There is an extreme shortage of medical abortion drugs across the country, with acute crisis due to lack of stocks in Delhi, Punjab, Tamil Nadu, Haryana and Madhya Pradesh, a study on August 10 revealed.
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The study conducted by the Foundation for Reproductive Health Services on 1,500 chemists showed that merely one percent of the chemists in Punjab, two percent in Tamil Nadu and Haryana, 6.5 percent in Madhya Pradesh and 34 percent in Delhi have stocked the abortion drug. The state which fared best is Assam at 69.6 percent. As per the study, the non-stocking of drugs seems to be linked with over-regulation by drug control authorities. About 79 percent of chemists do not stock the drugs to avoid legal issues and excessive documentation requirements.
Even in Assam, which has the highest stocking percentage, 58 percent chemists report over-regulation of drugs. State-wise legal barriers continue to be a major reason for non-stocking of the abortion drugs, with 63 percent chemists in Haryana, 40 percent in Madhya Pradesh, 74 percent in Punjab and 79 percent in Tamil Nadu reporting so.
The FRHS Chief Executive Officer told IANS: "The main reason for not stocking drugs is over-regulation by local drug authorities. Even while it is a Schedule K drug and is even given to ASHA workers to distribute in communities, many retailers are not stocking them due to misconceptions and legal barriers." He added that medical abortion drugs are the most preferred method with 81 percent of abortions being administered through them and hence their lack of availability hinders women, who do not wish to opt for surgical abortion methods. "In the midst of the pandemic when movement of people is restricted and clinical methods of family planning are not adequately available, there is a dire need to ensure unrestricted access to drugs," he said, who is also the member of Pratigya Campaign Advisory Group.
While the purpose of the study was to verify the availability of drugs, the findings also reveal that Emergency Contraceptive Pills (ECP) are not being stocked by chemists in the state of Tamil Nadu. Only 3 percent of the chemists surveyed in the state reported stocking ECPs and 90 percent not stocking shared that the pills are banned in the state. Emergency Contraceptive Pills are non-prescription drugs and are also stocked and distributed by ASHAs under the National Family Planning Program. Not allowing chemists to stock ECP denies women of Tamil Nadu a safe and easy to use contraceptive choice.
The primary reason for non-availability of MA drugs seems to be the incorrect understanding that medical abortion combipacks can be used for gender biased sex selection among regulatory officials. A Medical abortion combipacks is indicated for use only up to nine weeks while an ultrasound can detect the sex of the fetus at 13-14 weeks gestation.
Chemists, however, do not seem to share this misconception, only about 10 percent chemists across the states where the study was conducted, reported that MA drugs can be used for sex-selective termination of pregnancy. In Tamil Nadu however, 36 percent have this misunderstanding. "The Ministry of Health and Family Welfare should clarify that MA drugs which are approved for use up to nine weeks in India cannot be used for sex-selective termination of pregnancy. This will allow women to seek medical support and access drugs with a prescription," said Dr Rashmi Ardey, Clinical Services Director, FRHS India
Scrutiny and over-regulation, leading to non-availability of MA drugs is a major cause of concern and is likely to result in millions of women being denied access to a safe abortion method. WHO in 2019, included MA drugs in its Core List of Essential Medicines, removing an earlier advisory which required medical supervision while taking the drugs.
Removing unnecessary barriers in stocking of MA drugs will ensure that women are able to access the method of their choice. "Non availability of MA will push women to seek surgical abortion which can be cost intensive and can further widen the access gaps," said the Senior Manager-Partnerships, FRHS India.
The study recommends addressing misconceptions regarding medical abortion and gender-biased sex-selection; harmonising Central Drugs Standard Control Organisation approvals and the MTP Act, amending rules to allow MBBS Doctors to prescribe MA drugs increasing investments in safe abortion communication and providing support to women who access drugs by setting up toll-free helpline numbers.
