Radha, 31, a busy radiologist at a private hospital in Delhi and mother of a two-year-old girl, sees herself as a practical, no-nonsense person. So when she discovered recently that she was pregnant, she allowed herself only a moment or two of anguish before calling her gynaecologist. She knew she could not keep the baby-the strong dose of antibiotic pills she had taken to fight a severe infection might have led to foetal defects. Now, the gynaecologist offered her another pill-this time to end the pregnancy. The new pill allowed Radha to have an abortion with her privacy intact and without her body being invaded. "I was back at work the next day and nobody except my doctor knew about it," she says.

"This new drug empowers a woman to abort silently." Geeta chaddha, Gynaecologist, Indraprastha Apollo Hospital, Delhi

Not everyone, however, is enthused by the emancipating power of the new abortion pill, RU-486. Approved in India as a prescription drug in October 2002, the pill will soon be introduced in the family welfare programme by the Ministry of Health and Family Welfare in a phased manner. It is a move being fiercely opposed by women's rights organisations. The idea of introducing the pill was to make abortions-medical termination of pregnancy as it is officially known-in India safer and to provide greater choice. Of the more than one lakh women in India who die annually during pregnancy and childbirth, 10,000 deaths are due to unsafe abortions. "Instead, there should be safe abortion facilities," says Brinda Karat of All India Democratic Women's Organisation.

So far, the only available methods of abortion were surgical. Abortion is legal in India only if the pregnancy adversely affects the health of the mother or the child, including "physical and mental agony" for the mother. The reasons for mental agony encompass rape and failure of contraceptive methods. In trained hands, under sterile, well-equipped conditions, surgical abortion is 99 per cent effective and safe. But in wrong hands, it can lead to infection, rupture of the uterus and death. "Women, many of whom are unmarried, are worried about the social stigma. They are not aware of the fact that abortions are legal, so they end up going to quacks. Then they get infected and die," explains Dr J.B. Babbar, chief gynaecologist at the Family Planning Association of India.

"There should be safer abortion facilities instead." Brinda Sarat, Activist, All India Democratic Women's Organisation

While RU-486 eliminates the element of human skill involved in an abortion, the privacy that it offers is seen as a big advantage. The drug is also hassle-free-no surgical intervention, no anaesthesia, no hospital stay involved. "It empowers a woman to abort silently," says Geeta Chaddha, gynaecologist at Delhi's Indraprastha Apollo Hospital, who has practically stopped conducting surgical abortions since this pill was approved. "It is definitely more patient friendly," agrees Alka Kriplani, senior gynaecologist at the All India Institute of Medical Sciences, Delhi.

Price is another attractive factor. Marketed by companies like Cipla, Sun Pharma and Cadila, the entire course costs less than Rs 400. Nevertheless, RU-486 is far from being a miracle drug. Neither does it work alone. The abortion "pill" is actually two pills, taken on two different days. The first tablet, RU-486 or Mifepristone, acts by blocking progesterone, a hormone essential in pregnancy, and hence kills the foetus. The second pill, Misoprostol, is taken three days later. This causes uterine contractions that expel the foetus. The patient frequently complains of pain in the abdomen, nausea, vomiting and severe cramps. The women are also advised to return to the doctor on the 14th day to ensure all is well. Usually, they are also provided counselling on contraception at the time.

The drug is also not entirely risk free. Five to 8 per cent of women bleed severely after taking the drug and may need hospitalisation. Medical abortion-as abortion using the pills is called-is also dangerous for anaemic patients, those with abnormal pregnancies, those on steroid therapy and in case of a few other conditions. Sometimes the action remains incomplete and the abortion might need to be completed by surgical methods. It is for these reasons that RU-486 has only been approved under medical supervision, only within the first seven weeks of pregnancy, and in clinics with complete back-up facilities.

What is particularly worrying is that medical supervision is often bypassed as desperate women, unaware or uncaring of risks, get hold of the pills without prescription. There are even reports of the drug being sold at paan shops. "Many people have come to us asking for the abortion pill," says Anurag Gupta, a chemist at Connaught Place, Delhi. "But we cannot give them the pill as they do not have a doctor's prescription." In fact, in some countries like China, the pills cannot be sold over the counter and are made available only at approved clinics.

There have also been fears that the abortion pill could be misused for gender selection. Though this may not be easy as the sex of the child is usually detected by ultrasound at 14 weeks, there are some tests that could be used to determine the child's sex earlier.

No wonder then that women's rights groups are concerned. But V.K. Manchanda, deputy director-general at the Ministry of Health and Family Welfare, insists efforts are on to ensure that better reproductive healthcare, including safer abortion facilities, are made available. The amendment to the Medical Termination of Pregnancy Act passed on December 18, 2002, has made three key changes to this effect. It has allowed the power of approval for abortion clinics to be provided at the district level. Currently, there are 9,806 private hospitals approved for abortions. It also specifies stricter punishment for quacks with two to seven years in prison. This includes trained doctors who perform abortions in unauthorised precincts, and owners of clinics where unauthorised abortions have taken place. Trials are also going on for new methods of surgical abortion, with extensive programmes for training more people to perform them.

RU-486 is only a small part of a much bigger problem, but for now, more and more women are happily succumbing to the power of the silent saviour.