A recent fact-finding report from the Center for Reproductive Rights and its collaborators highlights significant legal obstacles to safe abortion access in India, resulting in approximately 800,000 unsafe abortions annually (Pillai, 2024). Currently, unsafe abortions contribute to 8-10% of maternal deaths in the country (Yokoe et al., 2019). This alarming statistic warrants a deeper understanding of abortion and the plethora of nuances associated with it. This article then aims to delve deeper into the overarching theme of abortion, with special emphasis on its complex intersectionality. 

Introduction: 

Emerging from a Latin root meaning ‘miscarry’, abortion remains one the most controversial words used in English parlance. Simply said, an abortion is the medical termination of pregnancy, using either medication or surgical methods. The first tangible evidence of abortion can be traced back to 1550 BCE when Egyptian Ebers Papyrus was used to induce an abortion in Ancient Egypt (Hunt, 2023). For thousands of years, women have supported each other in the process of getting rid of unintended pregnancies across the world. It was in the early 19th century when the anti-abortion movement and its rapid criminalization picked heat. This happened due to several factors, which are all analysed in the following text. 

To put it simply, the pro-life and pro-choice conundrum acts as the focal point of the discourse surrounding abortion. Backed by religious preconceptions and the so-called right to life of the foetus, the pro-life lobby acts as champions of foetal personhood, further demonising the agency of a woman. Its rival, the pro-choice lobby, focuses on the woman’s right to choose- be it termination or continuation of pregnancy, thus fighting for the right to bodily autonomy of women. The choice, they argue, is informed by a variety of factors like the mental and physical condition of the woman, the social and monetary status, availability of resources etc. 

Even with countries that have legalised abortion, be it for a stipulated period of pregnancy (India allows termination of pregnancy till 20 weeks and 24 weeks in special cases), the social stigma looms dark. The entrenched stigma can be traced back to the traditional notion of women as caregivers and the limitation of the relationship between sex and women to that of procreation. Adding to the valiant onslaught against the unrestricted right to abort, the overturning of the historical Roe v. Wade verdict upholding the constitutional right to abortion in the U.S. in 2022 has reignited the contemporary discourse on abortion. 

Thus, the criminalization and extreme social stigma associated with abortion have not only prevented women from getting complete agency over their reproductive trajectories, but they have also contributed to the marginalisation of certain socially disadvantaged communities even further. Any lobbying for better sexual and reproductive rights would be incomplete and biased without looking at the concerns through an intersectional lens. 

Access to Abortions and Marginalisation 

When the contraceptive pill was launched in the Western markets, after an immensely popular Feminist lobby, it was regarded as a revolution. It gave women better control over their reproductive lives, enhancing their life experiences by multitudes. The Second-Wave Feminists fought for better sexual, reproductive, property and information rights for women, and the criminalization of abortions soon stood out as a thorn in the path of emancipation. It is crucial to note that the criminalization of abortion also emerged as an outcome of the male desire to control every aspect of the world, including the female body. To maintain the forthcoming hegemony male doctors enjoyed in the profession, abortion was soon criminalised, making women dependent on ‘back-alley’ doctors, who extorted exuberant sums of money. This excluded a large section of women, who had little sums to spare and hence added to the marginalisation of already marginalised sections. 

For centuries, midwives and apothecaries, albeit with only informal training, remained the trusted abortionists for women who needed their services. The hegemony of male doctors changed their roles, making their presence outlawed and insignificant. The mistrust most women had while approaching a male doctor, due to strict gender segregating social norms, added another layer of barriers to their access to abortion rights. Another very crucial intersectional factor in analysing abortions comes with the point that the pro-life movement, the primary opposition to unconditional abortion rights, emerged with the fear of mineralization of the Anglo-Saxon people in America. With a rapid increase in immigration, a new lobby emerged which presented the immigrants as people who reproduced like ‘rabbits’, hence creating the idea that they have a higher birth rate than the Caucasian population. This strong pro-life lobby (as they called themselves) prompted Caucasian women to have more children and started equating abortion with murder. The latter part of the pro-life movement got immense religious sanction, especially from the Catholic Church, hence adding an angle of religious sin to an already criminal right. The history of abortion is hence, directly linked to the issues of religion, race, class and gender-based discrimination, and it has emerged from the male desire to control each aspect of women’s lives. 

Abortion, Rights, and Social Justice

Audre Lorde once stated, “Among those of us who share the goals of liberation and a workable future for our children, there can be no hierarchies of oppression”. The concept of Intersectionality emerged from the racial need to change the dictum that female experiences are common and universal, with no further differences. For instance, the forerunners of the Second-wave feminist movement were, inadvertently, caucasian upper-class women. This meant that the “universal” issues put forth were, to a large extent, portraying the life experiences limited to white upper-class women. Every other woman, who was not white and upper class, felt alienated. 

It is in this context that the concept of intersectionality came about. Coined by Kimberlé Crenshaw in 1989, the concept challenged the universality of female experience as propounded by second-wave feminists by stating that gender when intersecting with the women’s class, race or region, adds or subtracts the level of oppression one might experience. It then examines how a person’s identities, such as their gender, ethnicity, and sexuality, affect their access to opportunities and privileges. 

The movement of reproductive justice follows the same maxim, it just seeks to apply it to the areas of sexual health and reproductive rights. For women of colour, women coming from a sexual minority community or immigrants, the access to both information and resources to avail reproductive healthcare facilities is limited. Intersectional activists have often claimed that the pro-abortion movement has sidelined this unique social standing, hence adding to their inability to access their fundamental rights toward their bodily autonomy. 

The reproductive justice movement, hence, works from a place of intersectionality and articulates that reproductive oppression is both a product and tool of other forms of oppression such as sexism, homophobia, racism, classism, ableism, and others. To ensure the well-being of women, families, and communities need to collaborate with all social justice struggles to end injustice. Hence, the fight is not just limited to making abortion accessible and decriminalised, it extends beyond that. The policies working on the ground need to have an intersectional approach, and the policymakers need to be cognizant of the unique social standing a woman has. Once this is the new normal, and it might take years before we come close to that, we can dream of achieving complete reproductive justice for every woman.  

Abortion in the Indian Context 

On September 29, 2022, a three-judge panel of the Indian Supreme Court issued a landmark ruling regarding the abortion rights of unmarried women (Jain, 2023). This decision marked significant progress for reproductive justice in India, affirming that unmarried women possess the same right to access abortion as their married counterparts. If implemented effectively, this ruling can broaden access to sexual and reproductive health services for various groups. This judgement represents a notable shift from the Supreme Court’s previous stance on sexual and reproductive health issues. 

The transition in the discourse about abortion in India has been increasingly interesting. It is important to note that the discourse around abortion in India differs significantly from the West. Before colonial times in India, the discourse around abortion was shaped by a mix of traditional practices, cultural beliefs, and religious texts. Ancient Indian texts, such as the Manusmriti and the Rigveda, reflect a nuanced understanding of reproductive rights, where abortion was sometimes accepted under specific circumstances (Pallav, 2022). Women often relied on herbal remedies and traditional knowledge passed down through generations to induce abortions, viewing it as a means of controlling fertility and managing family size. This practice was not uniformly stigmatised; instead, it was integrated into the broader context of women’s health and autonomy. However, societal norms surrounding gender and the preference for male offspring began to influence attitudes toward abortion, setting the stage for more restrictive views that would emerge during colonial rule.

In the present context, India has relatively liberal abortion laws, allowing it for several physiological and social reasons. But, the approach of the judiciary in most cases is influenced by pro-life ideology, leading to a conservative interpretation of abortion rights. The issue of sex-selective abortion, or “female foeticide”, is a major concern in India, with state population control policies and the unchecked use of reproductive technologies contributing to its normalisation in the 1980s and 1990s. It has also been argued that the legalisation of abortion in 1971 was driven more by population control motives than women’s emancipation.

So, at first glance, India appears to have one of the highest abortion rates globally and some of the most advanced abortion legislation. However, this facade conceals a complex array of challenges that hinder many women from obtaining safe abortion services. 

Despite abortion being legal in India, unsafe abortion remains the third leading cause of maternal mortality in India, and close to eight women die from causes related to unsafe abortion each day (Roy, 2022). This is why the provision of safe, effective and accessible abortion services is a priority in the Government of India’s current Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCH+A) program. Ensuring Comprehensive Abortion Care (CAC) services is now an integral component of the efforts made by the Government of India to bring down maternal mortality and morbidity in the country.

Unsafe abortion is a significant yet preventable cause of maternal deaths. Though Medical Termination of Pregnancy (MTP) has been legal in India since 1971, access to services is still a challenge, especially in the rural and remote regions of the country. While there is a desire for small families among married couples, this has not translated into contraception usage. Further, no contraceptive is 100% effective and therefore, safe abortion services will always be a necessary component of reproductive healthcare. 

The paradoxical nature of Indian discourse on abortion presents itself in the Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act, enacted in 1994, aiming to curb female foeticide and address the declining child sex ratio in India by prohibiting sex-selective abortions and prenatal sex determination. The act bans the use of prenatal diagnostic techniques for sex selection and imposes strict penalties for violations, including imprisonment and fines. Despite its intentions, the effectiveness of the PCPNDT Act has been questioned due to persistent cultural preferences for male children and the underground nature of sex-selective practices.

Statistically, the implementation of the PCPNDT Act has seen mixed results. As of December 2017, there were 3,986 court cases filed under the act, with 449 convictions secured, leading to the suspension or cancellation of 136 medical licences for violations. However, the child sex ratio in India remains a concern, with the 2011 census reporting a national child sex ratio of 918 girls for every 1,000 boys, indicating a continued preference for sons despite legal restrictions (Laxity in Implementation of PC and PNDT Law, 2018). The act’s enforcement has been hampered by insufficient awareness and training among law enforcement and medical professionals, as well as societal attitudes that continue to favour male offspring.

Reliable data on the prevalence of induced abortion in India is scarce. Official statistics and national surveys often fail to provide comprehensive coverage of this issue. Since the early 2000s, the availability of medication for abortion has increased, enhancing women’s access to abortion services. This shift has improved the methods through which women can obtain abortions, yet the overall understanding of abortion incidence remains limited due to insufficient data collection and reporting practices. As a result, the true extent of abortion and its safety in India is not fully understood, complicating efforts to address women’s reproductive health needs effectively. The Maternal Mortality Ratio (MMR) for India is 130/per 100,000 live births (RGI-SRS: 2014-16) and unsafe abortions account for 8% of the MMR. Many of those who survive these secret, unsafe procedures typically suffer from chronic, debilitating diseases that have a bearing on the future health of the woman. 

In conclusion, while India has made significant strides in expanding legal access to abortion, exuberant barriers remain that prevent many women from obtaining safe abortion services. Unsafe abortions continue to be a major contributor to maternal mortality, especially among marginalised communities. Addressing this issue requires a multifaceted approach that tackles legal obstacles, improves access to safe abortion facilities, and provides comprehensive reproductive health education. Adopting an intersectional lens is crucial to understanding how factors like gender, class, caste, and region intersect to shape women’s experiences and access to abortion rights. Ultimately, ensuring reproductive justice in India necessitates a holistic commitment to dismantling all forms of oppression and empowering women to make autonomous decisions about their bodies and lives. The recent Supreme Court ruling recognizing the abortion rights of unmarried women represents a positive step, but much more work remains to be done.

References

Pillai, Gauri. (2024). India’s Push-And-Pull on Reproductive Rights. April. https://doi.org/10.59704/41b437064b3e88d3.

Yokoe, Ryo, Rachel Rowe, Saswati Sanyal Choudhury, Anjali Rani, Farzana Zahir, and Manisha Nair. (2019). Unsafe Abortion and Abortion-Related Death among 1.8 Million Women in India. BMJ Global Health 4 (3). https://doi.org/10.1136/bmjgh-2019-001491.

Hunt, Katie. (2023). Abortion Is Ancient History and That Matters Today. CNN. June 23, 2023. https://www.cnn.com/2023/06/23/health/abortion-is-ancient-history-and-that-matters-today-scn/index.html.

Jain, Dipika. (2023). Supreme Court of India Judgement on Abortion as a Fundamental Right: Breaking New Ground. Sexual and Reproductive Health Matters 31 (1). https://doi.org/10.1080/26410397.2023.2225264.

Roy, Esha. (2022). Report: 67% Abortions in India Unsafe, Cause Nearly 8 Deaths Every Day. The Indian Express. March 31, 2022. https://indianexpress.com/article/india/india-unintended-pregnancy-abortion-7845655/.

Laxity in Implementation of PC and PNDT Law. (2018). Pib.gov.in. https://pib.gov.in/newsite/PrintRelease.aspx?relid=178043

Nagpal, S. (2013, February). Sex-selective Abortion in India: Exploring Institutional Dynamics and Responses. McGill Sociological Review (MSR). https://www.mcgill.ca/msr/volume3/article2

P.M, A. (2022, October 20). Concerns around abortion in India differ from those in the West. Frontline. https://frontline.thehindu.com/columns/concerns-around-abortion-in-india-differ-from-those-in-the-west/article66000417.ece

Women’s emancipation or population control? Why abortion was legalised in India in 1971. (2022, July 2). The Indian Express. https://indianexpress.com/article/research/womens-emancipation-or-population-control-why-was-abortion-legalised-in-india-in-1971-8004345/

Bhujel, Pallav. (2022). RIGHT TO ABORTION UNDER ANCIENT INDIAN JURISPRUDENCE AND CONTEMPORARY LEGAL SYSTEM: A COMPARATIVE STUDY. Education and Society.