“Why blame the govt. for enforcing rules when the fault is yours?”

Regulation on OTC sale of abortion pills in Tamil Nadu leads to a discussion on the freedom to choose, problems of self-medication and the path ahead.

Meghana Kurup and Shivani Ramakrishnan

Chennai, February 28, 2019: The recent attempt by the Tamil Nadu government to strictly enforce the ban on over the counter sale of abortion pills has sparked off a debate in the state.

Though most doctors and even some officials at  the state  Directorate of Drug Control (DDC) were not clear about when the government banned OTC sale of abortion pills, a recent report in The Hindu has brought this to the foreground.

 

Office of the Directorate of Drug Control (DDC) located at DMS DMRHS, Anna Salai.

The report had said that the government had extended the ban on OTC sale of emergency contraceptives pills (ECPs) imposed in 2006 to abortion pills also.

The decision has come under much scrutiny given the abortion laws in India.

Abortions in India are legal up to 12 weeks of gestation and up to 20 weeks for severe cases. It is prescribed only in four scenarios – in case of rapes, high risk pregnancies (mother is weak), anomalies in the baby and failure of contraceptives used by a married woman or her husband (MTP Act, 1971).

But access to abortion pills, to many, meant the ability to make choices without the interference of a medical practitioner.

People in Tamil Nadu have responded to the decision by filing petitions to challenge the order, with many describing it as a ‘hurdle’ in their ‘right to choose’.

“What youngsters must understand is that this is not a ban, it is merely a regulation that we have enforced to ensure that ECPs and abortion pills are not misused by the public. Calling it a ban portrays the government as the bad guys,” asserted the senior official in the DDC who wished to remain anonymous.

According to Dr. Manu Lakshmi from T Nagar’s Gunasekaran Hospital (commonly known as the Chennai Abortion Clinic), there are two kinds of pregnancies once a woman conceives – uterine pregnancy and ectopic pregnancy.

Gunasekaran Hospital in T Nagar carries out atleast 30 abortions a months, most of them being teenage pregnancies.

“Before taking abortion pills, a patient has to be scanned to determine the kind of pregnancy before starting the course of the pills. When women do not understand the difference between the two and self-medicate themselves, it can result in continuous bleeding and death,” said Dr. Manu.

Dr. Surya, Medical Supervisor (MS) for Obstetrics and Gynaecology (OG) at the Government Kilpauk Medical College and Hospital (KMC) added that women who took pills OTC and overdosed ended up having anaemia, cardiac arrest and eventually death, medically known as Hypovolemic shock (lack of blood circulation in the body).

“Sometimes, certain components of the pill remain in the uterus and result in sepsis. The patients then go into shock and saving the patient turns into a battle against death,”she said.

But several consumers are ignorant of these aspects of the pill.

Srilatha* who works as a domestic help said that the pills were convenient as it did not need her to go to the doctor. “I ate it and then I bled. That was it.”

The side effects were many, she said, but nothing she could not deal with.

When told that wrongful consumption could lead to death she insists that ‘the doctors say these things to scare us.’

“I have had many but nothing has happened to me. I may have vomited and even fainted once or twice but that is part of being a woman,” she added.

Doctors say that it is this attitude among people that can cause the drug to be a real killer.

“There is absolutely no sense of awareness. There are a few rare cases where the women do not bleed. These women panic and assume that they are still pregnant, take more pills and further damage their reproductive health,” said Dr. Gopinath, Regional Health Officer (RHO) at the Tamil Nadu Health and Family Welfare Department.

There also exists a deep rooted misconception that the morning after pill and an abortion pill are the same. One prevents a pregnancy, another terminates it, and the pills cannot be consumed interchangeably. When you do that it leads to a mountain of other issues,” Dr. Surya said.

The extent of misconceptions is evident from a mere search online. A search on abortion pills on popular online shopping platforms like Amazon throws up a variety of morning after pills at very cheap rates.

A search on Amazon shows the different kinds of pills that are offered online as ECPs, thus resulting in the confusion between I-pills and abortion pills.

“Very few people are aware of the difference even among the educated. These pills are supposed to be banned. It is a shame that they are available online without even a prescription and proper guidelines,” Dr. Surya added.

Both, doctors and pharmacists have agreed that the bans were instituted as a result of intake of the pills without medical supervision, primarily by educated women and those belonging to the Information Technology (IT) sector.

“Why do people even need to resort to unprotected intercourse in the first place? You are educated, you know about the different methods of contraception that are available and you know you do not want a child. Then why do you blame the government for enforcing rules when the fault is yours?” questioned the Deputy Director from the DDC.

Lahari Nagasai, an IT employee said, “While I understand the government’s need to regulate the usage of the pills, one also needs to understand while they were being so sought after in the first place. While are people so hesitant to go through the proper channel for abortion? The huge stigma around premarital sex is such that just going to the hospital for an abortion is met with so much judgement.”

“I agree that there may be stigma but that is not an excuse to self-medicate. We are here to help you. And just because it has not affected you once does not mean that it won’t cause harm to you the second time,” countered Dr.Surya.

Doctors and staff at the DDC assert that the sale of these pills online is illegal and it is impossible to procure them online. However, a search on Amazon yields results like the above. How effective is the ban?

“We have all heard of stories of cousins and friends who have popped two pills in the hope of better chances of avoiding pregnancy and frankly, most of us thought it (the two types of pills) worked the same way. I feel what we need to go a few steps backwards and improve the way the country handles sex education. May be we won’t then have to ban something to ensure that it will be used appropriately,” Lahari said.

This view is echoed by Dr. Gopinath who said, “For the ban to be effective, we need to educate doctors to not turn away pregnant teenagers who seek abortion. In addition to that, we need to also educate the public about the abortion procedure and create awareness about the dangers of OTC diagnosis for abortions. We need to start at the beginning.”

*name changed on request