Women's Abortion Needs and Practices in Rural Maharashtra

How do women perceive the issue of abortion? What are their abortion needs? What standards of abortion care do they expect? What are their concerns when choosing abortion service providers? What are the complex dynamics involved in decision-making on abortion? How much do women know about the Medical Termination of Pregnancy (MTP) Act? Even 25 years after the implementation of the MTP we have very little understanding of abortion issue from this perspective. Most of the earlier research on abortion focused on the interests and motivations of policy-makers, doctors and demographers. Women were simply not in the picture. To understand politics of abortion and to place abortion in the larger context of women's rights to determine their own sexuality, fertility and reproduction are very important. This project emerged from this need. A qualitative study to understand abortion from women's perspective was carried out in the villages of Pune district using qualitative methodology. The study revealed that -

• Women were poorly informed about the abortion legislation. Besides, the MTP Act does not provide right to abortion, but essentially liberalises use of medical technology for termination of pregnancy in certain conditions. Thus, women do have to give reasons for seeking abortion. This complicates women's real life problems and the moral dilemmas, for often abortion was neither desirable nor dispensable. Often, women approached the issue of abortion tentatively, with some guilt and as something that is necessary to bail them out of a no-choice situation.
• Various factors have an impact on women's role in abortion decision making. They are: their status in the family, fertility history, number of sons she has had, her husband's status (including his economic capacity) in the family, the relationship between spouses, relationship with in-laws, etc.
• Women's sexuality was disregarded, denied or suspected. The abortion decision that women may take in these situations though appear liberating, but were in fact reflections of women not having any space. As a result, they resorted to clandestine abortions, indicating the reduced bargaining power in negotiating their sexuality.
• Use of contraception and undergoing sterilisation has its own complex dynamics, once again woven with sexuality and unequal spousal power relationship, in favour of men. Men do not allow their wives to use contraception, fearing the latter's promiscuity. Men do not undergo sterilisation perhaps to keep their reproductive options open at all times. Wives refuse to consent to tubectomy out of fear of their husband. Since, the husband (if the family too desires) could get another woman under the pretext that she was not able to produce any children.

These complexities in decision making suggested that there is need to increase space for women to negotiate their sexual and reproductive rights within and outside the family. She needs to have back-up support through legislation and social activism. Enhancing women's role in decision making in other aspects of their lives, including that related to marriage, is an important pre-requisite to making women more assertive about their reproductive rights. Empowering women in all aspects of life, within a marriage or otherwise, is essential if we wish to increase women's role in decision-making in the area of reproduction and sexuality.

This study indicated that women are far from happy with the existing abortion services. They are upset that doctors demand their husbands' approval before performing an abortion and that government services pressurise them to accept an IUD after abortion. They are upset that doctors in the private sector take advantage of their situation and charge unreasonably high fees. They resent having to pay for health services in the private sector because the Primary Health Centre is inadequate or indifferent to their needs. They would like easier physical and economic access to abortion services.

Supported by: The Ford Foundation,New Delhi Research Team:Manisha Gupte, Sunita Bandewar and Hemlata Pisal