referral from the local dispensary. Such mechanisms and bureaucratic ways put the anonymity of the abortion seeker at risk and further discourage marginalised people from availing safe healthcare services.
Based on the findings of the audit, the fellows were able to formulate some important recommendations to improve the youth-friendliness of abortion clinics and make safe abortion accessible for all.
These recommendations focus on upholding a rights-based approach with a key emphasis on maintaining the confidentiality and the client’s autonomy, providing informed consent, sensitive communication, and providing the abortion seeker with comprehensive information among others.
To find out more, you can read our full report here: https://theypfoundation.org/resources/assessing-youth-friendliness-of-abortion-services/
By Sunanya Deka, The YP Foundation