Modern health care, specifically abortion care has made access to abortion services easy in India. Abortion services remain predominantly in the private sector when it comes to metropolitan cities. The practice of abortion was made legal in 1971 and ever since abortion is legally allowed to be carried out only by those certified under the Medical Termination of Pregnancy Act. Certification is available to all allopathic doctors who meet the requirements under the MTP Act. Hence, in metropolitan cities of India, there is no dearth of certified abortion providers. One of the factors that determine the charges for abortion is the location of a pregnancy abortion clinic in Chennai.
Literature on abortion costs in India
The focus of growing literature on abortions in India is on unintended pregnancy rates, health consequences of unsafe abortions, and limited access to abortion services. There has been no data on the real economic cost of abortion and its burden on women. An abortion can succumb a woman to incur various expenditures in both direct and indirect forms. All Indian household survey on abortion-related expenditure has not been conducted so far. Micro-level surveys carried out in a specific state, district, or district specially focussing on abortion have been the only available literature to derive the cost of abortions in various parts of India. Though the sample size of these surveys is very small, there is some revelation of the expenditure incurred by women on abortion in India. These studies have expressed that women living in metropolitan cities of India have to incur some expenditure to get MTP services even from public clinics though they are expected to provide free services. Government providers still being cheaper and probably safer than illegal providers has made it a feasible option for abortions.
Wide range of abortion services across metropolitan cities
The quality of abortion services offered and the charges for those services vary according to the different segments of a city’s population that the providers cater to. A small-scale study on different types of MTP providers in the capital city reveals that there is a wide range of services available across the city. Government hospitals, family welfare centers, clinics run by NGOs like the Family Planning Association of India, government-approved or unapproved private clinics, qualified private doctors as well as illegal providers like dais and quacks are the different abortion services available in a metro city. A large extent of the safety and cost of abortion provided would depend upon the method of abortion used by the providers. The most commonly used method of abortion in India has for a long time been through dilatation and curettage (D&C). Alternative methods of early abortion such as manual vacuum aspiration (MVA) are not widely practiced, even in the government-operated abortion clinics in metro cities of the country. Because of this, the average cost of abortions incurred by women living in metropolitan cities becomes very high.
Abortion cost variability in metropolitan cities
The cost of abortions located in metro cities such as abortion centers in Chennai varies considerably, depending on the provider being certified and the clinic is registered under the MTP Act. A private nursing home or clinic would charge more for a second-trimester abortion using anesthesia than for a first-trimester medication abortion. The pricing of abortion services is unregulated in India. Stigma and secrecy that accompany abortions in India, paves for abortion cost to women being determined by supply-side economics prevalent in metro cities. Employees State Insurance Scheme, Central Government Health Scheme, Mines and Plantations Acts, and Maternity Benefit Act are the only social insurance programs that offer fixed abortion charges. Such programs benefit fixed abortion rates which are reimbursed only for a small population with such cover in metropolitan cities.
According to recent studies undertaken under the aegis of the Abortion Assessment Project, India, dimension in private sector abortion economics, relates to the methods used for abortion. Certified and uncertified abortion providers may insist on curettage procedure even for very early abortion and also demand forcefully for check curettage after vacuum aspiration. This widespread practice can add to the cost as well the risk of post-abortion infections and other complications contributing to 13% of maternal deaths. Thus, abortion costs due to botched abortions and complications could be seen high in metropolitan cities.
Cost of medical abortion in metropolitan cities
The cost of medical termination of pregnancy using an MTP kit may range from Rs 350 to 600 depending on the brand of medicines prescribed. As per MTP Act, MTP kits cannot be sold without a prescription from a licensed doctor for abortions. This scenario can encourage chemists and drug stores to dispense the kit without a prescription at higher costs.
Cost of surgical abortion in metropolitan cities
The cost of surgical abortion in metropolitan cities differs with individual cases of abortion requirements like:
- The number of weeks of pregnancy
- Abortion method used
- Type of anaesthesia required
- Need for a pregnancy test, blood tests, ultrasound, and other laboratory tests
- Medications if necessary
- Duration of hospitalization if needed
There are 2 types of surgical abortions that can be provided for second-trimester abortions. Vacuum aspiration and D&C with evacuation. The overall cost of surgical abortion including basic hospitalization and post-abortion care costs in metropolitan cities in India can range from INR 20,000 to 30,000. The cost of a surgical abortion can vary depending on various factors in force. A reference for the average cost for the two different methods of surgical abortion available in metropolitan cities of India is based on data derived from cities of Delhi, Mumbai, Pune, Bangalore, and Chennai. Average cost of D&C abortion can range from 20,000 to 30,000 and 35,000 to 45,000 for vacuum aspiration abortion. Abortion doctors in Chennai may charge for surgical abortions depending on the experience, amenities of the clinic, and the tests required for evaluation. Charges towards hospital stay and anaesthesia may vary based on the condition of the patient.