Have the relaxations in legislation related to termination of pregnancy made abortions safe in India? A meta-analysis on the prevalence of unsafe abortions among 15–49-year-old females in India

Background: Pregnancy which is not terminated within the boundaries of legal definition in India is called an unsafe abortion. Objective: To observe the proportion of unsafe abortions among total abortions in 15–49-year-old ever married women across India between 1990 and 2020. Materials and Methods: A comprehensive search was conducted in National Library of Medicine's PubMed database, IndMED, TRIP, Web of Science, and Google Scholar for articles published between January 1, 1990, and February 29, 2020. A combination of medical subject headings and free text word like abortion, induced, unsafe, women 15–49 years, prevalence, and India were used. Each article was assessed for quality using Joanna Briggs Institute Critical Appraisal Tool. The proportion of subjects classified as having unsafe abortion was the outcome of meta-analysis. Analysis was done using Comprehensive Meta-Analysis version 2.2. All pooled estimates were calculated using DerSimonian–Laird random-effects model and reported as a proportion with 95% confidence intervals. Results: The pooled estimate of the mean prevalence of unsafe abortion in India was 37.56% (confidence interval: 20.68–54.44). There was a significant heterogeneity between the studies (I2 = 99.98% and Cochran's Q = 113538.65, df = 18, P < 0.001). Conclusion: Even after several amendments in Medical Termination of Pregnancy Act 1971 till 2020, unsafe abortions are highly prevalent in entire India, irrespective of high-performance or low-performance states. In urban India, the prevalence of unsafe abortions is comparatively higher than rural areas.