Saturday, Mar 08, 2003
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By Gargi Parsai
The consortium, organised by the All-India Institute of Medical Sciences (AIIMS), in collaboration with the WHO, the ICMR and the Ministry of Family Welfare, is deliberating the strategy and guidelines for launching the pill in the family welfare programme as a safe alternative to surgical termination of pregnancy.
The Act calls for surgical termination of pregnancy at "a place certified and approved for the purpose". However, experts feel that administration of the pill should only be under medical supervision with proper back-up facilities for blood transfusion and MTP services. This rules out self-medication and clandestine administration of the pill as has been reported from some parts of the country. In fact, amendment might be required to prevent misuse.
Besides, under the Act, an abortion has to be reported to the authorities. In case of the pill, the question raised was: when does the practitioner report at the time of initiation of the abortion or upon completion involving between three and 15 days?
There was another view that the role of NGOs in terms of advocacy, monitoring and training might have to be incorporated in the Act. However, Manchanda from the Ministry of Health and Family Welfare pointed out that the National Population Policy had the provision for "medical termination of pregnancy" and thus no amendment was necessary.
The pill, for which approval was granted by the Drug Controller of India a year ago, is already available on prescription. Trials are still on for the safe protocol required for its use in the second trimester.
On day one of the consortium on Thursday, what emerged was that the abortion pill in the agreed regimen was a "milestone" in India, which has a reported 20,000 annual deaths from unskilled abortions.
Studies conducted at the AIIMS, the ICMR, at a village near Pune, in Mumbai hospitals and in China, the U.K. and Romania show a common feature: The pill shows 85 to 97 per cent rate of success although the side-effects remain similar i.e. 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.
The areas of concern in India are the anaemic nature of a sizeable number of women (though loss of blood occurs in surgical method as well), lack of well-knit, equipped health facilities and apprehensions of misuse.
To this, N.C. Saxena of the ICMR said clinics functioning from 9 a.m. to 6 p.m. should not be allowed to administer the pill as it required availability and services. However, there was agreement that the pill was the need of the hour considering the high risk of maternal deaths in surgical abortions.
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