Illustration: Jayachandran
Illustration: Jayachandran

Abortion comes at a steep price in India

Strict law on drugs coupled with social stigma associated with termination of pregnancies have left women seeking abortions vulnerable to exploitation

Mumbai: “You can pay for the ultrasound by card, but the procedure will be Rs4,500 in cash. Please come after my clinic hours, I will give you the pills." This is what a gynaecologist in South Mumbai told a young, unmarried media professional, who was six weeks pregnant.

This was the second gynaecologist that the woman, who wanted to get an abortion, was consulting after the first demanded Rs10,000 for the procedure.

The procedure itself was simple: Give the woman pills and tell her how to take them. Why such steep fees then?

The law governing medical abortions in India gives doctors the final authority to prescribe abortion pills and patients must take them only under their supervision.

While the medicines can be bought from retailers if patients have a valid prescription, doctors often prefer to dispense the medicines themselves.

As these pills are given to patients directly by doctors, most women are unaware of the actual prices, and sometimes even the name of the pills, allowing doctors to overcharge them.

Now, combine this power that doctors have with the social stigma associated with abortions. The scenario is worse for unmarried women. The result: women seeking abortions are vulnerable to exploitation.

Termination of pregnancy can be done surgically, that is removing the foetus under anaesthesia, or medically, using a combination of pills that alter hormones to trigger an abortion. This story is about the second, medical abortions, done by taking pills that are either orally ingested or vaginally inserted.

In India, abortions are governed by the Medical Termination of Pregnancy Act, 1971 (amended in 2003). Under the Act, pregnancy can be medically terminated only by a “registered medical practitioner" at a medical facility (government-owned or private) registered as a medical termination of pregnancy (MTP) centre.

While the MTP Act intends to safeguard the health of a woman seeking an abortion and prevent sex-selective abortions, it gives immense power to doctors over how abortions are conducted, which can be misused.

The drugs used for medical abortions are mifepristone and misoprostol, both of which are under India’s National List of Essential Medicines and thereby under government price control.

According to data on drug price regulator National Pharmaceutical Pricing Authority’s website, the ceiling on mifepristone 200mg is Rs304.38, while that on misoprostol 200mcg is Rs15.80.

For providing these pills, doctors allegedly charge anywhere between Rs1,000 and Rs10,000, which include consulting fees and ultrasound charges, according to four patients and two doctors, all of whom requested anonymity.

According to data from global healthcare information and services provider QuintilesIMS, Mankind Pharma’s Unwanted Kit, Cadila Healthcare Ltd’s Mifegest Kit, Macleods Pharmaceutical Ltd’s Instakit, and Aristo Pharmaceutical Pvt Ltd’s Mifty Kit are the top selling brands of abortion pills. The total market for abortion pills in India is around Rs400 crore, with Mankind Pharma and Cadila Healthcare taking a share of 25% each, as per QuintilesIMS data.

One might think that such exploitation on the pretext of consulting charges would be confined to unmarried women seeking abortions but that is not the case.

A married woman staying in a central suburb of Mumbai said she paid Rs2,500 to her gynaecologist to abort her second child. “The doctor did a sonography to ensure that the foetus was in the uterus. Then gave me one tablet and asked me to come back after a day for the second. I just took two tablets and the abortion was done," she said.

In India, there is no legal bar on consultation fees doctors can charge. But patients can complain to a state’s medical council regarding any issues encountered with doctors. “Our prices are not for the pills, they are for the consultation we provide," said a gynaecologist in Mumbai, requesting anonymity. “When you go to a cardiologist and he asks for a consulting fee of whatever amount, do you contest it? Only a doctor can prescribe these pills and tell the patient how to take them. Now if a doctor charges Rs100, or Rs10,000 or Rs15,000, what is it to the patient?"

Apart from overcharging, dispensing of abortion pills by doctors whose clinics are not registered as MTP centres is an area of concern.

Registration, monitoring and inspection of MTP centres is done by local civic bodies. “There is no way for us to regulate how much doctors charge for this," said Padmaja Keskar, executive health officer of F ward, Municipal Corporation of Greater Mumbai. “Our job is only to make sure doctors (and clinics) prescribing abortion pills are registered with us (under the MTP Act)."

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