Can the Abortion Pill Really Be Everywhere?

Can the Abortion Pill Really Be Everywhere?

As a young reader of world literatures at university, I was first introduced to the tragic genre of ‘whore biography’ in Mary Wollstonecraft’s ​The Wrongs of Woman, Or Maria ​(1798), where the unrelenting protagonist, a feisty young prostitute called Jemima, proceeds with a timely abortion, and sets off a series of disastrous mishaps that leave her a convicted felon in an asylum. In another instance, Anne Sexton’s ‘The Abortion’ (1962) colours the imaginably bland picture of abortion with pain, turmoil, confusion, and sadness that almost seems rudimentary to the procedure. Her signature poetic voice retains its confessional undertones - but the poem is significantly occupied with the overwhelm of ​not feeling understood​. As Eloise Millar notes in her ​short yet incisive piece​, there is no black or white in Sexton’s commentary; racial and other boundaries blur into the backdrop of an anguish that can only ever be grasped via lived experience. White feminism aside, both texts spoke to me of a reality that somehow managed to escape the textual commodification and perverse voyeurism that abortion literature often endures: location is decisive in who gets to terminate an unwanted pregnancy, and who doesn’t.

It was through three years of undergraduate study and two of postgraduate research, that I learnt an invaluable lesson which changed the way I perceived the abortion debate: to be understood and to not be misunderstood are not the same thing. And occupying the very delicate space between the two is the matter of choice. Importantly, choice here must be differentiated from freedom: thanks to feminist thought co-opted by enthusiastic, sex-positive neoliberalist thought, the freedom for women to be sexually active is welcome - albeit only for an upper middle-class minority of educated women. But to be able to choose how to deal with a pregnancy is a socio-politico-legal issue, not a personal one, and one that denotes differently for women from different class and caste demographics. Which is why the sensitive matter of self-managed abortions finds its future poised on the back of temperamental rhetoric: how much freedom is too much freedom?

Self-Managed Abortions in the Indian Landscape

In 2013, shortly after the uproar in Ireland over Savita Halappanavar’s septic miscarriage and consequent passing, a ​study​ published in the Indian Journal of Forensic Medicine and Pathology reported the tragic death of a 40-year old Tamil woman who succumbed to the effects of dubious medication made available to her by a village quack. Worlds apart in every sense imaginable, both women had one thing in common: timid and obsolete abortion laws dictated how they could access their bodies in societies of compromised safety and violent misogyny. Needless to say, it was the mere lack of choice that rendered both women vulnerable in situations where, ideally, the right to access their bodies should have been of paramount importance.

It is unsurprising, given that a vicious cycle impedes safe access to medical abortion for a majority of Indian women, that self-managed abortions have been a consistent phenomenon in the country. Reproaction and the World Health Organisation define a self-managed abortion as one that occurs outside a clinical setting, and one where a drug is self-administered by an individual to induce termination. The most common routes to a self-managed abortion include ingesting misoprostol and manual aspiration, although, given its propensity to be more unmanageable, the latter is less preferred. In rural areas, however, this usually translates to dodgy herbal concoctions, concentrated papaya decoctions, and intra-uterine insertions designed to induce local trauma.

The obsolete Medical Termination of Pregnancy Act of 1971 has made indefensible victims of those it was meant to protect: a minor seeking to terminate a pregnancy borne of rape was denied an abortion by a licensed doctor, despite her legal right to clinically terminate. Upon petitioning a High Court in Madras, she is made to wait until the 20th week of gestation is over, making it illegal for her to then seek a termination. The minor gave birth to her rapist’s child, while the Courts sought a medical opinion on whether her termination would posit risks to her physical health - notwithstanding the irreversible harm it did to her mental health. The Act has failed in accounting for technological advancements, and a testimony to the fact lies in the number of abortions sought outside of a clinical setup - a number that has quintupled in four years.

Looking Forward

Self-managed abortions promise women the privacy and dignity to terminate a pregnancy as and when they deem suitable - and more significantly, offer the choice of location in a landscape where political agendas have displaced the right to self-determination. According to research (and common sense), confidentiality and quick service are the chief determinants of how a woman approaches her abortion. To enforce abortion laws that necessitate intervention by a medical practice extends the draconian intention to exercise control over women’s reproductive rights from a sociological ambit to the realm of medico-legal jurisdiction.

Importantly, self-managing could proffer a singular solution to the many threats intersectionality poses to the debate on access to safe medical abortion. The digitization of healthcare, which is already underway, can help deliver an abortion policy designed for a spectrum - and not just for a few - by focalizing confidentiality and alacrity in its approach to delivering reproductive health care services to India’s large and variegated female demographic.

Literature has done well to campaign for women’s reproductive rights - it might be time to contextualise location and rethink our priorities when it comes to unwanted pregnancies. If the best abortion debate is in books, it is time to read with nuance. If there’s one thing abortion literature has consistently militated for, it's that the choice to terminate and proceed with grieving - or not grieving - is a personal matter that warrants respectful privacy. Self-managing an abortion will allow women to carve a niche of uncompromising privacy and safety in a country where rampant misogyny and legal negligence lead to 10 deaths due to unsafe abortions every day, and should be treated as inseparable from the right for a woman to self-determination.