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A study conducted by Pratigya Campaign for Gender Equality and Safe Abortion found that medical abortion (MA) drugs are rapidly vanishing from the shelves.
The study named 'Availability of MA drugs across four Indian states' found that chemists in Rajasthan and Maharashtra are not stocking MA drugs anymore and only 37.8 per cent are stocking in Bihar and 66 per cent in Uttar Pradesh.
Those who are not stocking identified legal or regulatory barriers as the main reason for non- stocking. Non-availability of MA drugs is threatening women's access to safe abortion, especially in a scenario where even today an estimated 10 women die in India due to unsafe abortions, the third leading cause of maternal mortality in India.
The study was conducted among 1,008 chemists across Bihar, Maharashtra, Rajasthan and Uttar Pradesh.
Provision of safe, effective and accessible abortion services including medical abortion drugs is a priority for promoting women’s health and reproductive rights. Medical abortion has emerged as the preferred method of abortion care in India with an estimated 81 per cent of the 15.6 million annual abortions being performed using MA drugs. Yet, abortion drugs seem to have started vanishing from chemists shelves.
The study found that of the chemists who are not stocking MA drugs in Rajasthan, Maharashtra and Uttar Pradesh, regulatory or legal barriers was the primary reason for not stocking the drugs.
Bihar was the only exception, where low demand was cited as a reason for not stocking. Chemists have been informally asked not to sell MA drugs and there have been MA specific visits by regulatory authorities. Specific visits related to MA drugs were high in Rajasthan at 14.3 per cent and Maharashtra at 17.4 per cent. As high as 56 per cent chemists reported that MA drugs are overregulated as compared to other schedule H drugs.
Speaking at the launch of the report, VS Chandrashekar, Pratigya Campaign Advisory Group member and chief executive officer, Foundation for Reproductive Health Services India said, “India has achieved great success in improving access to safe abortions, thanks to the proactive steps taken by the Ministry of Health and Family Welfare over the past decade and a half. Availability of MA drugs, particularly combi packs has been instrumental in the decline of unsafe abortions. The non-availability of MA drugs can potentially reverse the gains made over the past few years.”
The study attempted to capture chemists' awareness, knowledge and attitudes about abortions and MA drugs.
Dr. Kalpana Apte, Pratigya Campaign Advisory Group member and Secretary General, Family Planning Association of India. "Certain misconceptions seem to be resulting in over regulation of MA drugs, significantly affecting availability of a safe, simple and affordable method of safely terminating a pregnancy, compromising the health, well being and reproductive rights of women in India" she added.
The study estimates that very few, 9.6 per cent of women who purchase MA drugs actually return to the chemists for advice to manage complications or contraception.
“Allowing all allopathic doctors to prescribe MA drugs will definitely increase prescription and medical support for women seeking MA. As law and rules stand now, only Obstetrician and Gynaecologists and allopathic doctors who are approved abortion provider under the MTP Act can prescribe MA drugs. It is estimated that only 60-70,000 doctors, largely in urban areas, can prescribe MA drugs in the India which is woefully inadequate for a country of our size," says Chandrashekar.
Given the number of abortions estimated annually in the country, if chemists stop stocking MA drugs, a black market for MA drugs could emerge, pushing up prices and creating economic barriers for women to access their preferred method of abortion.
The study clearly indicates that MA drugs are under greater scrutiny by drug control authorities and their non- availability in retail chemist shops is a major cause of concern in Maharashtra and Rajasthan.
To ensure that MA drugs are easily accessible Pratigya Campaign recommends that the Ministry of Health and Family Welfare and the Drug Controller General of India should send an advisory/guidance to all State Drug Controllers clarifying that cracking down on combipack does not help in curbing sex selection and that MA drugs should be subjected to the same standards/scrutiny as other schedule H drugs.
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