CASE NARRATIVE ON TRACING COMPREHENSIVE ABORTION …

Jharkhand Journal of Development and Management StudiesXISS, Ranchi, Vol. 17, No.4, December 2019, pp. 8279-8290

CASE NARRATIVE ON TRACING COMPREHENSIVEABORTION CARE (CAC) PROGRAM IN RURAL TELANGANA-FACTS AND GAPS ON THE GROUND ON ABORTION CARE

IN LOCAL HEALTH GOVERNMENT INSTITUTIONS

Sudha Bharati*

The present paper is the outcome of a field study based on womennarratives on unwanted pregnancy and abortion care conducted ina single village, Laxmipur (name changed) during the period of2015- 2018 of Sangareddy district (recently merged into this district,previously located in Medak district as one of the most backwarddistrict of Telangana state. In the study a social mapping was doneto track various health institutions- public/private/informal/individual practitioners –inside or outside the village visited by thelocal women for abortion care. The description of the local discoursewith the various stakeholders in the rural region who discussed‘abortion’ as a notion and about the abortion services dispensed attheir facility area. It was observed that medical practitioners fromthe village and private nursing homes where the local women visitthe most for abortion care were more reserve to talk on the topic ofabortion and remained mostly silent on it. The study also hadinterfaced with the local medical practitioners and about theircommunity relations. The study had made an attempt to criticize theexisting health system for not being there in favor of women andhad reflected the poor health status of rural women in the regionwhere the trend of need for abortion care for rural women are stillnot too much recognized till date. The present paper discussionsare limited to the findings on the abortion care discourse in thegovernment health institutions at the field site as a case study andits reflection upon the larger issue of need of robust abortion carein the government health infrastructure at all levels as basic healthrights for Women.

Keywords : Unwanted pregnancy, abortion, comprehensive abortioncare, primary health care, district hospital

Introduction

Abortion1 in India has been legalized since 1971, under the MedicalTermination of Pregnancy (MTP) Act, 1971. Under the MTP Act (1971)abortion is defined as the termination of pregnancy by the removal orexpulsion from the uterus or embryo resulting in causing its death.Under the Act abortion is classified into two categories- spontaneousabortions which are classified as occurs due to the complications duringpregnancy and which occur intentionally. It is also termed as amiscarriage. The second category is called as Induced abortion and

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* Research Scholar, Centre for Women Studies, University of Hyderabad,Hyderabad, Mob: (0) 8142912837

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which are again classified into two types. One is Therapeutic Abortion– An abortion which is induced to preserve the health of the motherwhen her life in danger, or when it is found that if the child is born, itcould be disabled. And the second one is Elective Abortion-an inducedabortion for any other reason is known as elective abortion.

According to a survey report published in The Lancet GlobalHealth (Singh et al., 2018, pp. e111-e120) had estimated that 15·6million abortions (14·1 million–17·3 million) occurred in India in2015. Out of these, 11.5 million took place outside health facilities. Inthis study estimated the abortion rate was 47·0 abortions (42·2–52·1)per 1000 women aged 15–49 years. Whereas 3·4 million abortions (22%)were obtained in health facilities, 11·5 million (73%) abortions weremedication abortions done outside of health facilities, and 0·8 million(5%) abortions were done outside of health facilities using methodsother than medication abortion. Overall, 12·7 million (81%) abortionswere medication abortions, 2·2 million (14%) abortions were surgical,and 0·8 million (5%) abortions were done through other methods thatwere probably unsafe. The report also estimated 48·1 millionpregnancies, a rate of 144·7 pregnancies per 1000 women aged 15–49years, and a rate of 70·1 unintended pregnancies per 1000 women aged15–49 years. According to the ministry of health and family welfare,abortion deaths constitute 8% of all maternal deaths per year inIndia. Abortions accounted for one-third of all pregnancies, and nearlyhalf of pregnancies were unintended and approximately 6.8 millionabortions were recorded being performed per year in India (Ministry ofHealth and Family Welfare, 2009)

Various literatures on abortion had found that throughout historywomen have practiced forms of birth control and abortion. Thesepractices have generated intense moral, ethical, political and legaldebates since abortion is not merely a techno-medical issue, but, “thefulcrum of a much broader ideological struggle in which the verymeanings of the family, the state, motherhood and young women’ssexuality are contested” (Petchesky,1990). The other authors like Jesaniand Iyer (1995) have observed for various evidences in the past thatwomen have overtly or covertly resorted to abortion, but their accessto services has been countered by the imposition of social and legalrestrictions, many of which have origin in morality and religion. Thenorms governing the ethics of abortion have been constantly remoldedto suit the times and the social contexts in which they are set. Theyargued that despite the dissimilarities in their construct, intent andorientation, these norms have invariably been directed to the fulfillmentof social needs that do not recognize women’s right to determine theirsexuality, fertility and reproduction.

The issue of abortion due to unwanted pregnancies was foundtotally out of the purview of government health institutions. It wasfound from the ground level that Sub Health Centre at Village levelwhere ANM, ASHA, and Anganwadi Workers were dealing with localvillage women on their pregnancies matters, but did not want to talkabout the abortion incidences taking place in the village outside of theirregistration records. Totally the focus was on the newly identifiedpregnant women and attending regular follow-ups with them and takingthem to have institutional delivery at the government institutions. Thethree tier structure of the state health system was found entirely focusedon handling the institutional delivery cases where normal pregnancycases were taken to PHC, the high risk pregnant women were eithertaken to Area Hospital in Narsapur or at the District Hospital totallydepends on the nature of risk involved in the delivery cases. In thepoor visibility of any government infrastructure on abortion care hadboosted the private health sector in taking a lead for the provisions ofabortion care without meeting any benchmark for giving qualityabortion care. Rather the abortion cost for the services in private healthsector had added more burdens economically on women in facing thesituational need for abortion care due to unwanted pregnancy and bearthe cost.

This paper is dedicated to the feminist question – why the localwomen more than ninety percent were found seeking abortion healthcare in private health clinics or in case to unauthorized private nursinghomes only. In the same strength why the women were visiting toGovernment Health Institutions for the child birth care and hadsurgeries for Tubectomy as the only method adopted by them to preventfrom more pregnancies in future after having the desired number ofchildren. Apparently the abortion health care in this rural area foundtotally to be under the control of private health sector and has becomea huge market of profit making. On the other side, irrespective of theauthenticity status of these clinics, they were observed to be verypopular among the rural women. As per women these clinics werevery convenient, more economical than city hospitals, their abortionservices are timely available and said to be more suited to the localwomen needs. Also women found themselves less hesitant to interactwith local health practitioners mostly the male doctors and womenstaff from the private clinics or nursing homes located in thesurrounding area of this rural region.

Methodology – Key research questions

In this present scenario it was important for the researcher to do asocial mapping of the health systems and enlisting of various local

Case Narrative on Tracing Comprehensive Abortion Care (CAC) 8281

health institutions giving abortion care for the rural women in thestudy region. The study did a feminist inquiry on when women doabortion for unwanted pregnancies in such a situations how the varioushealth institutions had actually responded to the local women needsfor abortion care. Also the revelation had in this paperon how subtlythe substandard quality of abortion health care these rural womenwere receiving and women themselves bearing the health cost underthe poor socio-economic conditions of their families. Also it is very trueto the larger Indian context for not considering ‘abortion care for women’at par with the government agenda and proactive role in making‘institutionalization of birth care and free health services’. Had raisedthe question why in the same breath there was no governmentpropaganda and health infrastructure at the village level on qualityhealthcare for abortion in women access.

Area of the study and research methods

This study is a case-base on a single village selected from Sangareddydistrict of Rural Telangana region. This study has collected primarydata to know about women questions of those who experienced unwantedpregnancies2 and abortions for it, in the narrative forms which servedthe research purpose in questioning the existing health system onabortion care. In-depth Interview was the key research technique usedto collect women narratives, interviews with health personnel, othertechniques were used as focus group discussions, informal interactionsand meetings with the local village community.

Case narrative on tracing comprehensive abortion care(CAC) program in rural Telangana

Comprehensive abortion Care (CAC) is an integral component ofmaternal health interventions as part of the National Health Mission.Induced abortion has been legal in India for a broad range of conditionssince the passage of the Medical Termination of Pregnancy Act in 1971.The National Health Policy 2017 envisaged the incorporation ofcomprehensive abortion care as an integral agenda in the lifecycleapproach envisioned under the RMNCH+A framework. TheGovernment has in place provisions for free drugs and diagnostics inall public health facilities in order to strengthen the comprehensiveabortion care. Provisions for budgetary allocations have been ensuredfor training, operationalization, supply of drugs and commodities aswell as for communication for abortion services under the NationalHealth Mission. The main objectives of CAC are to assist serviceprovider in achieving and maintaining optimum standards of care, toassist in strengthening the current available abortion care services, to

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promote the concept of woman-centric care in the provision of abortionservices, to be used for CAC training in conjunction with guidelines onother aspects of maternal health and family planning (Ministry ofHealth and Family Welfare, 2018).

During the study a research inquiry was carried out on the Indianstate role on access of abortion services at the doorstep of rural women.At the ground level there was no abortion care program was existed inthe government institutions at a grassroots level which was witnessedin the social interaction with government stakeholders – Anganwadiworkers, ASHA workers, Auxiliary Midwifery (ANM) and MedicalOfficer at Primary Health Centre. Only in the very recent times from2018 onwards, the government of India had started mentioning aboutthe Comprehensive Abortion Care (CAC) under RMNCA under NationalRural Health Mission. But still no imprints of the ComprehensiveAbortion Care (CAC) implementation found in the study region.

For this study, an exercise of social mapping was done at thevillage level in order to locate where the local women go for abortionswhen experienced with unwanted pregnancies. For this, an attemptwas made to trace the whole structure of the local health care systemwhich was in place both formally and informally. The purpose was toenlist all those existed institutions which were found to be catering tothe rural women needs on abortion matters. It was important to knowabout them by their geographical locations and the category of theinstitutional settings whether it was a private or informal health careproviders or state-based health infrastructure units in this rural region.For this, both formal and informal health care providers of abortionservices were identified at the village and the regional level. The purposewas to question the credibility of these institutions for their role in theprovisions of abortion care for the local women and where do they standwhether at par with meeting the set parameters drawn under theabortion law of the country. Also to interface how the ground realityhad surfaced in this rural region and its critical relations with thelocal rural women seeking abortion care. The study had criticized theexisting health system for not being there in favour of women and hadreflected the poor health status of rural women in the region wherethe trend of need for abortion care for rural women are still not toomuch recognized till date.

Government machinery on the registration of pregnantmothers vs. abortion for unwanted pregnancy

The issue of abortion due to unwanted pregnancies was found totallyout of the purview of government health institutions. It was found


from the ground level that Sub Health Centre at Village level whereANM, ASHA, and Anganwadi Workers were dealing with local villagewomen on their pregnancies matters, but did not want to talk aboutthe abortion incidences taking place in the village outside of theirregistration records. Totally the focus was on the newly identifiedpregnant women and attending regular follow-ups with them and takingthem to have institutional delivery at the government institutions. Thethree tier structure of the state health system was found entirely focusedon handling the institutional delivery cases where normal pregnancycases were taken to PHC, the high risk pregnant women were eithertaken Area Hospital in Narsapur or at the District Hospital totallydepends on the nature of risk involved in the delivery cases.

A report was collected on Female Sterilization Camp orLaparoscopy Camp for the period (2013- June 2017) in the regionprepared by the FPAI based NGO health official. This report haddetailed about the number of women from two PHC- Jinnaram andGummudidalla based rural targeted areas which roughly comprised oftwenty villages and hamlets. Following were the details of the report:

Age of Women/ PHC PHC PHC PHC PHC TotalTotal Tubectomy Areas- Areas- Areas- Areas- Areas-Incidences 2013 2014 2015 2016 2017

(upto June)20-22 Years 1 7 3 5 4 2823-25 Years 40 36 32 52 23 23026-28 Years 45 39 32 57 20 22729-30 Years 4 5 3 5 1 2131-35 Years 1 1 0 1 0 4

Total 91 88 70 120 48 510

This report is the indication on how state machinery is proactiveon bringing rural women in the health camps to undergo the femalesterilization under an incentivized programme on family planning. Inthe time period of 2013- June 2017, approximately five hundred tenwomen had undergone female sterilization. 457 Women in the age group23 years – 28 years, 28 women who were too young in their 20-22 yearsand 25 women in the age group between 29- 35 years had undergonethe female sterilization.

The incentivized government programme on pregnancy andmaternity care where women are exclusively targeted for familyplanning is a clear narrative of regularization and controlling womenbodies. As women entity are justified for giving birth of two legitimatechildren within the sanctity of marriage. There was one hundredpercentage of coverage of rural women to undergo tubectomy in

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government hospitals through the initiatives of frequent health campsorganized for women with the transport facility and receiving monetaryaward of 1000 Rs. On the contrary women doing abortion due tounwanted pregnancy was perceived as very private matter to womenby the government senior health officials and according to them that‘swhy they go to private doctors or take medicine at home to terminatethe pregnancy. The perception of women doing abortion after the sexdetermination test is highly prevailed which restricted the approachof women doing abortion for other reasons and sometimes preventedthe women to have abortion at times. We have seen how the healthrecords had excluded the women going for abortion in private clinicsand was just restricted to only those registered pregnant women whowant to deliver the child and in case had to undergo therapeuticabortion mainly due to fetus anomaly. The Local ASHA workers toowere observed for not referring women for doing abortion in governmenthospitals and suggested that it involves lot of documentation processand it de motivated women to visit government hospital. On the otherhand the private health care institutions were seen more preferred bythe women for their speedy health package of abortion service.

Insights of a training for ASHA and ANM at primary healthcentre

I had visited Primary Health Centre on the occasion of monthly reviewmeeting with the ANM (Auxiliary Nurse Midwife) and ASHA workersthat fall under the jurisdiction of Gummadidala PHC (Primary HealthCentre). In this meeting, five ANM and eleven ASHA workers werepresented in the meeting and out them one ANM and three ASHAworkers were from Laxmipur village. In this review meeting mainlyANM and ASHA workers were given orientation on by then newlyintroduced scheme of the state government namely- KCR Kit. Underthe scheme, 13000 RS amount was allocated to spend on PregnantMothers upon their Ante Natal Care to the institutional deliverycharges. The health workers were told do the registration all pregnantmothers; take them for scanning as per the norm, nutrition to be given,medicines to be given and bringing these mothers to the PHC for theinstitutional delivery. Also did the revision exercises on how to identifyand maintain a record of high-risk mothers to meet the target to reducethe mortality rate of mothers and infants in the region. Among thepregnant women who were under the age of twenty years, those whohave more than three children, those Pregnant women having twochildren in the past by cesarean, Pregnant women having the historyof high blood pressure, diabetes, thyroid or any chronic diseases liketuberculosis, HIV/AIDS, heart problems were identified as High riskmothers and instructions of regular follow up with them and facilitated


to have child birth in a specialized Area Hospital located at Narsapur.On the other among women who had two children or more have to bemotivated for the family planning operation and to be brought ingovernment camps organized for women on female sterilization inSangareddy and Pathancheru at the district hospital level .

The training was given by a male project coordinator of the PHCon how to record data on the prescribed forms by the districtadministration in order cover the target population of the newly marriedcouples, unprotected couple, high-risk mothers, immunization ofpregnant mothers and children and follow-ups, family planningoperations reported under government camps. These forms are to befilled by all ASHA workers in her area against the total number ofhouseholds allocated in the village. ANM on duty of the respectivevillage has to supervise them and collect all the data from them andsubmit the reports to their respective PHC at the project officer desk.The project officer is responsible for data entry in computers and thensharing it with the District Health data management office throughonline submission after having reviewed by the Medical Officer of thePHC by the due date of submission to the district health department ofSangareddy.

It was observed that during this training there was no singleword of ‘abortion’ was uttered by any government health authoritativeperson from the PHC in their training module for the health workersnor any case was put up by the grassroots workers- ANM and ASHAworkers. While attending this meeting it was pursued from them tobring out any abortion related local women cases. But all the workersechoed in a single voice that we had no such cases reported from ourvillages. When I tried to speak out with some of the ASHA workersindividually, it was lately revealed by them that ‘as they did not haveany directions from their Health department to reach out women oftheir villages on abortion matters. Therefore they have not paid anyattention for abortion cases to be brought up into the notice of thehealth department or require any maintenance any records on it.Usually the abortion cases are of those registered pregnant womenfaces missed abortion at later stages of pregnancy or need to undergothe surgical abortion due to fetus anomaly.

It was understood from the grassroots workers that theyintentionally do not bring all those women pregnancy cases in therecord who do not want to carry pregnancy for various reasons or otherwomen who lately discontinue visiting them or stop taking health carefacilities without informing them. The local ASHA workers stated that,if they do then women and their families would raise objections. Also

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we all live in the same village and cannot keep bad relations with thecommunity and invite their enmity towards us. It is up to them whetherwomen want to register their pregnancy in the government record ornot. Also if we register any case of abortion against pregnancy conductedin the private health sector then it involves lot of legality and producinglot of documentation work from village level to the Primary HealthCentre then District Hospital. So our ANM discouraged us in the pastnot to get into this mess and even from the higher authorities also givemuch pressure on registered pregnant mothers and safe delivery forthem and zero down the maternal deaths and infant mortality in thevillage. This was the another reason behind where local Anganwadiworkers and ASHA workers gone by their ANM directions and theyalmost denied for having any information having on abortion historiesof women known to them. The initiative to meet local health workerswas mainly to get their references in order to meet those women forthe study but this did not work it out due the nature of abortion matterswere took it as confidential and nonexistent in the local health recordsat the village level as it appeared in the interaction with the localhealth staff.

The ASHA workers were found not so keen on taking up thesubject of ‘abortion’. They had completely avoided by simply statingthat we do not have such cases in our village and moreover do not fallunder our job responsibility. Also they took a stand that the issues ofabortion are actually the personal matters of women and of theirfamilies. How it is not right for them to enter their houses to find outto ask a woman whether did an abortion or not.’ It was then becomingcomplicated to take the discussion further with them as the subject ofabortion for unwanted pregnancy got more related to hold ASHA workerson policing on abortion matters and suspecting the women for herintentions on going for an abortion.’ But the whole point was to emphasishow the government institution needs to be more reliable for women tovisit for abortions in situations of unwanted pregnancy. The prevailedapproach of government officials that they have nothing to do withabortions for unwanted pregnancy have repercussions which playednegatively and it seems hard for women to search for a place wherethey are in need of abortion to do.

District health department on ‘abortion and rural women’ The Primary Health Centre located at the distance of 7 KM away atthe Mandal level where Women Medical Officer and other staff weredeputed by the health department of the district and doing the job ofImplementation and monitoring of Family Health Welfare Program.Under the Government health institution the Primary Health Centres


at Mandal or subdivision level located at Domadgu and Jinnaramsubdivisions, Community Health Hospital at Zonal level located atNarsapur and General Hospital at the District level located atSangareddy Headquarter.

Lack of abortion care in government health institutions In an interview with the Medical Officer stated that ‘we do have theonly medical facility for the ‘babies’ delivery and do not have anyprovisions for abortion care services at the PHC level’. And for thequestion whether any records are maintained at the PHC level onabortion for which she had completely denied. Also, it was observedthat there was no mention of any record/prescribed forms related toabortion. In training held at PHC level with ASHA and ANM healthworkers on the health record maintenance. The medical officer toldthat ‘we take the cognizance of only those abortion incidences wherewomen are advised to abort the pregnancy on the medical groundssuch as the development of abnormalities in the growth of the fetus orif carrying the pregnancy further risks the life of the mother or in caseof miscarriages only. Follow up for such cases are done only for thosepregnant women who have themselves initially registered at the sub-centre of the village either directly by the ANM or through ASHAworkers during their home visits to identify newly pregnant mothersto avail the provisions of Ante Natal Care (ANC) and Pre Natal Careat the Sub Centre/ local Anganwadi Centre/ Primary Health Centre(PHC)/ Community Health Centre (CHC) /Area Hospital/GeneralHospital at district level. Mostly such cases come in our notices onlyafter the third month of pregnancy onward to nine months or in caseof registered women had miscarriages naturally. All such cases arereferred to the Community Health Centre (CHC) at subdivision levelat Narsapur and General Hospital at Sangareddy at the district level.

It was very clear from the statements made by the Medical Officerthat there was no state machinery to reach out to those women who donot want to continue their pregnancy for the various social reason andin need of abortion care. There was no establishment of abortion careservice provisions at the government health infrastructure at Primaryhealth level and also the Medical Officer did not provide any clarity onthe subject of women seeking for abortion for non-medical reasons dueto unwanted pregnancy within the government health sector. So withoutany doubt it can be presumed that due to non-availability of healthcare services required by women for the abortion at the governmenthealth institution premises they were compelled to visit such privatehealth clinics who were giving substandard quality of health care andcould be more chances of running such private clinics illegally or even

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in case not registered with the government agencies or non-renewal ofthe license as per rule. This was also coming out from the womennarratives who had visited such private health clinics as they hadabortion care services at the cost which a woman or woman’s familycan afford in comparison to the other Nursing homes or Big Hospitalscharging the high fees for availing abortion.

Absolutely there was complete silence on the subject of ‘abortiondue to unwanted pregnancy’ from the sides of health officials at PHClevel and grassroots health workers at the village level and unmet theabortion needs of women/couples or women’s family living in this partof the rural region by the public health sector in contradictory to theirnational agenda of pro family planning approach and free access toabortion care under the legislation of Abortion law. Under suchcircumstances women in need of abortion care had limited options andonly left to visit the Private health clinics wherever the abortion serviceswere available. In the of absence of such proactive abortion care programwithin the outreach of rural women with unwanted pregnancy situationsgot more marginalized and pushed them sometimes in a moreimpoverished state for example - if the spouse behave in non-cooperativemanner or women living in abusive relationship wants to abortunwanted pregnancy or due to loss of job or poor economic conditionsor poverty do not want bear the pregnancy further or it’s against thewomen wish to continue the unwanted pregnancy or the couple takedecision to abort the pregnancy for any other reasons etc.

Conclusion - Intentionally women made invisible for theirabortion need

In the lack of appropriate health institutions for abortion care andnon-existent of the free discourse on women needs of abortion care hadmade women invisible going for abortion due to unwanted pregnancies.Consequently in many ways had pushed women to be mostly at thereceiving ends on facing the situations of unwanted pregnancies andwomen found to be more vulnerable in performing their sexual andreproductive roles in a patriarchal ideology based dominated societyand had faced domestic and sexual violence on the other end. Also verysubtly the revelation made about how the local rural women weresubjected to the risks of unsafe abortion when approached to theunauthorized health institutions and more chances of attended by theuntrained medical practitioners or using out dated invasive abortiontechnology. The belief system of women going for abortion in secrecy,again and again, sustaining to get normalized in the mainstreamdiscourse of abortion and becoming very easy to be unnoticeable andunrecorded before the government health institutions which actually


had undermined the women entitlement for the abortion care. In thepoor visibility of any government infrastructure on abortion care hadboosted the private health sector in taking a lead for the provisions ofabortion care without meeting any benchmark for giving qualityabortion care. Rather the abortion cost for the services in the privatehealth sector had added more burdens economically on women in facingthe situational need for abortion care due to unwanted pregnancy andbear the cost.

End notes

1 The terminology of abortion and termination of pregnancy are usedinterchangeably. The caution is taken as the term ‘abortion’ has variousconnotations. Therefore here it meant when pregnancy was terminatedintentionally for the main reason like unwanted pregnancy and rarelyfor the instances of medical termination where women were foundwilling to continue the pregnancy.

2 Women participants who in the past had conceived where they didnot want to continue their pregnancies due to any of their individualchoices, social and economic reasons or any other reasons other thanthe medical /therapeutic reasons to terminate the pregnancy.

REFERENCES

Jesani, A., & Iyer, A. (1995). Abortion: Who is responsible for our rights? In MaliniKarkal (Ed.), Ourlives, our health (pp. 114-130). New Delhi: CoordinationUnit, the World Conference on Women.

Ministry of health and family welfare (India) (2009). .India family welfare statistics.New Delhi: Ministry of Health and Family Welfare (India).

Ministry of health and family welfare (2018, January 5). Abortions. PressInformation Bureau, Government of India. Retrieved from http://pib.nic.in/newsite/PrintRelease.aspx?relid=175379

Ministry of health and welfare, government of India (2015, February). Guidance:Ensuring access to safe abortion and addressing gender biased sexselection. Retrieved from http://www.nrhmtn.gov.in/guideline/SafeAbortionHandbook.pdf

Ministry of family health and welfare (2018). Comprehensive abortion care-Training and service delivery guidelines (Second Edition). National HealthMission Government of India. Retrieved from https://nhm.gov.in/New_Updates_2018/NHM_Components/RMNCHA/MH/Guidelines/CAC_Training_and_Service_Delivery_Guideline.pdf

Petchesky, R. P. (1990).Abortion and woman’s choice: The state sexuality andreproductive freedom. Boston: Northeastern University Press.

Singh, S., Shekhar, C., Acharya, R., Moore, A. M., Stillman, M., Pradhan, M. R.,& Sundaram, A. (2018).The incidence of abortion and unintendedpregnancy in India, 2015. The Lancet Global Health, 6(1), e111-e120.

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CASE NARRATIVE ON TRACING COMPREHENSIVE ABORTION …