Times of India
18 July 2011
By Umesh Isalkar
Pune, India

Medication Is Easily Available; Unauthorised Doctors Prescribing Drug
The misuse of abortion pills by some doctors and women in the city is raising concern. Along with cough syrups and painkillers, these pills, which help induce termination of pregnancy up to seven weeks, are among the most abused medicines, said medical experts.

Ignorance and stigma combined with easy availability of the abortion pills have become a way of dealing with unwanted pregnancies. In many cases, it is a do–it–yourself process, medical experts said. The pills were introduced in the country six years ago.

Going by the law, only gynaecologists and registered medical practitioners recognised under the Medical Termination of Pregnancy Act, 1971 can prescribe the drug. One needs a prescription to buy it.

However, the drug is easily available. When this reporter visited five chemists in prominent areas of the city and asked for the abortion pills without a prescription, three sold them across the counter while at two places the chemists said they had run out of the stock.

"The pill is sold across the counter at most chemists. The buyer has to hand over twice the money and get the pills, no questions asked. The acrossthe–counter sale has multiplied its misuse," senior gynaecologist Charuchandra Joshi, president of the city chapter of Pune Obstetrics and Gynaecological Society (POGS), said.

"The sale of abortion pills is certainly high. We don’t know the exact number," Mahendra Pitaliya, co–coordinator of the Chemists’ Association of Pune District, said.

Another area of concern is that the pills are being administered by doctors not recognised by the MTP Act. Only doctors linked to an established clinic are allowed to prescribe these drugs so that in case of an emergency, the patient can be moved to a hospital quickly. However, there is rampant flouting of the rule.

"The sale of the MTP pill is rampant in the city. Changing behaviour patterns among youngsters and easy access to such pills has led to the misuse. The pills can only be administered by gynaecologists and registered medical practioners recognised to perform MTPs by the Act. However, these drugs are being widely prescribed by unrecognised doctors and even sold across the counter in the city," said senior gynaecologist Sanjay Gupte, past president of Federation of Obsterics and Gynaecological society of India (FOGSI).

Many small clinics provide the entire drug package in one visit which is dangerous, medical experts said. Doctors warn that if these pills are not taken under proper medical supervision, it may lead to severe bleeding and can be life–threatening. The termination process is in two stages. In the first visit, the patient is given 200 mg of the drug which blocks pregnancy hormones. Another drug is given after 48 hours, which triggers miscarriage.

Usually, the patient is kept under observation for 2–3 hours after the drug is administered. But illegal abortion clinics while doling out this drug ignore safety often at the cost of the patient.

The pills are convenient as they avoid surgical intervention. "At the same time only doctors recognised by the MTP Act should be allowed to prescribe these drugs. Besides, acrossthe–counter sale of these drugs should be stopped immediately by the government. This has been the society’s policy statement since 2003–04," said Gupte.

There are complications if the pills are not taken under medical supervision and if the pregnancy is more than seven weeks. "If the patient has tried the drug at home and it has not triggered complete abortion, she needs surgical methods. The drug’s efficacy is in the early stages of pregnancy – less that seven weeks – but only a few know this. If the pills are taken in the later stages of pregnancy without the doctor's supervision, it might result in severe infection, severe bleeding and in rare cases, even infertility making conception impossible in future," Joshi said.

Confidentiality is an issue for patients, especially for adolescents and unmarried women. "Fear of stigma while terminating an extramarital pregnancy is why many approach illegal providers of abortion pills," said family physician Hillary Rodrigues, past president of Indian Medical Association (IMA).

Most general practioners who prescribe these drugs do not know that it is not a 100 % solution for abortion. "Monetary gain and retaining patients’ loyalty spur GPs to prescribe abortion drugs. There may be cases of failure which need a gynaecologist for surgical intervention (dilatation and curettage). Family physicians are not qualified to carry out these procedures hence they should not prescribe the pills and refer patients to gynaecologists," Rodrigues said. When contacted, civic health officials said they were monitoring all the 271 MTP centres in the city. The Food and Drug Administration authorities said they would raid chemists.

Side–effects
Excessive bleeding Nausea Headache Painful cramps Diarrhoea Vomiting

Hardly a chill pill
Statistics collated by the society show that 78% of pregnancies in India are unplanned and at least 25 % are unwanted, leading to approximately 11 million abortions a year, half of which are unsafe and are associated with high morbidity and mortality.

The pill shows 85 to 97 per cent rate of success although the side–effects remain similar like abdominal pain and bleeding (attributed to the process of abortion), vomiting and nausea (on account of pregnancy) and in some cases, diarrhoea and fever. Apparently, the side effects vary from woman to woman.

FOGSI recognizes the universal evidence on the effectiveness and safety of abortion pills for inducing the medical termination of pregnancy up to 49 days from the last menstrual period (LMP), as approved for use by the Drug Controller General of India (DCGI).

Not morning after

• The pills are not morning–after pills which are emergency contraceptive drugs. They are taken within 72 hours of unprotected intercourse so that further fertilisation or conception does not occur
• The MTP pills are to be taken when the pregnancy is proved and the person is not willing to carry on with the pregnancy irrespective of the sex of the foetus
• The morning–after pill is taken before missing the monthly period while the MTP pill or abortion pills are taken after missing it