Chemists not stocking enough medical abortion drugs; low availability puts women's lives at risk

Medical abortion pills are disappearing from chemists shelves in several retail pharmacies in the country despite the government's approval for the Medical Termination of Pregnancy (Amendment) Bill in March. The government allowed several changes in the MTP (Amendment Bill), 2020, and had also extended the upper limit for permitting abortion to 24 weeks from 20 weeks.

However, a report published by Foundation for Reproductive Health Services India (FRHSI) stated that more than half (53.4 per cent) of chemists across India have cited legal issues as a reason for not stocking medical abortion drugs.

And, as many as 79 per cent chemists in the state of Assam, Haryana, Delhi, Madhya Pradesh, Punjab, and Tamil Nadu, have emptied their stock of medical abortion pills in the months of the January-March period.

According to VS Chandrashekar, Chief Executive Officer, FRHSI and Pratigya Campaign Advisory Group member, medical abortion has increasingly become the preferred method to terminate a pregnancy in India. He added that the non-availability of drugs is threatening women's access to safe abortion.

Chandrashekar also said, "Evidence shows MA drugs are a safe and effective means to terminate a pregnancy, their non-availability can potentially reverse the gains made by the country in reducing unsafe abortions, maternal mortality and morbidity".

The study surveyed 1,500 chemists across six states, including Delhi. In each state, five cities were covered, and in Delhi, five sub-districts.  

The study highlighted that only 1 per cent chemists in Punjab stocked abortion drugs; Madhya Pradesh 6.5 per cent; Delhi 34 per cent; and Tamil Nadu and Haryana 2 per cent each. Assam was the only state where almost 70 per cent pharmacies kept a stock related to pregnancy termination.

MA drugs availability in six states.

As per the report, chemists in Delhi (38.2 per cent), and MP (43.9 per cent ) said that "Too much paperwork/documentation requirement" was a key reason for not keeping enough abortion drugs in the shop. Besides, the low demand for such drugs was also deterrent.

Around 54.8 per cent chemists reported that MA drugs were over-regulated as compared to other Schedule H drugs. However, more than 40 per cent of the chemists reported that over-regulation was required to avoid misuse or health complications from such drugs. The majority of the chemists was reluctant to restock on medical abortion pills as they have to maintain separate registers for it, which entails, doctors and client detail, as well as a photocopy of any government ID. Chemists also said stocking of such drugs could invite trouble from drug inspectors, like a penalty or cancelling of the licence.

Around 65 per cent of the chemists stated that the availability of medical abortion drugs has led to an increase in the abortion rate in the country. Around 80 per cent chemists in Punjab and 66 per cent chemists in Madhya Pradesh reasoned that they have stopped stocking abortion drugs in order to reduce medical abortion. Whereas in Assam, 36.8 per cent reasoned that these drugs were harmful to women's health.

"Medical Abortion has reduced the cost of early abortion. In COVID-19 times, many providers have started asking for a COVID-19 test before carrying out a surgical abortion, which can further increase the cost of service for women. MA in comparison is cheaper as it does not require a clinical setup. Non-availability of MA will push women to seek surgical abortion which can be cost-intensive and can further widen the access gaps," said Debanjana Choudhuri, Senior Manager-Partnerships, FRHS India.

Nearly 85 per cent of the chemists said that taking medical abortion pill is an easy method for terminating a pregnancy as it is inexpensive, ensures privacy, and saves time. However, 55 per cent of them still believe that abortion drugs are ineffective.

Around 9.8 per cent of the chemists in these six states reported that abortion drugs could be used to terminate a pregnancy based on gender.

Dr Rashmi Ardey, Clinical Services Director, FRHS India said the drug controllers authority needed to address the misconception regarding MA drugs and gender-biased sex-selection. According to Ardey, "The Ministry of Health and Family Welfare should clarify that MA drugs that are approved for use up to nine weeks in India cannot be used for sex-selective termination of pregnancy."

On the other hand, Chandrashekar urged the government to allow all MBBS doctors to prescribe MA drugs. So far, only doctors approved as abortion providers under the MTP Act can prescribe MA drugs.

"At present, only 60,000-70,000 doctors can prescribe MMA drug in the whole of India," said Chandrashekar. "Widening the pool of providers to all doctors can increase doctors in India able to prescribe this drug to 800,000-1 million."

Around 82.3 per cent chemists in these six states said they never sold abortion drugs without prescription. Around 10 per cent said they would not sell abortion drugs to unmarried woman, also they would refuse to attend request if the unmarried woman is below 18 years of age. Only 3.5 per cent chemists in Delhi said they will provide abortion drugs to such women.

According to the IPas report--an international organisation on safe abortions-- of the estimated 15.6 million abortions that happen in India annually, 73 per cent are through MA drugs accessed outside of facilities, 16 per cent in private health facilities, 6 per cent in public health facilities, and 5 per cent via unsafe traditional methods.

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