India has one of Asia’s broadest abortion laws, allowing pregnancy termination in a wide range of circumstances. Under the Medical Termination of Pregnancy (MTP) Act, enacted in 1971, abortions may be performed during the first 20 weeks by a registered physician in a government-approved hospital or facility.

But in a sprawling country of one billion, having a progressive law does not guarantee access to safe services. Though abortion has been legal for decades, unsafe abortions far outnumber legal procedures in India, the world’s second most populous country. It is estimated that nine percent of reported maternal deaths stem from unsafe, illegal abortions. This translates to about 12,000 to 18,000 avoidable deaths every year or up to 25 percent of all global maternal deaths due to unsafe abortions. 

A range of factors contribute to the prevalence of illegal abortions, including a dearth of trained providers; a disproportionate concentration of certified providers and facilities in urban areas; inadequate and underutilized training facilities; poorly maintained or nonfunctioning equipment; and legal restrictions on who can provide abortion services. This situation is compounded by the fact that millions of Indian women remain unaware that abortion services are legal and available, including for adolescents and unmarried women, among others.
 
Based in New Delhi, Ipas India works with local governments to implement safe abortion care. In 2001, Ipas India initiated its work with a programmatic focus on three states: Bihar, Jharkhand and Maharashtra.

As the program has grown, it has had national impact through its research, advocacy, distribution network for manual vacuum aspiration (MVA) instruments and promotion of other abortion technologies.

In 2006, Ipas India expanded its programmatic reach to two new states, Madhya Pradesh and Uttarakhand. In addition, its technology promotion activities have been intensified in the states of Andhra Pradesh, Karnataka, Kerala, Orissa, Punjab, Uttar Pradesh, West Bengal and the North Eastern States.

• Promoted the concept of comprehensive abortion care (CAC) among a variety of stakeholders;
• Developed curriculum materials and provider training program. To date, 482 certified providers, 247 MBBS (Bachelor of Medicine and Bachelor of Surgery) doctors and 325 support staff have been trained in CAC;
• Strengthened training capacities of 37 public and private training sites by developing and conducting CAC Training of Trainers programs, which have trained 470 doctors and 269 support staff to prepare their peers;
• Developed and successfully implemented a model for CAC service delivery in 17 primary health care settings, 16 of which are regularly offering services;
• Expanded use of medication abortion by researching medication abortion issues, participating in the development of guidelines and disseminating technical and legal information;
• Conducted national, state and district level advocacy events to increase access to safe abortion care;
• Established a commercial distribution channel for MVA instruments in partnership with Romsons, a reputed manufacturer and marketer of surgical instruments. About 150 distributors in more than 90 towns are carrying Ipas MVA instruments.

Among Ipas India’s major future goals are expansion of comprehensive abortion care in primary health-care settings; training providers and health systems to improve quality of care and access for women; distributing a sustainable supply of MVA instruments; promoting advances in abortion methods; and furthering public and policy discussion about the spectrum of reproductive health services.

Given India’s size, needs and disparities, increasing access to safe abortions is uniquely challenging. While India has a liberal law, supportive policy environment and a large number of obstetrician-gynecologist providers, access to safe abortion services is still a problem for many women, especially the underprivileged and those who live in marginalized or rural areas.

Ipas India’s work has demonstrated that women’s lives can be saved by improving service quality and availability. The future challenge is to scale up these interventions and effect long-term, sustainable changes in the public and private health-care systems. As the only nongovernmental organization dedicated to decreasing maternal deaths due to unsafe abortions, Ipas India is uniquely able to forge partnerships and ensure that safe abortion remains firmly on the public-health agenda.

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