Seeking Solutions to Safe Abortion in India

Photo by Naganath Chilveru from Unsplash

Shrini nervously scrolled on her phone as the rest of her family slept. She had missed her period last month and feared that it meant bad news. Too scared to consult her mother or friends - she turned to the Internet.

She searched for information on missing periods, which led her to websites and social media pages on pregnancy and abortion. YouTube was loaded with videos about abortion pills and inaccurate home remedies, such as - eat papaya so its acid results in miscarriages. Facebook and Twitter users were furiously telling her that an abortion was forbidden - a sin.

Shrini was overwhelmed and conflicted, but she kept searching. Was abortion legal in India? What was the process? How could she secretly take care of this dilemma? Did an abortion mean she could never again have a baby?

Shrini’s story is similar to thousands of women in India. Sexual and reproductive health remains a taboo topic, preventing women from seeking information and services related to family planning - especially abortion.

In 2015, there were 48.1 million pregnancies in India, of which half were unintended - meaning they were wanted later or not at all. Limited access to contraceptives, lack of knowledge around sexual and reproductive health, and desire for a son are just some of the barriers to having healthy and desired pregnancies.

These barriers have led to an alarming demand for medication abortions or “abortion pills”. India has seen a 646% increase in misoprostol pills sales in the last five years. Further, 81% of abortions were achieved using medication abortion obtained from health facilities, chemists, or other sources. For girls and women, using medication abortion is a private and quick method, away from judgmental doctors and nosy neighbors.

Though abortion has been legal for 49 years in India, the first national study of the incidence of abortion and unintended pregnancy was only conducted in 2015. Using surveys in several states, the study’s complex methodology proves that quantifying completed abortions and need is challenging. Furthermore, girls and women hesitate to report abortions, leading to a considerable under reporting of abortion and mis-classifying abortion-related deaths.

Since it is hard to gather data from girls and women on taboo topics like abortion, Quilt.AI has found an alternative solution to the following questions: 1) how else can we know the needs of women and girls when it comes to abortion and 2) how do we reach them with accurate information and services?

It is quite simple - we must leverage the Internet as girls and women are turning to it for confidential information like medication abortion.

The Internet as a Research Field

Quilt.AI uses the largest research field in the world, the Internet, to collect crucial information on topics that impact the future of humanity. Search data represents human truths by providing an unfiltered lens into what people are actually looking for.

For example, girls such as Shrini might post her favorite dance videos on Facebook to project a certain image on social media while privately searching for information on ‘where to get condoms’ and ‘signs of pregnancy’.

People used the Internet at soaring rates during COVID-19 so we used search data to learn about challenges in accessing SRH and abortion services. During the national lockdown, the government mandated family planning and abortion as an essential service. However, restricted movement, limited transport services, and overwhelmed hospitals have made it increasingly harder for women to receive medical help. In April 2020, it was estimated that the disruption from lockdowns left up to 26 million couples unable to access contraception, leading to an additional 2.3 million unintended pregnancies and over 800,000 unsafe abortions! The dire need for abortion services before and during COVID-19 is known, but it is hard to quantify given the stigma around abortions.

Our team at Quilt.AI set out to understand abortion-related needs and the impact of COVID-19. We analyzed search data before and during the pandemic’s lockdown across city, district and village levels from 5 Indian states: Bihar, Jharkhand, Maharashtra, Rajasthan, and Uttar Pradesh.

During the week of International Safe Abortion Day, our findings reflect its important mission - to secure safe, affordable, and legal abortions by meeting girls where they are - online.

Secret Searches are Just the Beginning

There is a preference and high uptake of medication abortions in India, which is also reflected in our online analysis from Patna, Bihar. Out of all the searches related to interest in family planning we studied, 13% were on abortion pills and 12% on abortion services. Searches for understanding abortion corresponded with searches for abortion pills. Girls were also looking for other private abortion methods like home remedies. About 12.5% of searches for abortion methods were related to natural, herbal and home abortions compared to searches for clinical services. Search keywords for these include “natural abortion” and “abortion tips at home”. Many of these searches led to ‘influencer’ videos on YouTube that are homemade with Hindi text and oral narration.

The videos provide alarming advice such as conducting home abortions by “rubbing custard apple seeds inside your vagina repeatedly for a few days” or “the vitamin C in papaya facilitates regular periods and the acid results in miscarriages”. These types of searches point to the desire for discretion and privacy to address abortion and potentially find comfort in using natural approaches.

The Pandemic’s Impact

During COVID-19, complicated access to abortion clinics has only amplified the demand for abortion pills and home abortions. During the nationwide lockdown, searches for abortion pills spiked between March to June. The trend is more pronounced in cities that saw a 48% increase than in districts which only had a 14% increase. In January, there were almost 15,000 searches for abortion pills/home abortions which grew to nearly 20,000 searches a month in March, when lockdown started. There were spikes in searches for abortion pills/home abortions across all states but it is especially stark in Rajasthan. We also found that searches for abortion pill brands (particularly RU-486) were especially popular along with information on its side effects.

This trend reflects activists’ concerns that girls and women are struggling to get medical help. Instead, they are pushed to take abortion pills without supervision or seek help from people who lack training. For example, informal advice on home abortions flourished across alternative online platforms such as local parenting/ health websites and ShareChat.

The Urgency to Access Abortions Continues

We also found that among abortion topics, price, location, and privacy are key concerns for abortion services sought. Before COVID-19, searches for medical or surgical abortions relate to clinical, doctors, and hospitals that are close by. Keywords such as “abortion services near me” and “where to get an abortion” highlight the importance of proximity which indicates urgency. During the pandemic lockdown, searches for abortion clinics have declined in cities from almost 8,000 search in March to 2,000 in April. On the other hand, searches for ‘abortion clinic’ remained relatively flat at the district level. Despite the gradual decline in searches for abortion clinics, there are still searches for “abortion clinics near me” which signifies urgency.

Even during the pandemic, NGOs and independent news agencies are driving awareness about abortion access issues. The Population Foundation of India, YP Foundation, and CREA are some organizations disseminating information on accessing safe abortions during COVID-19 and demanding accountability.

Numerous studies demonstrate that the journey to learning about or having an abortion starts at missing one’s period. A critical and early part of this journey is the use of online searches to gather information or access services. The results can often be crowded and full of misconceptions and myths. At the same time, search platforms provide confidentiality, anonymity, and serve as a powerful self-care tool. We can unlock a search platform’s potential to direct girls or women to accurate information even before they walk into a clinic or take abortion pills without medical supervision. For example, an online intervention can include redirecting abortion-related searches to websites and videos with friendly and accurate information.

By reaching girls and women where they are and on time - we can equip them with the right information and options to access safe abortions, enabling them to make better decisions for a healthy future.