Times of India
25 June 2010
By Umesh Isalkar
Pune, India

The Number Drops To 1–2% By 2010, Compared To 8–10% In 2005
In a matter of five years, the number of deaths caused due to unsafe methods of abortions in rural Maharashtra has come down drastically thanks to the safe and easy abortion technique, called manual vacuum aspiration (MVA), introduced four years ago by the state government at primary health centres (PHC) and rural hospitals (RH) across the state.

So from hovering around eight to 10 per cent in 2005, abortion–related deaths in rural areas in the state is down to one to two per cent in 2010. The technique has succeeded in weaning rural women from traditional abortion methods as offered by quacks. As a result, there is a significant drop recorded in maternal mortality rate mainly in the last three years. As per the latest statistics available, only 12 women died due to abortion–related complications in 2010, as against 156 deaths in 2005.

Prakash Doke, executive director of the state health systems resource centre (SHSRC), said, “Our data suggests that abortion complications were a leading cause of overall maternal mortality in the state till 2005. The reason was largely unsafe methods of abortion, especially the traditional methods offered by quacks in areas where advanced medical facilties have not seeped into the system, that resulted in serious injuries or, in some extreme cases, even death. The introduction of the MVA has been an effective, safe method of uterine evacuation.”

An analysis of the causes of maternal deaths carried out by the SHSRC shows that deaths due to abortion–related complication plummeted drastically in the last three years. In 2008, as many as 15 of the total 1,716 maternal deaths were due to abortion–related complications. In 2009, there were 878 maternal deaths, of which only four were caused by complications following abortion. The state recorded 12 abortion–related deaths in 2010 out of 942 maternal deaths, said Doke.

“It may be noted that till 2005, abortion–related complications constituted 8 to 10 per cent of total maternal deaths, which means 156 out of 2,611 maternal mortality deaths,” said Doke. “The MVA technique has also fostered confidence among rural women who — instead of going to rural quacks for aborting an unwanted pregnancy — are availing benefits of the technique at government–run set–ups.”

“Experiences with the use of MVA for treating abortion complications have been positive, as measured by shorter lengths of hospital stay and a reduced need for a repeat evacuation,” said Doke.

Narrating the story of how MVA was introduced at PHCs and RHs across the state, Doke said, “Ipas — an international non–governmental organisation (NGO) — was instrumental in introducing MVA in the state.”

Ipas initiated a pilot project in the Pune district to develop models for increasing access to comprehensive abortion care. This involved strengthening training capacities and establishing a model for providing comprehensive abortion care services in three rural hospitals and six primary health centres.

India’s National Population Policy 2000 delineates strategies to decentralise abortion services adopting new and easy technologies like the MVA. Considering the success of the pilot project in Pune district and keeping in line with the policy of making all Reproductive and Child Health services available to the people of the state, the state government introduced MVA across the state in 2006–07.

“Based on the experience gained and lessons learnt during the pilot project, it was decided to scale–up this component across the state under the National Rural Health Mission,” said Doke.

Manual Vacuum Aspiration
The MVA is performed with the use of a hand–held syringe as a source of suction for removing uterine contents. The procedure time is five to 15 minutes and is performed in settings such as a doctor’s office, clinic or emergency room. A patient typically leaves a doctor’s office or a clinic within two hours. Typically, cervical anaesthesia is used in combination with orally administered ibuprofen.

And its advantages
Compared to a medical abortion, reported success rates of MVA are higher, the procedure shorter and completed in a given period, fewer visits are needed and the cost is lower. The MVA is quieter than electric suction techniques. Also, by using a gentler, hand–held syringe, the gestational sac comes out intact so pregnancy termination can be confirmed.