‘What I know of the divine science and Holy Scripture, I learnt in woods and fields.’
St. Bernard, Epistel 106
THIS note is based on two true life case histories drawn from the study ‘Abortion Seekers and Informal Service Providers’ – conducted by Karuna Trust, Yelandur both in tribal and non-tribal areas such as B.R. Hills, Yelandur, T. Narasipur taluk and Kollegal taluk of Chamarajanagar district during August 2002 and April 2003 through focal group discussions.
Basamma became a widow when she had conceived for the third time. The death of her alcoholic husband, coupled with the responsibility of her two young children, forced Basamma who was barely leading a hand-to-mouth existence to go to Ketamma. She requested Ketamma for herbal medication to induce an abortion. Ketamma who had been giving hasiru soppina aushadhi or ‘the green herbal medicine’ orally to abortion-seeking women for over three decades, resides in Kanneri Colony of B.R. Hills. She is uneducated and belongs to the Soliga community. Ketamma had become known to the womenfolk because of ‘word of mouth’ publicity and had learnt the procedure of giving ‘hasiru soppina aushadhi’ as a family tradition.
After receiving confirmation that she (Basamma) was still in her 10th week of pregnancy and drawing on her own ability to assess the duration of pregnancy, Ketamma administered the herbal medication to Basamma orally for three consecutive days inducing abortion. The induced abortion was uneventful and Basamma resumed earning a livelihood by the 10th day after the abortion.
However, for the last five years Ketamma, who is now 70 years old, has stopped giving herbal medication because of poor eyesight (kannu manjagiruvudu). Her age and reduced eyesight has prevented her from gathering the medicinal plants and preparing the medication. Throughout her service to ‘abortion seekers’, Ketamma followed her own ethics of not giving the green herbal medicine to women whose pregnancies had advanced beyond 12 weeks. This in a way prevented the women who voluntarily sought abortion inducing medicines from developing any complications.
Doddatayamma of Gumballi village is an elderly woman aged around 65 years. Doddatayamma started her job as an abortion service provider to the needy women about three decades back. About 30 years back when I still had not got into this profession of giving abortion inducing kashaaya (decoction of herbal medicine), an unmarried girl who had become pregnant begged me to help her out. Since her parents were unaware of their daughter’s plight and the man who was responsible for her pregnancy was already married and had disowned this teenage girl, I took her to an experienced ‘abortion causing herbal medicine provider’ in a near by village called Kestur. The girl was only two months pregnant, I looked after her for a week to make sure that she did not suffer from any complications after having the abortion.
Doddatayamma had learnt to prepare the herbal decoction from the same lady (who provided the herbal medicine to the girl who was helped by Doddatayamma) and started working as a abortion service provider. Doddatayamma also gave herbal medication to women who had delayed expulsion of placenta, following delivery at home.
Usually women who seek oral herbal medicine from Doddatayamma would abort after consuming the herbs for two or three days. If the woman did not get a stomach ache or hotte novu (abdominal pain as a result of uterine contraction prior to abortion) Doddatayamma would mash fresh ginger (shunti) and mix the mashed ginger with jaggery which would induce a stomach ache, i.e. induce uterine contractions, thus leading to abortion. Doddatayamma would only give medicine to women who were no more than 16 weeks pregnant.
Though Doddatayamma no longer gives abortion inducing herbal medicine, she has trained a couple of women who are in their early forties to provide the same services. Doddatayamma was forced to give up her profession by her sons, when one of them accused her of being responsible for his wife losing two of their children because she helped other women to get their pregnancies terminated!
Nowadays, if any woman wants to undergo termination of pregnancy, Doddatayamma takes them to Ashwini Hospital in Kollegal and requests the doctor to conduct an abortion. Doddatayamma receives Rs 50 for each case of MTP conducted by the doctor whenever she accompanies the pregnant woman.
Ketamma and Doddatayamma represent a category of ISPs or informal service providers of abortions – their tribe having existed from time immemorial in the villages and tribal areas.
Who are the women who seek abortions from women ISPs? According to the study conducted in Gumballi village, B.R. Hills and tribal areas of Kollegal taluk, women seek abortions in order to have spacing between pregnancies. Also, when there is failure of contraception; when women are deserted and ill-treated by alcoholic husbands; when women have given birth to mentally or physically disabled children the phobia of having one more such child prompts them to go in for an abortion; and when the pregnancy is due to an extramarital affair or is illegal as in the case of widows or unmarried teenage girls.
What are the methods used by women ISPs to induce abortion? Abortion is induced by oral administration of herbal medicine, usually given for a duration of three to four days. Occasionally abortion is conducted by ISPs by introducing a stick into the uterus.
What makes women ISPs who give herbal abortion inducing medicines popular in villages and tribal areas?
Women ISPs are compassionate towards an abortion-seeking pregnant woman’s plight. They maintain strict confidentiality about the identity of the woman wishing to undergo abortion, which provides a much needed ‘emotional security blanket’ to the patient. Herbal medicine providers for ‘abortion-induction’ are very experienced and inexpensive. Such ISPs sometimes do not demand anything except some foodgrains or old clothes for their services. No serious complications have been reported from women who have utilized such services in the past three decades.
Herbal abortion-inducing medicine providers (i.e. women ISPs) follow their own code of ethics of inducing abortion in women whose pregnancy is usually below 16 weeks duration. The occasional complication reported following such abortion is only prolonged uterine bleeding but such women have been admitted to hospitals by women ISPs and timely treatment has been provided on each occasion.
The 3-Cs that make a traditional woman ISP popular among abortion seekers are confidentiality, compassion, and cost effectiveness.
Though one of the major causes of maternal mortality is unsafe abortion practices, there has been a dearth of community-based studies to understand the nature of abortion inductions. Hence, there is a need to examine and continually evaluate the role played by the informal providers of abortion services.
Though there is a declining trend in seeking informal abortion providers’ services, even now a considerable amount of abortion services continue to be undertaken by them. The timely intervention by women ISPs (below 12-14 weeks of pregnancy of an abortion seeker) probably explains the lower rate of complications in their services. It is also imperative to understand the nature and efficacy of the herbal medicines widely used by the informal providers through further research. The study conducted by the Karuna Trust recommends that there is a need to create a legal environment to encompass the services of the ISPs along with other MTP services and to regularize and provide training programmes for women ISPs by the government, similar to the dais training programme. Finally, clinical trials need to be organized to assess the efficacy of herbal medicines in inducing ‘safe abortions’.