A 20-year-old woman from Nagaland reached out to an abortion care service through WhatsApp. She told the anonymous platform called Carechat that she is pregnant before marriage and does not know what to do.
“She was suicidal and one of our counsellors had to be with her on chat for hours to provide support and make sure she is safe,” said Manu Raveendran, the founder of the organisation Vipasyin, that created Carechat. The pregnancy was in a later stage and nothing could be done. “But we finally convinced the woman to tell her parents who were understanding and helped her,” said Raveendran.
Why did you start an organisation for providing abortion services?
We noticed that there was a clear difference between education and awareness around abortion laws and actually knowing where to go and utilise this service. In India, it is a huge positive for us because our law is quite progressive. We have had this law since 1971. It has now increased to people who are pregnant for 24 weeks. People know that they can go get an abortion but don’t know where to go and get it. Thus Vipasyin (which means to see clearly) started two years ago to bridge this gap. We just went around asking people what they need and provide our services for free. We heard a lot of heartbreaking stories. Eventually we started asking for a fee to sustain ourselves and found out that people were willing to pay rather than facing harassment and horrible treatment elsewhere.
What are the primary reasons for which people reach out to you for abortion services?
We get cases everyday and over the past one year we have handled thousands of cases. The primary reason for which women reach out to us during an unwanted pregnancy is unprotected sex. We have observed that it is a theme that people get into sex in the heat of moment without thinking of consequences. Even well educated men and women end having sex without precaution. The second most frequent reason is the failure of condoms. The condom can also break and in rare cases leakage might happen. It can also get stuck inside the vagina. We have also encountered instances where people got pregnant if pre-cum or sperm has gone in from unprotected insertion, foreplay, oral sex, or fingering. Sometimes even when a woman wants a child before marriage they ask for an abortion because it is very tough to survive as a single parent in Indian society. It takes a lot of courage. There are also financial reasons, unplanned pregnancies without stable income or accidental pregnancies very late into the marriage.
How do you approach the patients that reach you?
When someone has a pregnancy scare they need instant support and relief, and that’s what we provide. As soon as the person reaches out to us we try to figure out the core issue they are facing within 5 minutes. We then either provide them with medically approved advice from our side or directly connect them to a doctor. They can then calm down and get to a position where they can think. We wanted to get doctors who were loving, caring and kind to provide help. We provide end to end services in matters of pregnancy scares and to people seeking abortions. We don’t care if the patient is married or unmarried or if they identify with a particular gender or sexuality. Even though there are various hospitals around the country, that care and affection is lacking. That is where we come in to provide support.
How do you ensure the safety and privacy of the patient?
Our WhatsApp Carechat number is published through blogs and websites. We especially use WhatsApp because women aren’t comfortable having any other app related to sexual health on their phone because of the fear of someone finding out. They don't even talk about these issues to their partners. They are more comfortable talking to us because it is less complicated. The moment the conversation is over and the problem is solved, they can delete the chat. We never send a follow up message to the patient to maintain their security. We respond to them only if they approach us through Carechat.
Sometimes the woman herself is scared to reach out to us so their friends and partners do it on their behalf. We ensure that the person is above 18 years of age. We also ask for the city they live in to help them properly and then try to find out the issue they're facing. We only ask for the name and identity if we have to connect them to a doctor. We give the details to the doctor and brief them about the patient. After verifying the patient’s identity, the medical care provider then gives the required attention. We don’t give any medical advice prescriptions on chat.
What are some of the challenges of running an anonymous abortion service?
Even though the law is very clear that you don’t need the consent or presence of a partner to get an abortion, sometimes when the partner gets to know that you have done an abortion they can create a havoc. They emotionally torture the woman or threaten the doctor for not telling them. There can also be various political and religious issues.
Sometimes women also go through an emotional conflict before getting an abortion even though they know that it is a practical thing and something they are choosing on their own. But due to conditioning or individual feelings they can experience guilt. Some women might also develop hatred toward their partner for causing the pregnancy. The trauma can be very long lasting. Pre-abortion care is very important where we take them through the process, tell them what will happen and hand hold them for a month after the abortion is completed.
Women also come to us after the damage is done by certain informal sources who claim to provide abortion. Around 15 million abortions happen in India annually and out of those, almost 80 percent are illegally done. People reach out to quacks, fake doctors, or unscientific traditional medicine.