Ballari is not a word that rings a bell for someone new to Karnataka. For the uninitiated, the word can even morph into Bel Air, when pronounced with a rolling tongue and playfulness! Ballari and Bel-Air, however, are two worlds apart. Karnataka, a state in south India, has its trump card districts like Bangalore and Mysore which win the hearts of people as it offers them hopes and dreams to build a better future. Ballari, for many, remains that place identified as “rural”, “village”, “countryside”.The stamp of Steel City on Ballari does little to make the place a sought after one.
Introduction to the SAAF project:
As part of the SAAF (Safe Abortion Action Fund) project “Abortion is Care”, we charted out a plan to travel to Ballari, assess and map out service providers who can give safe and legal termination of pregnancy in accordance with the guidelines of the Medical Termination of Pregnancy Act, 1971. What should otherwise have been meticulous fieldwork of weeks, ended up getting shrunk to a series of telephone calls to service providers during the COVID-19 pandemic. We had to adapt as there were no other means to reach Ballari.
Can the internet help me find an abortion?
For Google and smartphone-driven youth, the internet is the first place to go when in need of information. Usually, a quick search can unfold pages after pages of information on anything under the sun. However, when it comes to information on accessing medical termination of pregnancy near your place, the internet does not have it all, especially for a place like Ballari. Whatever combination of words one uses – Ballari – Abortion – MTP, the net gives either a list of gynaecologists in Ballari or a hospital/ nursing homes where gynaecologists/ or department of gynaecology are present. Questions remain: “how many youths will pluck courage and call/ go to these people/places and risk getting insulted/humiliated for asking about abortion/getting an abortion, especially if they are unmarried women? And how much of the lists on the net are accurate about providing abortion?”
Hear hear the doctors:
Calls were made to the hospitals and nursing homes to enquire about MTP. Most often, the staff who handled the helpdesk/ enquiry/ reception were not equipped with necessary information on MTP and were quick to dismiss further questions with a reply “you can come here and get the consultation done. We don’t know much about MTP, the doctor can tell you.” Some offered the contact number of the doctors to take the conversation further while a few maintained that they cannot share the numbers due to the organization’s policy. However, the latter offered to connect the doctor through the hospital landline.
Calling the doctors was a hit or miss as very often they would either be in O.T or away for breaks. This was especially the case when the doctors were connected via the organization’s phone line. One had no option but to wait and call again later or on another day. We, at Collective, were left wondering how a young woman in distress about MTP, will handle these waiting periods, just to have a few words with the doctor! When we did get the “golden moments” to talk to the doctor, many took out time to tell us more about what was happening in Ballari and many others abruptly ended the call stating that they do not conduct MTP for single women.
The charm and pain of naivety:
Doctor A was very empathetic to the issues single women are facing to access safe and legal abortion in Ballari. She said that she can provide MMA under 7 weeks of gestation for single women. However, for above 7 weeks, she will not be able to help as the hospital she works for, will not want to get involved in any possible complications that can arise post-termination, especially if it is a surgical termination. She explained that a single woman most often does not have legally authorized signatories for conducting the procedure nor does she have people who can take up the responsibilities in the wake of any procedure going not as planned and these put the hospital in a tough spot.
Doctor A shared about her years at a government facility where she had seen cases of single women who came in past 12 weeks of gestation. She said it was saddening to hear the stories of these women who had no idea about anything that has to do with sex or pregnancy and are put in a position where they now need to terminate the pregnancy. By the time they seek medical help, the pregnancy has advanced and many complications could have been avoided, had they approached the doctor at an earlier gestation period. She added that most of the cases she has seen at the government hospital, filled her up with the need to go to the communities and educate them about safe sex, the timeliness in accessing the termination and the importance of taking help from doctors and staying away from quacks.
Doctor A, however, confessed that her position as a gynaecologist in a government setting did not give her the time and the role to reach out to the community for the same. She strongly feels that if public health groups, NGOs are to take up this role, it will do immense good to the community. She highlighted that most often everyone has this notion that villagers are naive and conservative, and that they will not receive well all these information & awareness programms on safe sex, contraceptives, pregnancy and termination. But, from her experience as a gynaecologist, she believes that they are far more receptive to these informations and earnestly want interventions that will help them.
Mushrooming nursing homes:
Doctor B who had previously worked at the only tertiary government hospital in Ballari, VIMS (Vijayanagar Institute of Medical Sciences), and now working in a private nursing home as a consultant, shed some light on what was happening in Ballari when it comes to abortion. She said that a lot of people reach out to government hospital for an abortion, given how affordable it is there. However, because of the patient load and the ensuing delay in getting a consultation, many abandon the waiting queue and resort to nursing homes to get a faster resolution. She pointed out that many nursing homes have been mushrooming in Ballari in the last decade, and most of them offer termination services. According to her, what is worrisome is that many of these nursing homes are not authorized to conduct MTP, and people are not aware of that. Doctors too partake in this and provide MTP when they are not qualified to do so. When asked about whether she can provide MTP, she said that she is only a consultant in X nursing home and that nursing home conducts only deliveries. So far, they have not provided any MTP to any women, be they single or married. She, however, suggested a few leading nursing homes in Ballari where MTP is provided but added that she is unsure whether they are single women friendly or not.
Yes and No to abortion:
Doctor C stated as a matter of fact that she discourages abortion even in married couples. She opined that couples should proceed with pregnancy to full term and counsel for the same to any couple who approaches her for termination.
Doctor D was not outrightly against abortion. However, she conducted abortion only for those married couples who are carrying pregnancy with foetal abnormalities that warranted abortion.
Legal tangles in abortion:
Doctor E revealed to us that the nursing home she worked for, had a case last year wherein a minor girl had to get termination and the POCSO investigation had to be initiated. She said that currently, the nursing home is not providing termination for single women. She ascribed this change to the legal entanglement that doctors can get dragged into, the numerous court appearings for depositions, the unending dramas which the parents of a single woman can stir up when they come to know about the termination, and in worse cases, they malign the doctors’ reputation too. According to her, many doctors (including herself), even though are sympathetic to the single women’s need for abortion, are wary of taking up the issue because of the possibilities of compounded factors of medico-legal cases. She confided that a few of her friends from the medical fraternity in Ballari were embroiled in such cases and thus decided to stop providing termination for single women. She noted that many senior doctors in Ballari are adept at navigating all these red flags and have been helping single women in Ballari get a termination. However, in light of the pandemic and them being in the high risk group due to their age, they have suspended all their practice for the time being.
Ballari in news:
We were in for a surprise when our preliminary internet search on Ballari turned up news reports about Ballari and abortion. According to the Times of India report dated 21 December 2001 ( that is almost two decades ago!) Ballari was chosen for the Safe Abortion Project. Under this Safe Abortion Project, Karnataka had three districts viz Ballari, Raichur and Bijapur.
We also found news wherein the Supreme Court stayed the arrest of a Ballari doctor accused of terminating the pregnancy of an alleged rape victim. We realized doctors have it tough in Ballari when we found news of a husband pressing charges against his wife and the doctor for terminating a pregnancy without his permission. We were again left wondering, how cases like these can have its own ramifications within the medico fraternity in Ballari who provide termination.
Fieldwork amidst the pandemic:
As the weeks go by and we all are starting to let it sink in: the virus is here to stay, we also are looking forward to having safe access to Ballari. Our preliminary search, so far, has given us the narratives from doctors and news from the net. We are eager to meet the communities and youth of Ballari and hear what they have to say when it comes to accessing sexual and reproductive health services. We are sure that having the youth with us will help us see Ballari through another lens.
Dr. Nishitha Aysha Ashraf is Programme Associate for SAAF Project at Hidden Pockets Collective. She completed her B.A. Journalism & Communication (2010) and Bachelor of Dental Surgery (2015) from Manipal, Karnataka. She has covered the Nipah outbreak in Kerala during her stint as Health Reporter with The News Minute (2018). The reportage furthered her interest to be a key player in public health/ community health. Her internship and work at SOCHARA – Society for Community Health Awareness, Research and Action (2019) was instrumental to learn more about the People’s Health Movement. She is keen on exploring the SRHR issues of Kerala, especially those amongst the Muslim and Christian communities.