We are sitting in a little room in a clinic at Kuncholi village of Udaipur district. This is one of the most backward districts in Rajasthan, one of the six most backward states in India. There are only three of us in the room, the daktarni bai (lady doctor), myself and the last patient for the day, Modki Bai, a Bhil woman who came to the clinic for safai (cleansing), the local Hindi euphemism for abortion.

As her story unwinds in whispered tones, it turns out that Modki Bai is a married woman in her 30s and is a mother of three—two boys and a girl. She lives in the village with her children and mother-in-law. Her husband works as a taxi driver in Mumbai. He had come home on a brief visit two months ago and now she has discovered that she is pregnant. She thinks if she were to announce her pregnancy now, her husband and mother-in-law will immediately suspect her of promiscuity. Someone had told her about this clinic so she has stolen out of her house to come here where no one knows her. She says she wants an appointment early in the morning, so that afterwards she can catch the 3.30 bus and be home in time to cook lunch for her children as usual. What about the bleeding and weakness that will follow? Modki Bai says she will handle it.

Modki Bai is lucky in that she has access to a free clinic in this remote area, run by a good voluntary organization. Most government primary healthcare centres in villages have only an auxiliary midwife, who is not permitted to handle abortions unless there is a visiting doctor present, which is rare. Talks with midwives reveal other startling and disturbing facts. Most abortion seekers in the rural areas, unless they are young brides and the husband’s family is keen to abort a female foetus, must go furtively to some local quack or midwife suggested by a friend. The quacks will use either some herbal potion or insert some object into the uterus to abort the foetus, thus posing a great risk to the woman. Having exacted their fee, they tell their patient to go home. There is no accountability thereafter in case the abortion is botched and the woman dies. Although safe abortion (performed in the first three months of pregnancy by a trained doctor) was legalized long ago in India, due to lack of doctors and the stigmatization of abortion, three in five abortions are still being performed illegally by untrained attendants.

Both in rural and urban India, blame for an unwanted pregnancy is mostly put on the woman. Male responsibility is seldom, if ever, pointed out and enforced. Many married men suspect that if the wife wants an abortion, it might be another’s baby and will beat or even abandon her. And if they are sure they are the father, they will still refuse her a written permission without which she cannot ask for a safe and legal abortion in a government hospital. Women, ranging from wives who have conceived because of a failed contraception or because the husband forced them to have unprotected sex, to young unmarried girls and widows duped and/or raped by relatives or boyfriends, are rarely accompanied by men when they go in for the actual procedure.

And this is not just happening in India. According to a report (Abortion Worldwide: A Decade of Uneven Progress) of the US-based Guttmacher Institute, despite improved access to contraception, each year there are 76 million unwanted pregnancies globally. In 2003 alone, 41.6 million women underwent abortion; of these, almost half (20 million) were in developing countries. Poor medical help resulted in some 70,000 deaths. These were mostly young women between 15 and 35 years of age.

The issue is no longer whether or not women should have the right to terminate an unwanted pregnancy. Abortion cannot be, and must not be, viewed in isolation from other contraceptive choices for women, since it is the only insurance against contraceptive failure for them. Contraceptive failures will occur and abortions will continue to be sought, no matter how many voices are raised against it, how many religious leaders condemn it, or how widely all kinds of contraceptives are distributed by health ministries, neighbourhood chemists, panwallahs or smart vending machines. Easy access to hospitals and facilities for properly performed abortion should, therefore, be viewed as two of the most important reproductive rights for young women everywhere.

Mrinal Pande likes to take readers behind the reported news in her fortnightly column. She is a writer and freelance journalist in New Delhi. Comment at theotherside@livemint.com