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Recent data from the National Family Health Survey (2019-21) reveals striking insights about family planning in India: while 75% of married women express a need for family planning, only 67% have access to contraceptive methods
As per the fifth National Family Health Survey, 3.6% of the women who sought abortions attributed their pregnancies to contraceptive failure
Have you ever wondered why healthcare providers emphasize the importance of understanding different reproductive health options and making informed choices? At the heart of this conversation lies a crucial distinction between two often-confused terms – contraception and abortion. Understanding their differences can transform how we approach reproductive health decisions.
Dr. Astha Agarwal, Consultant Obstetrician & Gynecologist, Max Super Specialty Hospital , Vaishali , Ghaziabad, says, “As an obstetrician, I see women every day who stand at crossroads, caught between making informed and proactive choices about their reproductive health and seeking emergency options in the absence of planning. Some seek my counsel about contraception, while others are presented with the option of terminating an unwanted pregnancy. In India, where cultural taboos, gender norms, religion, and social norms influence individual choice to a significant extent, women often find it difficult to access contraception services and safe abortion care.”
While contraception is a preventive intervention for unwanted pregnancy, abortion is a corrective intervention for those with an unwanted pregnancies and/or health issues. Both services must be available for women to make choices right for them. However, choosing a right contraception should always be the preferred option or rather a smart choice for women who are not planning to get pregnant.
Recent data from the National Family Health Survey (2019-21) reveals striking insights about family planning in India: while 75% of married women express a need for family planning, only 67% have access to contraceptive methods. Furthermore, nearly half (48%) of reported abortions were due to unplanned pregnancies. This means that women have inadequate access to preventive methods and are seeking abortion services for averting an unwanted pregnancy. Abortions, especially if not carried out under the guidance of a doctor, can have long term healthcare consequences.
Modern contraceptives have emerged as a powerful tool in global healthcare, with an impressive 99% effectiveness rate when used correctly. This reliability has contributed to their widespread adoption, with WHO reporting that 842 million women of reproductive age worldwide now use modern contraceptive methods. The impact is significant: contraceptive use prevents an estimated 67 million unintended pregnancies each year, while simultaneously reducing maternal mortality rates by 40%. This interconnected benefits underscore contraception’s crucial role in protecting women’s health and enabling families to choose and plan their future.
Dr Agarwal shares key differences:
The distinction between contraception and abortion extends beyond their basic purposes to encompass methods, accessibility, and duration. Contraception offers a spectrum of choices, from daily birth control pills and barrier methods like condoms to long-acting options such as IUDs and IUS and more recently subdermal implants, all available through healthcare providers.
Conversely, abortion involves either medical pills or surgical procedures, typically requiring trained and licensed healthcare facilities and providers. The legal framework surrounding these options also differs significantly: while contraceptive access is widely available, access to abortion services can vary as per the policy and legal framework across regions.
Another crucial difference lies in their duration and reversibility: contraceptive methods can be either temporary or long-term, allowing users to start or stop based on their family planning needs, while abortion is a one-time medical procedure with possible long-term effects on body and mind.
Dr Agarwal shares the different types of contraception
Women can make a choice between temporary and permanent methods. Permanent methods like tubectomy for women and vasectomy for men are permanent. It doesn’t have any major adverse side effects on either males or females. However, couples should be certain of their decisions, long term goals and discuss options with their gynecologist.
Among temporary methods that provide long terms protection, women can choose from a wide array of options which provide protection for three to five years, and with some products even longer. Women can choose between uterine and non-uterine methods. Copper Intra Uterine Device (IUD) or Hormonal (IUD) are long term methods that are highly effective. These are T shaped devices which are placed in the uterus and are commonly used by women for birth spacing and even after completing families.
The latest in the category, sub-dermal implant is a non-uterine method which is a small hormone eluting device placed under the skin of the non-dominant arm. It provides long term protection from pregnancy and according to WHO, is 99.99% effective. Implants are discreet, non-uterine, suitable for women who want to delay their first pregnancy, for birth spacing, and for limiting family size. The return to fertility with implants is very quick; therefore, its often a choice of method for many.
Among short-term methods, couples can choose options such as condoms, daily oral pills, vaginal rings and injectables. Based on your health condition and contraceptive needs, your doctor can suggest a suitable method for you. Many hormonal methods also have non contraceptive benefits also like they can be used for the treatment of acne, irregular periods, symptoms of PMS, endometriosis, and polycystic ovary syndrome (PCOS).
Limitations of contraception
As per the fifth National Family Health Survey, 3.6% of the women who sought abortions attributed their pregnancies to contraceptive failure. It is not just the lack of knowledge that leads to contraceptive failure, but also other barriers.
Hormonal methods, while highly effective, may not be suitable for everyone. Barrier methods require consistent, correct usage and can fail due to human error or product defects. Even long-term options like IUDs have their drawbacks, including insertion discomfort and potential expulsion. Practical challenges such as cost, accessibility, and the need for regular medical consultation can also impact contraception uptake. Understanding these limitations is crucial for making informed decisions about reproductive health, as no single method offers a perfect solution for all users
The government-issued Comprehensive Abortion Guidelines says, “no contraceptive is 100% effective and therefore, safe abortion services would always be a necessary component of reproductive healthcare.”
Abortion – The Reality, in India
Despite the availability of contraception, unintended pregnancies occur through contraceptive failure, unavailability, or rape. In these instances, abortion is still a legal and medical solution for women.
Abortion, where it occurs, must never be a substitute for contraception. Access to safe and legal abortion services must be guaranteed, but efforts have to go beyond that to prevent unwanted pregnancy in the first instance.
Despite the fact that abortion is secure if performed by expert professionals in a lawful setting, unsafe abortions are still a source of worry in India. As per Lancet Global Health, 78% of abortions are carried out outside of health facilities, leading to severe complications.
The Legal Framework: The Medical Termination of Pregnancy (MTP) Act
India’s abortion legislation is liberal compared to the majority of countries. One of the important features of this law is that women( age > 18 yrs) do not need spousal or parental consent to undergo an abortion, which guarantees the women a better control over their reproductive decisions. The Medical Termination of Pregnancy (MTP) Act, 1971, amended in 2021, allows for abortion under these circumstances:
• A woman can terminate a pregnancy with the consent of one doctor up to 20 weeks.
• Special categories of women (survivors of rape, minors, women with disabilities, or women who have been victims of incest) can have an abortion with the approval of two doctors until 24 weeks.
• Severe foetal deformities are the only reason a woman is allowed to terminate a pregnancy after 24 weeks and this has to be approved by a Medical Board
Medical constraints include strict timing requirements, as procedures vary based on gestational age and carry different risk levels. Legal restrictions vary widely, potentially including mandatory waiting periods, parental consent requirements, and provider limitations. Furthermore, psychological and social factors, including emotional impact and the need for support systems, must be considered. These limitations underscore the complexity of abortion care and the importance of comprehensive healthcare support systems.
It should be responsibility of healthcare providers to educate women about smart contraceptive choices, provide non-judgmental abortion services and support better reproductive health policy.
Society as a whole must assist the women during reproductive years and male partners should also learn about contraception and encourage their female partners in making smart contraceptive choices.
“As an obstetrician my perspective is that contraception is the first line of defense in preventing unwanted pregnancies. A women fertility is her choice, and she should be encouraged to freely make this smart choice. Putting a high value on contraception translates into limiting the incidence of unwanted pregnancies, and hence the need for abortion—to a healthier, better-educated population,” signs off Dr Agarwal.