ABORTIONISTS AND J. C. BHATIA* ABORTION SEEKERS Induced abortion as...
ABORTIONISTS AND
J. C. BHATIA*
ABORTION SEEKERS
Induced abortion as a means of getting
The present study is an attempt to find
rid of unwanted pregnancy has been in out the type of practitioners who are likely
vogue since times immemorial. In India, to be most popular among the abortion
particularly in the rural areas, a large seekers alongwith a few demographic
number of abortions are being performed characteristics of the women who seek
by unqualified medical practitioners under abortions.
most unhygienic conditions. Although medi-
cal termination of pregnancy Act has been
METHODOLOGY
enforced in the country from 1st April,
1972, this has not made any appreciable
The following procedures were used for
difference in the number of abortions still conducting this study (i) This study is con-
being performed by unqualified hands as fined to practitioners of indigenous medi-
is evident from the report of the Director cine1 in one of the community development
General of Health Services for the year blocks of Ludhiana District in Punjab. In
1972. This report indicates that during addition, the practitioners having their
seven months from 1st April to 30th Octo-
clinics in the adjoining market places/towns
ber, 1972 only 8535 terminations have who were patronised by the villagers from
been performed in the country under the the community development block, were also
Act. The analysis of the report further included in the study. (ii) All the indige-
shows that among the abortion seekers nous medicine practitioners in the area
only 10.5% belonged to rural areas. This were identified by knowledgeable persons
number is insignificant considering the of that area like school teachers, panchayat
millions of illegal abortions which take members, fellow practitioners, health and
place in the country every year. Due to other block officials who make routine
some of the socio-economic, psychological visits to these villages and also from the
and situational factors, the women prefer office bearers of the various Ayurvedic,
to seek the help of these practitioners to Unani, Homoeopathic and other private
terminate their unwanted pregnancies.
practitioners organisations in the area. The
Inspite of the importance of the subject, Register maintained by the Registrar, Board
this area has so far remained unexplored of Ayurvedic and Unani Systems of Medi-
and very few empirical investigations have cine, Punjab was also consulted. (iii) Keep-
been conducted due to the obvious diffi-
ing in view the delicate and sensitive nature
culties involved in collecting reliable data of investigation it was thought most essen-
on the various aspects of abortion.
tial to establish a good rapport with the
* Mr. J. C. Bhatia is Senior Research Officer, Indian Council of Medical Research, New
Delhi.
1 The indigenous medicine practitioners for the purpose of this study have been defined as
those who derive all or major part of their livelihood as Vaids using Ayurvedic System
(Science or knowledge of life), as hakims practising the Unani (Unani or Greek System),
as Homoeopaths using homoeopathic system or as generalists using no one system of medi-
cine but borrowing freely from all systems including allopathic or modern.

276
J. C. BHATIA
practitioners. This also followed out of
FINDINGS AND DISCUSSION
another longitudinal study3 on community
health problems in which the author was
Forty-six medical practitioners of Indi-
involved as a member of the research team genous systems of Medicine were practising
and as part of that, lived in one of the in the villages of the community develop-
villages of this block, for a period of about ment block under study. Further, there
five years. Contacts with the practitioners were 16 practitioners of the same type,
were strengthened by paying courtesy calls practising in the market places in and
to them in their respective villages as around the study area who catered largely
well as inviting some of them to the author's to the medical care needs of the people of
residence for tea, lunch or dinner. This this block. Not all these practitioners, how-
helped in creating confidence in them, ever, induced abortions due to various
thereby ensuring better reliability of res-
reasons, ethical, religious, medical or legal.
ponse from them. (iv) In all 62 practitioners There were 36 practitioners who were per-
were contacted and interviewed with the forming abortions with considerable varia-
aid of a guideline. An interview guideline tion among them as to the number of abor-
was preferred to a structured schedule be-
tions performed. The analysis here is
cause of its flexibility. All the interviews limited to these 36 practitioners who per-
were conducted during February to April formed abortions. The number of abortions
(3 months) 1970. (v) Different recall periods performed by them has been studied with
ranging from one month to one year were reference to their salient characteristics in
tried. One month was found to be the most order to find out the type of practitioners
suitable recall period for which the prac-
who are likely to be more popular among
titioners could give most reliable informa-
the abortion seekers, the index of popu-
tion. (vi) Information was solicited with larity being the number of abortions
regard to the salient characteristics of the performed.
practitioners such as age, general and pro-
fessional educational level, caste, daily
NUMBER OF ABORTIONS PERFORMED BY
patient load, income and number of abor-
INDIGENOUS MEDICINE PRACTITIONERS
tions performed by them during the refe-
ACCORDING TO
rence period. The information about the
demographic characteristics of the abortion
PLACE OF PRACTICE : As mentioned in the
seekers was also obtained from the prac-
preceding paragraphs, in addition to the
titioners.
practitioners practising in the villages of
The information on complications and the Community Development Block studied,
mortality resulting from abortions was diffi-
other practitioners who had their clinics in
cult to obtain as the practitioners were the adjoining market places or towns usually
reluctant to admit of any case induced by patronised by villagers from the area
them which resulted in serious complica-
studied were also included in the sample.
tions and mortality.
Out of a total of 36 practitioners 25 or
2 The Functional analysis study of the Primary Health Centres in which the author was
involved, revealed that a small fraction of the villagers utilise the Government health
services and an overwhelming majority of sickness cases are attended to by Indigenous
Medicine Practitioners. It was decided to undertake a detailed and comprehensive study
to unfold the role of these practitioners in providing medical care to a large segment of
rural population. As a consequence, the contacts with the practitioners were developed.

ABORTIONISTS AND ABORTION SEEKERS
277
69.4% were practising in the villages while
This may be because the practitioners
the remaining 11 or 31.6% had their clinics practising in the semi-urban areas are more
in the nearby market places and towns.
liberal, have better facilities, have more
The number of abortions performed by clientele, are comparatively better known
the indigenous medicine practitioners in and have wider contacts.
relation to their place of practice is shown
below in Table 1.
PROFESSIONAL EDUCATIONAL STATUS
T A B L E 1
An overwhelming majority of the prac-
titioners who performed abortions viz 28
N U M B E R OF ABORTIONS PERFORMED BY THE I.M.P'S
out of 36 or 77.8% did not have any formal
BY PLACE OF PRACTICE
training in a recognised school of indige-
N = 36
nous medicine. Only a small minority of
8 or 22.2% of the total reported had
undergone some institutional training. The
number of abortions performed by both
these groups of practitioners are indicated
in Table 2.
T A B L E 2
N U M B E R OF ABORTIONS PERFORMED BY THE I . M . P ' S
ACCORDING TO THEIR PROFESSIONAL EDUCATIONAL
STATUS
N = 3 6
(Figures within brackets show percentages)
The above table clearly shows that the
number of abortions performed by the
I.M.P's is closely related to their place of
practice. Those practising in the villages
performed lesser number of abortions as
compared to those practising in the market
places and towns. The average number of
abortions performed during the reference
period of one month by those practising in
the villages and market places/towns works
out to be 6.7 and 16.7 respectively.
(Figures within brackets show percentages).

278
J. C. BHATIA
It is evident from the above table that combination of different systems of medi-
unqualified practitioners performed more cine but the relationship between the system
abortions as compared to those who were of medicine mainly practised and number
institutionally qualified. The average
of abortions performed has been analysed.
number of abortions in case of the former The findings are presented in Table 3.
works out to be 10.6 while the latter cate-
gory of practitioners on an average per-
Table 3 shows that out of the
formed 6.6 abortions in a month. The most total, 77.7% were mainly practising allo-
plausible reasons for this difference seem to pathic or modern system of medicine, while
be that because of certain professional the remaining 22.3% were resorting to in-
ethics, the institutionally qualified practi-
digenous modes of treatment most of the
tioners are more selective in taking up time. The number of abortions performed
cases for abortions and are better aware of by those practising allopathic or modern
the risks involved. On the contrary the only system of medicine is far more than those
consideration which weighs with the un-
practising mainly indigenous system of
qualified practitioners is pecuniary and all medicine. The average number of abortions
cases of abortions are welcome to them performed by the former is 10.8 while for
so long as the abortion seekers are willing the latter it works out to be 5.9.
and able to pay their fees irrespective of
the various risks involved.
DAILY PATIENT LOAD
SYSTEM OF MEDICINE MAINLY PRACTISED
The practitioners have been divided ac-
The practitioners may be practising a cording to the number of patients seen by
them in a day. The practitioners who see
TABLE 3
less than 10 patients daily may be called
N O . OF ABORTIONS PERFORMED BY I.M.P'S
not busy. Those having between 11-30
ACCORDING TO SYSTEM OF MEDICINE MAINLY
PRACTICED
patients as moderately busy; those between
N = 3 6
31-50 as fairly busy and the practitioners
having a daily patient load of above 50
may be termed as extremely busy.
Table 4 explicitly brings out a
direct relationship between the daily patient
load and number of abortions performed
by them. The busier practitioners have
more wider contacts and therefore are
popular among the abortion seekers too.
CASTE
Caste-wise the practitioners who perform
abortions have been grouped into 2 broad
categories viz. practitioners belonging to
higher castes and those of middle and lower
(Figures within brackets show percentages)
castes. In the former category there are 28

A B O R T I O N I S T S AND A B O R T I O N S E E K E R S 279
TABLE 4
N O . OF ABORTIONS PERFORMED BY I.M.P'S ACCORDING TO THEIR DAILY PATIENT LOAD
N = 36
*(Figures within brackets show percentages)
TABLE 5
practitioners while the remaining 8 belong
to the latter caste group.
NUMBER OF ABORTIONS PERFORMED BY I.M.P'S
The relationship between caste affiliations
ACCORDING TO CASTE OF THE PRACTITIONER
of the practitioners and number of abor-
N = 3 6
tions performed by them have been studied
and are presented in Table 5.
It could be seen from Table 5
that the average number of abortions per-
formed by the practitioners belonging to
higher castes is 11.8, while for the middle
and lower caste practitioners this average
works out to be 5.0.
GENERAL EDUCATIONAL L E V E L
The number of abortions performed has
further been analysed according to the
general educational level of the practitioner.
For the purpose of analysis all the 36
practitioners who performed abortions have
been grouped into 3 broad categories viz.
Literate and Primary; Middle; High School
and above. The results are presented
in Table 6.

280
J. C. BHATIA
TABLE 6
AGE
N O . OF ABORTIONS PERFORMED BY I.M.P.'s
For the purpose of analysis the practi-
ACCORDING TO THEIR GENERAL EDUCATIONAL
LEVEL
tioners have been divided into 3 broad
N = 3 6
age groups i.e. younger age group (25-34
years); middle age group (35-54 years) and
older age group (55 years and above) and
number of abortions performed by each of
these groups of practitioners has been
studied. The age group distribution and
number of abortions performed by them
is indicated in Table 7.
Table 7 reveals that maximum number
of abortions have been performed by the
practitioner belonging to the middle age
group and the least by the older age group.
The average for these three groups work
out to be 9.3, 5.3 and 11.5 respectively.
(Figures within brackets show percentages)
MARITAL STATUS OF THE WOMEN AND PLACE
The above table reveals that the number
OF MEDICAL PRACTICE
of abortions performed are directly related
with the general educational attainments of
In all 341 abortions were performed by
the practitioner. The practitioners with the sampled practitioners during the refe-
higher general educational attainments per-
rence period of one month out of which
formed more abortions as compared to 177 (51.9%) were performed in the villages
those with generally low educational level. by 25(69.4%) practitioners, while the re-
TABLE 7
N U M B E R OF ABORTIONS PERFORMED BY THE I.M.P'S ACCORDING TO THE AGE OF THE
PRACTITIONER
N = 36
(Figures within brackets show percentages)

ABORTIONISTS AND ABORTION SEEKERS
281
maining 164 (48.1%) were performed in from this source works out to be as high
the market places and towns by the as Rs. 536.64. This clearly shows that the
11(30.6%) practitioners who had their charges of the practitioners practising at
clinics at these places. Out of the total market places/towns for inducing abortions
number of abortions 251 (73.6%) were per-
were relatively higher as compared with
formed on married women while the remain-
those practising in the villages.
TABLE 8
N U M B E R OF ABORTIONS PERFORMED ACCORDING TO THE MARITAL STATUS OF THE WOMEN
AND THE PLACE OF THE MEDICAL PRACTITIONER
Place of practice Total N o . of Married women Unmarried and widows
abortions
Village 177 (51.9) 145 (57.8) 32 (35.5)
Market/Town 164 (48.1) 106 (42.2) 58 (64.5)
Total 341(100.0) 251(100.0) 90(100.0)
(Figures within brackets show percentages)
ing 90 (24.4%,) abortion seekers were un-
The income of the practitioners from
married.
abortions according to the place of practice
The number of abortions performed in is shown below in Table 9.
village and market places/towns accord-
ing to the marital status of the abortion
TABLE 9
seeker is indicated in Table 8.
INCOME OF THE I . M . P ' s FROM ABORTIONS
The analysis of the table reveals that
ACCORDING TO PLACE OF PRACTICE
more of the unmarried abortion seekers
N = 36
preferred to go to the practitioners prac-
tising in the market places and towns for
the termination of their pregnancies. This
is because they wanted to remain incogni-
tion because of the social stigma attached
to pregnancy among the unmarried.
INCOME OF THE I . M . P ' S FROM ABORTIONS
On an average the practitioners who per-
formed abortions earned Rs. 274.50 from
this source only. There is a wide variation
between the income of those practising in
the villages and market places/towns. The
practitioners practising in the villages on
an average made Rs. 159.16 from abortions
while the average earning of the practi-
tioners located in the market places/towns
(Figures within brackets show percentages)

282
J. C. BHATIA
GROSS INCOME ACCORDING TO PLACE
market places and towns was almost double
OF PRACTICE
than those practising in the villages.
This disparity in the gross income ac-
The information about the total gross cording to the place of practice is more
income from medical practice (excluding wide-spread among the practitioners not
income from abortions) was ascertained in performing abortions. The non-abortionist
case of those performing and not perform-
practitioner practising in a market place/
ing abortions. This income data has further town had an average gross income of
been analysed according to the place of Rs. 890 per month, whereas his counter-
practice of the practitioners. The findings part practising in the village had made only
are given in Table 10.
Rs. 123.00 per month on an average.
TABLE 10
G R O S S AND AVERAGE INCOME FROM MEDICAL PRACTICE (EXCLUDING INCOME FROM ABORTIONS)
OF THE PRACTITIONERS PERFORMING AND NOT PERFORMING ABORTIONS ACCORDING TO THE
PLACE OF PRACTICE
N = 62
(Figures within brackets show percentages)
The above table brings out that there is PROPORTION OF TOTAL INCOME EARNED FROM
a wide disparity in the income of those per-
ABORTIONS ACCORDING TO PLACE OF
forming and not performing abortions.
PRACTICE
While the former group of practitioners on
an average earned Rs. 779 per month from
The gross income of the practitioners from
medical practice (excluding income from general medical practice and the income
abortions), average gross income of the earned from abortion cases was added up
practitioners belonging to the latter category and the percentage contribution by the in-
was Rs. 270 only. This clearly shows the come from abortions to the total gross in-
popularity of the practitioners performing come has been worked out according to
abortions among the patient population in the place of practice of the practitioner
the rural areas. A further analysis of the and is presented in Table 11.
table reveals that among the group of prac-
It could be seen from the table that the
titioners performing abortions, the average practitioners practising in the market places
gross income of those practising in the and towns earned a higher proportion of

ABORTIONISTS AND ABORTION SEEKERS
283
TABLE 11
PERCENTAGE OF TOTAL INCOME EARNED FROM ABORTIONS ACCORDING TO PLACE OF PRACTICE
N = 62
Percentage of total
Total No. of
Practising in
Practising in the
income from abortions
practitioners
the village
market place/town
Less than 20
19 (52.8)
18 (72.0)
1 ( 9.1)
20-29
5 (13.9)
2 ( 8.0)
3 (27.3)
30-49
9 (25.0)
5 (20.0)
4 (36.3)
50 and above
3 ( 8.3)
3 (27.3)
Total
36(100.0)
25(100.0)
11(100.0)
Mean
23.3
17.2
32.3
income from abortions as compared to
Table 12 shows that 47.2% of the
those practising in the villages. The share pregnancies were terminated before the
of the income from abortions to the total menses had been delayed for 4 weeks.
income in case of those practising in the This percentage, however widely differs ac-
market places/towns was 32.3 while income cording to the marital status of the women
from abortion cases on an average contri-
seeking abortions and is 64.6 in case of
buted 17.2% to the total income of those married women and only 4.4% in case of
practising in the villages.
unmarried abortion seekers. Ordinarily, one
would think that unmarried women would
DURATION OF DELAYED MENSTRUAL CYCLE get alarmed soon after the menses are de-
ACCORDING TO MARITAL STATUS
layed and would take necessary steps for
their resumption. However, the study shows
The duration of delay in menstrual cycle that the married women sought termination
when the women sought termination and during the early stages of pregnancy where-
their marital status is shown below in as majority of the unmarried women sought
Table 12.
termination after 8 weeks of delay in the
TABLE 12
DISTRIBUTION OF WOMEN SEEKING ABORTIONS ACCORDING TO THE DURATION OF DELAY IN
MENSTRUAL CYCLE AND MARITAL STATUS OF THE WOMEN
(Figures within brackets show percentages)

284
J. C. BHATIA
menstrual cycle. This clearly shows that sional abortionists have therefore, either
unmarried women tried some other reme-
employed a Woman nurse or have indige-
dies and avoided going to the practitioner, nous dais collaborating or have trained
unless it became a must.
their wives to look after these jobs. The
practitioners who had such assistance of
AGE DISTRIBUTION OF ABORTION SEEKERS female workers and the number of abortions
ACCORDING TO MARITAL STATUS
performed by them are indicated in Table 14.
The table reveals that the practitioners
The age distribution of the 341 women who had the assistance of female workers
seeking abortions according to their marital performed much more abortions as com-
status is shown below in Table 13.
pared to those who had no such help
TABLE 13
A G E DISTRIBUTION OF ABORTION SEEKERS ACCORDING TO MARITAL STATUS
(Figures within brackets show percentages)
The age distribution presented above is available. 9 or 25 % of the total practitioners
a bimodal curve with its first peak in the who performed abortions had a nurse as
age group 15-19 years who are mostly un-
their employee and they on an average per-
married. Then the curve shows a decline formed 18.2 abortions. Those having wife's
at the age group 20-24 and again rises assistance and dais collaboration numbered
reaching its second peak at the age group 4 each and they on an average performed
30-34. The mean age of the abortion seekers 14.2 and 6.5 abortions respectively. The
works out to be 27.9 years, 31.7 years for average number of abortions performed by
the married and 18.1 years for the unmarried those who had no assistance works out
abortion seekers.
to 5.5.
NUMBER OF ABORTIONS PERFORMED AND
SUMMARY AND CONCLUSIONS
ASSISTANCE RECEIVED BY THE PRACTITIONER
The above study was carried out in a
Some women in the rural areas are reluc-
Community Development Block of Ludhiana
tant to get their pregnancies terminated District in Punjab. Sixty-two practitioners
from a male doctor particularly if it in-
were interviewed at length after excellent
volves vaginal examination. Some profes-
rapport had been built with them. Informa-

ABORTIONISTS AND ABORTION SEEKERS 285
TABLE 14
NUMBER OF ABORTIONS PERFORMED AND ASSISTANCE OF FEMALE WORKER RECEIVED
(Figures within brackets show percentages)
tion was collected about 341 abortions per-
semi-urban areas were charging more and
formed by them Out of the practitioners hence their earnings from abortions were
interviewed, 36 were performing abortions greater than those practising in the villages.
and the remaining 26 practitioners dis-
One of the significant findings of the study
approved the same. The findings reported is that those who were not performing
earlier* by the author revealed that some abortions were also not popular with the
of the socio-cultural characteristics of the clientele seeking general curative medical
Indigenous Medicine Practitioners like age, care services. The study also reveals that
general and professional level, caste, place the practitioners who performed more abor-
of practice, system of medicine practised tions had at least some female assisting in
and daily patient load were influencing their their work — may it be a Nurse in employ,
opinions in regard to the approval/disap-
Indigenous Dai collaborating, or Wife of
proval of abortions.
the practitioner.
The data analysed above also reveal that
So far as the characteristics of the abor-
practitioners practising in the market tion seekers are concerned, about one-fourth
places/semi-urban areas, having no pro-
of the women who sought the help of an
fessional qualifications but having higher abortionist were unmarried. The unmarried
general educational level, practising mainly women generally preferred to seek the help
allopathic/modern system of medicine be-
of practitioners who were practising in
longing to higher caste group and middle market places/semi-urban areas. They
aged and having higher patient load were mostly reported at an advanced stage of
performing more abortions and were thus pregnancy, when the menses had been de-
comparatively more popular among the layed for 8 weeks or more, while most of
abortion seekers.
the married women wanted their pregnancies
The analysis of the data further shows to be terminated before a delay period of
that those practising in the market places/ six weeks.
* Bhatia J. C. and Mehta S. R. Induced Abortions — Opinions of the Indigenous Medicine
Practitioners. The Indian Journal of Social Work, Vol. XXXII, N o . 4 (January, 1972).