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This is the second in a four-part series where TNM surveys the lived realities of the migrant communities in Kerala.
“She was covered in blood and crying out in pain when we rushed to their room. We took her to a nearby hospital,” recalled Mahesh Babu from West Bengal, describing an incident a few months ago involving his neighbour Asina, a 22-year-old plywood factory worker in Perumbavoor.
Asina, who was pregnant, had suffered severe complications after having used abortion pills. Her experience points to a widespread issue among the migrant labour community in Kerala — despite the availability of safe and legal abortion methods, many migrant women resort to self-medication with pills, leading to dangerous consequences. This alarming trend underscores the urgent need for better inclusivity in healthcare, and education on safe contraceptive practices for vulnerable populations.
“Asina and her husband were from Odisha, and they had a child who was four years old. When she became pregnant again, she had taken some abortion pills. She was admitted to the hospital for many days, and later she returned to Odisha,” Mahesh said.
Although Mahesh and others, who live in a migrant labourers’ settlement near Aluva in Ernakulam district, know that many women in the migrant labour community use such pills for abortion, that was the first time he saw a complication arising from it.
Labourers like Mahesh, as well as activists who work with them, say that the use of illegally-acquired abortion pills is common among the migrant community of Ernakulam. The community is large — according to official data, there are around 31 lakh migrant labourers in Kerala, the majority of whom are from Jharkhand, West Bengal, Bihar, Assam, and Odisha. Perumbavoor and Aluva in Ernakulam are the most migrant labour-dense locations in the state.
Earlier, TNM reported on how working mothers in the migrant community in Ernakulam either take their children to the workplace or leave them at home in insecure and unattended situations. Women are required to both work for survival and look after their children. Unaware of proper contraceptive methods, migrant women largely use contraceptive pills and abortion pills without consulting a medical practitioner.
Medical supervision necessary when using abortion pills
A government doctor from Ernakulam, who sought anonymity, said that she has dealt with many cases where migrant women use abortion pills at home without proper guidance and end up with complications. The abortion pill is a combination of two medicines — mifepristone and misoprostol. The first blocks the hormone progesterone, while the second causes cramping, bleeding, and the loss of the pregnancy.
As per Indian law, mifepristone and misoprostol can only be prescribed by a registered medical practitioner, and pharmacies cannot sell them without a prescription. The dosage of the pills and the method of administration – orally or vaginally – are prescribed only after taking into consideration the patient’s health status and weight, and how advanced the pregnancy is. When these pills are taken with proper guidance from doctors regarding timing and dosage, the cramps and bleeding will not last for more than three days.
The government doctor from Ernakulam continued, “The migrant women usually take the pills improperly. If they are using misoprostol vaginally, they need to use at least 12 pills at regular intervals, but they often use much less, sometimes half or even fewer. Timing is also very important. If they take the pills after 12 weeks of pregnancy, it can create complications, such as heavy bleeding."
Priti, a native of Odisha, spoke to TNM from her village about how she used these pills to terminate her unwanted pregnancy. “Many of my friends used to take them. We don’t get them in Kerala; either we bring them from our village or they are sold by some people there, not in stores,” she said.
Priti, who has a three-year-old child, said that she could not afford to take care of another, as she also had to work to sustain the family. “A month after I missed my period, I took the pills. I used vaginal pills, inserting two pills each three times. I experienced severe pain and heavy bleeding,” she said.
Priti recalled that the pain was unbearable, lasting for hours, and that she couldn’t even get up once the bleeding started. “When it lasted for days, we went to the hospital. The first scan showed that the pregnancy was not terminated. Later that day, I experienced severe bleeding, and the doctor confirmed the abortion had taken place,” she said.
Priti had to return to Odisha a few months after this incident for other reasons. However, she said she will not take the pills again due to the severe difficulties she experienced. “The doctor scolded me that day, asking how I can take pills without consulting a doctor. I took them because everyone takes them,” she said.
Activists working among the migrant community in Perumbavoor and the neighbouring region said that the fact that the women use abortion pills without consulting a doctor is terrifying.
“A few months back, I took two Odisha-native women to the hospital after their bleeding did not stop. They had just taken two vaginal pills. They didn’t even know the name of the pills, their relatives sent them from their native place on a bus. The pills didn’t have any labelling — they were just tied in paper and put in a small plastic cover,” said Priya*, a social worker from Odisha who is associated with NGOs and government departments in the region.
“This happened a couple of months ago, and both women were in very poor condition. For the two of them, the abortion did not occur by the time they were taken to the hospital. For one, it happened later, but the other is still pregnant,” she said.
Medical system hostile towards migrant women
The Indian Parliament has passed the Medical Termination of Pregnancy (MTP) Act, which permits licensed medical professionals to perform abortions in specific predetermined situations. A 2021 amendment to the Act enabled women to undergo abortions in cases of unwanted pregnancies due to the failure of contraceptives, for up to 20 weeks.
Priya said that although abortion is legal, no doctor will help these migrant women. “When they take these pills, doctors shout at them. But if these women approach doctors seeking abortions, the doctors will not do it, oftentimes due to moral reasons. They are left with no choice but to take these pills illegally,” Priya added.
She alleged that government doctors show no patience with migrant women. “They misbehave and shout at them. On top of this, there are language issues, so women resort to self-medication or go back to their home state in case of medical issues.”
When TNM visited a government hospital in Ernakulam district, we saw doctors struggling to communicate with migrant women labourers. Doctors kept raising their voices and trying to speak to them in broken Hindi, but many women only know their regional languages, which would be non-Hindi languages like Odia or Assamese.
George Mathew, chairperson of the Progressive Workers’ Organisation, said that those illegally selling the abortion pills charge almost 10 times the original price. “Labourers get these tablets from their home state and sell them here for Rs 2,500 per set, but the original price would be around Rs 350. A year ago, one person was arrested for selling them in this manner,” he said.
George also said that there are many cases where women have spent days in hospital due to excessive bleeding. “About four months ago, I got a call saying that 19-year-old Rani*, who lived in Perumbavoor with her husband, had excessive bleeding and was in a critical state. Two days before the incident, she had told me that she didn’t want the child as her husband was a drug abuser and their elder child was just two years old. I told her we could go to a doctor and do the tests, but by then she had already taken some pills. She was in the hospital for many days, but the pills did not cause the abortion because she was in her fourth month of pregnancy, which she found out too late,” he said.
Rani had to go back to her home state of Assam, quitting her job in a plywood factory in Perumbavoor.
Awareness, access to safe pregnancy termination
Early medical abortions are not preferable for women who are anaemic, have other diseases, or have a tubal or ectopic pregnancy. This is why a doctor’s consultation is necessary before opting for an abortion.
Dr Anupama Sreekumar, a senior gynaecologist at Pran Fertility Centre in Thiruvananthapuram, said that repeated abortions through pills are dangerous and can harm the uterus as well as the neighbouring organs in the body.
“Firstly, before taking pills, we need to do a scan to check whether the pregnancy occurred inside or outside the uterus. Secondly, if you don’t take the course properly, it can lead to incomplete abortions, which may result in infections and future complications. Abortion is legal in our country, and it is the woman’s decision, but safe abortion practices need to be followed,” Anupama said.
She emphasised that the migrant women community needs to be given proper awareness about safe abortion and contraceptive practices. “There are many cheap and safe contraception methods, such as the use of copper IUDs. In government hospitals, the installations are free, and even in private hospitals, they are inexpensive. But women should be given awareness,” she said.
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