Why do women travel from the Maldives to India for abortion and what are their options?

Why do patients travel from the Maldives to India for abortion and what are their options?

An archipelago of 1190 coral islands, Maldives is the smallest Asian country located in the Indian ocean. It has been the choicest travel destination but residents face massive challenges in availing safe abortions. 

The coarse population dispersal across all the islands makes access to basic health care facilities at affordable prices very difficult. Access to Comprehensive abortion care (CAC) services is the right of every woman. But women in countries like the Maldives have very limited to zero access to CAC.

The rate of unwanted pregnancies is quite high in southeast Asian nations and women of Maldives too face similar situations due to inadequate knowledge and availability of contraceptive methods. Their situations further worsen due to restricted abortion policies of the country. The biggest rescue for such women has been to avail medical abortion tourism facility and travel to the nearest country with flexible abortion laws.

With liberal abortion laws and high-quality and safe medical facilities for abortion in India for foreigners, it has been the nearest, safest and the preferred choice among women of Maldives. 

Abortion laws in the Maldives:

Just as in many other countries, abortion is illegal even in the Maldives under most circumstances. 

As per Section 416 of the Maldives Penal Code (MPC), abortion in the Maldives is permissible only for restricted criteria:

  • To save the woman’s life.
  • In events where pregnancy is a result of rape or incest.
  • Few fetal anomalies

Due to restricted abortions, there have been many instances of unsafe abortions. When women were not allowed to opt-out of unwanted pregnancies, they resorted to unsafe methods of abortion leading to high maternal mortality rates. 

Unsafe abortion methods are what you should never even think of because you do have options. Keep reading to know yours.

Upon recognizing the magnitude and impact of unsafe abortions, the National Reproductive Health Strategy approached the Ministry of Islamic affairs to update the rules and regulations governing abortions. 

In Maldives,  the current laws are being followed per Fathwa released by the Fiqh Academy of Maldives (Government’s Council of Religious Scholars) which has laid down conditions and gestation limits for a permissible abortion. These are:

In all the aforementioned circumstances, there are further conditions like:

  • Abortion is permissible to save if the woman’s life is in danger as declared by a registered medical practitioner.
  • Fetal impairment includes prenatal examination confirming a disease such as Thalassemia, Sickle cell anaemia or permanent deformity of the body or brain that cannot be treated through any available medication. 
  • Consent of the spouse is necessary along with the woman’s consent. In the events of the spouse’s unavailability, consent is required from the paternal father or guardian.

Abortion laws in India: The difference from abortion laws in the Maldives:

India is the only country in South Asia with liberal abortion laws. Here, abortion is permissible under many circumstances to help women exercise their reproductive rights and make a choice whether or not to opt-out of an unwanted or unplanned pregnancy.

The biggest advantage is that these laws are flexible not only for Indian citizens but for all women alike irrespective of their native country. This is so because India believes that every woman has a right to make her reproductive choices and her choice shall be respected. 

Are you living in the Maldives and cannot avail of a safe and legal abortion just because the pregnancy is unplanned or your gestation length restricts you to make that choice or for keeping it a private decision and availing it without consent from your partner or his guardians, then Welcome to Bangalore, India. Here, you can avail a safe, confident and legal abortion under the following circumstances which differ from abortion even at abortion clinics in Maldives:

  • Threat to woman’s life: If the pregnancy poses threat to your life or your physical or even mental health which is not permissible in the Maldives.
  • Rape/Incest: If the pregnancy is an outcome of rape or incest, you can avail an abortion in the Maldives for this reason. Still due to the societal stigma associated with it and being looked down as a criminal, it’s better to avail a safe and confidential abortion which may be very difficult with limited abortion clinics in Maldives and also limited as well as restricted healthcare facilities and a small population circle.
  • Fetal anomalies: If the pregnancy is wanted but prenatal tests reveal major deformities or fetal anomalies where the child after birth will have to live with co-morbidities or may not even survive, you can obtain an abortion in Maldives if recommended by a registered medical practitioner. Though reason is permissible, but comprehensive abortion care may or may not be available. Due to limited certified abortion clinics in Maldives, there can be a delay which is not recommended for the woman’s health.
  • Failure of contraceptives: If the woman gets pregnant out of a marriage and wants to obtain an abortion at will due to failure of contraceptives. Yes, in the Maldives, there is no provision for availing abortion by an unmarried woman. There it is considered a sin and you may even be punished both for getting pregnant out of a marriage and also for availing of an abortion. But in India, you have a choice to get an abortion for the reason of contraceptive failures regardless of your marital status.
  • Consent for abortion: In India, only a woman’s consent is required for abortion, if she has attained an age of 18 years. Whereas in the Maldives, besides woman’s consent, abortion can be availed for permissible circumstances only with spousal authorization and in events of his unavailability, the authorization is required from his parents/guardians. 
  • Gestation length: In India, abortion can be availed for aforestated reasons up to 20 weeks of gestation, i.e., 140 days as compared to 120 days in the Maldives and that too only in restricted cases. This gives a broader window to women in the Maldives if they choose to travel to India for a safe abortion. In some restricted circumstances, abortion in India is legal for up to 24 weeks in exceptional cases, such as in the case of fetal anomalies.  

Policy Gaps: A huge difference that makes access to CAC further difficult:

Though policy changes in abortion laws of Maldives over years had been progressive in light of maternal mortality rate, yet there are many unidentified and gaps less spoken of. 

  1. Lack of national standards and guidelines: Besides legalization of abortion under restricted circumstances, yet no legal clarity and no guidelines are governing comprehensive abortion care. There are no national standards available for induced abortion and even post-abortion care.
  2. Lack of medicines: The medicines and drugs used for medical termination of pregnancy (MTP) and other abortion-related drugs and other pieces of equipment or supplies are not mandatory in the national registered products list and their approval status is also ambiguous.

Travelling to Bangalore, India for a legal, safe and confidential abortion:

Female, unwanted/unplanned/unintended pregnancy, living in the Maldives: What are my abortion options? Do I even have them?

Well, if you are in a similar dilemma, you’re not alone. It has been a very common practice to travel abroad for safe and confidential abortion services. And the first choice of Maldives’ women has been Bangalore, India. What makes India a favourable choice is evident from the difference in the abortion laws and regulations it has in comparison to the Maldives and other Southeast Asian nations. 

Besides abortion rules and regulations, another big reason for which women often travel to Bangalore, India to avail abortion services are the world-class facilities being provided by the best abortion hospital.

The first thing to know when you travel to American Hospital Bangalore to avail a safe, legal and confidential abortion is that you do have multiple options, all of which are safe and effective.

Now, your options largely depend upon the length of your ongoing pregnancy. As per the World Health Organization (WHO)’s recommendation, there are three approved methods of abortion, out of which the best is prescribed by the registered medical practitioner according to individual case-specifics.

1. Medical Method of abortion:

Medical termination of Pregnancy (MTP) or the medical method is the earliest option any woman can opt for in the earliest stage of pregnancy. If your gestation length is also less than 6-8 weeks and your pregnancy is intrauterine, you too have this choice. 

This is a non-invasive method wherein safe abortion pills are administered either orally or applied vaginally. The two medicines approved for the purpose are Mifepristone and Misoprostol.

This is the easiest choice for any woman wanting an abortion, but its efficiency varies from woman to woman and there is no certain method that can tell which woman will have an incomplete abortion after taking pills and which one will have it eliminated besides other complications. 

After fertilization, a woman’s body starts secreting progesterone to sustain the pregnancy. The first pill, Mifepristone is an anti-progestin that blocks the action of progesterone and stops the growth of the fetus. It can be administered both orally as well as vaginally as per the patient’s comfort and the doctor’s assessment.

The second pill is Misoprostol. It is not administered at the same time. It has to be given hours later when anti-progestin has already done its work. Its job is to bring contractions in the uterus just like that of menstrual periods so that the embryo can come along the gestational products naturally via the vaginal route just as the periodic menstrual flow. 

In the Maldives also, this method is available but only for women whose life is at risk, which hardly gets noticed before 8 weeks and for the ones who are carrying a fetus as a result of rape. But due to a small country and lack of certified abortion hospitals and the medicines being imported from other countries, you cannot be sure of having it available in the small window.

No common diagnostic tests reveal a pregnancy before 4-5 weeks. The first 2 weeks are only for calculating the gestation age from the first day of the last menstrual period, commonly known as LMP. And in the next two, the fertilization takes place and the growth is in its initial phase. 

Urine pregnancy test (UPT) kits are generally used as the firsts marker to test for pregnancy upon a missed period which measures the human chorionic gonadotrophin (hCG) in urine to confirm the pregnancy. These levels rise to detectable levels only after 4 weeks. Though they are on the rise ever since the fertilization took place, yet blood levels may reveal and not the urine levels.  

So, women often realize their pregnancy after 4-5 weeks which leaves them with a very small window for medical method of abortion. And beyond this period, abortion by this method may not get completed leaving products of gestation (POGs) in the womb causing further complications. It is always better to consult a certified gynaecologist before opting for MTP.

Overseas patients rarely opt for this method because:

  • Two appointments are needed. Though the medicines to be taken orally can be given to the patient to self-administer at home, it is preferred that doctor first examine the patient and then administer the second pill.
  • The patient has to wait for up to a week to be assured that the abortion is complete. For a couple of days, menstrual bleeding will continue and only after it has ceased or spotting continues, can a transvaginal scan can divulge whether or not the abortion has been completed. 
  • Pain from abdominal cramps and discomfort is maximum with this method. Though for most women, it is just like the pain experienced during menses, some women may even bleed more and have heightened pain and that is why when a woman has to travel abroad for an abortion, she prefers the other methods which are mentioned below along with their benefits outlined.

     2. Vacuum aspiration method:

    This is one of the most common and gentle painless methods of abortion. Even women who have an option of medical method available opt for the Vacuum aspiration method due to its high efficiency (nearly 100%) as compared to MTP (95%-98% efficient). As per WHO’s recommendation and guidelines, this method is an open option for women with intrauterine pregnancy that has not progressed beyond 12 weeks. 

At American Hospital Bangalore (AHB), as a part of this gentle procedure, the embryo that has implanted in the uterine cavity and is attached to the uterine wall is gently sucked to detach and remove it. It is a gentle and outpatient procedure and not truly invasive. 

To add to the comfort, the method can also be carried under general or local anaesthesia as preferred by the anaesthetist and the patient. 

Vacuum aspiration can be done by two methods, one is using a manually operated aspirator, the method being known as Manual Vacuum Aspiration (MVA). And the other being a similar device that works through an electric-driven motor, the method being known as Electric Vacuum Aspiration (EVA). 

It is a small procedure lasting between 3-10 minutes. The patient can expect to get discharged as soon as she feels comfortable. It is advised to stay comfortably with a nurse by side for half an hour so that when the patient gets discharged, all the effects of the anaesthesia have weaned away and the patient is feeling absolutely fine.

If you too have this open option for abortion, you can avail it safely and entirely painless at AHB, the biggest thing being the confidence with which you will return to the Maldives that you have had a successful abortion. You will not have to wait for another week as is the case with MTP to be fully sure that the abortion was complete. 

3. Dilatation and Evacuation (D & E):

This is the recommended method of abortion for late pregnancies, such as beyond 12 weeks, but within the permissible period, which is 20 weeks in general circumstances and up to 24 weeks in special circumstances. 

It is the surgical method and hence the invasive one. But, if you plan to visit AHB for the procedure, you can expect to experience a completely reliable, safe and painless abortion. Surgical will seem only to be in the name of the procedure, actual being a gentle one. 

This is recommended for second-trimester abortions because, by that time, the size of the fetus has increased and even the uterine wall has thickened. To eliminate the chances of incomplete abortion by other methods, it is advised to terminate an ongoing intrauterine pregnancy beyond 12 weeks by this method. 

The D&E procedure at AHB lasts between 10-30 minutes and is performed under mild general or local anaesthesia to let the patient be relaxed and make it entirely painless. The uterine lining is gently scraped using special sterilized pieces of equipment, the fetus detached and all contents gently evacuated.

Since the procedure is surgical, a lot of precision and experience is required to do it efficiently and carefully, both of which can be experienced exclusively at AHB, Bangalore, India.

Women in Male, the Maldives who intend to abort for the reasons pertaining to fetal anomalies should also consider this option to travel to Bangalore for a safe abortion even when it is permissible there due to lack of facilities and ratio of healthcare professionals per patient very feeble. On the other hand, AHB is furnished with world-class facilities and each patient is privately treated with the doctor and a nurse attendant fully assigned to a single patient at a time. 

A message for women in Male’, the Maldives seeking a safe abortion:

Even though carrying an unwanted pregnancy may not be your first choice, but you do have options. Each option is just far enough for you to look out for and make a wise choice. In a country where getting pregnant is a criminal act for unmarried women or any woman out of her marriage or a divorced woman and similar others, getting an abortion can be further difficult. 

Most women do not either know or can explore options due to inadequate knowledge both of contraception and abortion if desired. They may sometimes resort to unsafe abortion methods and put their lives at risk. This post brings a message for such women to not feel alone as they have a better option of a safe, legal and confidential abortion at AHB, Bangalore, India. 

The big comforts of traveling to Bangalore India for an abortion are:

  • You can travel to India via a very short (nearly 2.2 hours) and cheap flight. And you can also fly back on the same day if you wish to. It is advised to stay overnight and rest in any place of your convenience. Bangalore has many affordable as well as comfortable stay options for people coming for medical purposes.
  • You can consult the doctor personally, have yourself examined and return with the confidence of a complete, successful and painless abortion.
  • The abortions at AHB are completely safe, legal and confidential. No details of you and your abortion status can ever be revealed to anyone besides yourself.
  • At AHB, whatever method be prescribed the best for you, you can be assured to receive complete care in a hygienic environment, gentle and painless abortion, along with medicines and supplements to support you in rapid recovery.
  • Getting an abortion in the Maldives may be looked down upon as a criminal and shameful act, but at AHB, no patient is asked about any personal details or judged for abortion preferences. Every patient is treated with compassion and care irrespective of her marital status, the abortion decision or any other discriminating thought.
  • You will receive complete guidance for post-abortion care and you can free to consult your doctor via telephone or email anytime regarding your concerns post-abortion.

Many women from Malé and other islands of Maldives have availed safe abortion services at American Hospital Bangalore and you too have this safest choice open. For any unaddressed questions or concerns, feel free to contact on the helpline number. 

You can call or WhatsApp the doctor at the hospital at +91 900 849 2277 or +91 934 382 6182. 

All calls are confidential with respect to patient privacy. 

Related Posts: 

Safe and healthy recovery after abortion

Reasons why women seek abortion in India

The difference between medical abortion and surgical abortion