Medical Termination of Pregnancy Act : Daily Editorial – Learn and Practice

Context

Medical Termination of Pregnancy Act Amendment bill is being introduced in the Parliament and is due for this session. Let us look at some of the contentious issues and why the amendment is being done.

Background

• The Indian Penal Code, enacted in 1860 based on British law, declared induced abortion illegal. The penalty for abortion practitioners was either three years in prison, or a fine, or both; for the woman availing of an abortion, the penalty was either seven years in prison, or a fine, or both. The only exception was when abortion was induced in order to save the life of the woman.
• But there was huge prevalence of illegal abortions, and it was also thought that abortion could be a mode of population control, caused the government to reconsider the law.
• In 1964, The Abortion Study Committee, headed by Mr. Shantilal submitted its report in December 1966.
• Medical Termination of Pregnancy (MTP) Act, which was enacted by the Indian Parliament in the year 1971 with the intention of reducing the incidence of illegal abortion and consequent maternal mortality.

Medical Termination of Pregnancy Act, 1971

• The Act in its present form permits a woman to terminate her pregnancy if one registered medical practitioner (in case she is up to 12 weeks pregnant).
• In case of pregnancies exceeding 12 weeks but less than 20 weeks, termination needs opinion of two doctors.
• The Medical Termination of Pregnancy (MTP) Act clearly states the conditions under which a pregnancy can be ended or aborted, the persons who are qualified to conduct the abortion and the place of implementation. Some of these qualifications are as follows:
  • Women whose physical and/or mental-health were endangered by the pregnancy.
  • Women facing the birth of a potentially handicapped or malformed child
  • Pregnancies in unmarried girls under the age of eighteen with the consent of a guardian.
  • Pregnancies in “lunatics” with the consent of a guardian.
  • Pregnancies that are a result of failure in sterilisation.

Issues with the Act

• The Act thrusts the power of decision-making on medical practitioners, expropriating women’s right to autonomy and self-determination.
• When a woman is beyond 20 weeks pregnant, the pregnancy may be terminated only if it’s immediately necessary to save her life. The Medical Termination of Pregnancy (MTP) Act of 1971 only makes abortion legal till 20 weeks.
• The baby’s physical and mental health, which is a ground to terminate pregnancy prior to 20 weeks, is no ground to terminate pregnancy post 20 weeks.
• This artificial distinction is not rational, for, medical opinions suggest that several foetal faculties develop much later than the 20 week period. Several foetal abnormalities become conspicuous only during late-term pregnancy.
• The Act is constricted in scope for it discounts a whole range of factors which compel a woman to terminate her pregnancy much later than the 20 week period. For instance, when there is a sudden change of personal circumstances like separation from, or death of the partner, the woman might not be in a position to raise the child single-handedly due to several reasons.
• There are also instances where women don’t even realize that they are pregnant until much later in the term, as they’re using contraceptives, or their periods don’t stop, or they are menopausal, etc. These situations, although fallible, reasonably impel them to rule out pregnancy.
• There are also psychological factors like living in denial, until a time when it’s too late when they finally gather the courage to even think of abortion. In the case of unmarried women, it is even more common to conceal pregnancy over long durations, owing to an ultra-conservative and a taboo-replete society.

Arguments for Amendment

• Article 21 of the Constitution entails right to live with dignity. A woman who’s certain that she will not be able to fulfil basic needs and raise her child with a life of dignity she envisions must be facilitated to exercise her right to reproductive freedom, which also is an integral facet of Article 21.
• The draconian provisions of the Act have been coercing women to access abortion services through backdoor channels, further affecting the bargaining power of vulnerable women and the unsafe abortions contribute to 8% per cent of the total maternal deaths.
• Also the Act has to be amended to increase the availability of safe and legal abortions in India, all stakeholders argue that unsafe abortions still continue to outnumber safe and legal abortions in the country.
• These maternal deaths and morbidities can be addressed through expanding the base of safe abortions, with increasing medical advancements.

What are the amendments that can be included?

• One of the major amendments calls for expanding the base for medical termination of abortions by including midlevel providers in conducting the procedures, particularly during the second trimester, and certification for allowing the abortion by one provider as against two, as is the case now.
• According to a WHO report, “trained mid-level providers can perform manual vacuum aspiration safely, and provide medical methods of abortion” and that doing so “can help ensure appropriate service availability and accessibility without compromising safety”. So they can be included for allowing the abortion.
• The amendments propose that until 12 weeks of pregnancy, the woman alone can take a call on abortion without the recommendation of a registered medical practitioner. If she’s between 12 to 24 weeks pregnant, one registered medical practitioner must recommend it based on the health of both the mother and the child.
• MTP (Amendment) Bill should allow abortion after 24 weeks take into account these medical realities. It would in favour of the woman as it is a pragmatic, life-affirming— decision instead of one based on moral and sentimental considerations.

Conclusion:

• SC recommended a medical panel to decide whether abortion was in the best interest of a 14-year-old rape survivor who was 24 weeks pregnant. In 2016, on the recommendation of a medical board, the SC granted permission to terminate a pregnancy, on account of the fact the 24-week foetus had multiple congenital anomalies which posed a grave danger to the physical and mental health of the mother.
• These precedents must trigger political will to move amendments to the Act, women in their trimesters shouldn’t be pressurised into running from pillar to post within the maze of judiciary, further aggravating the trauma.
• The first step towards undoing the historical wrong inflicted upon women is to deliberate upon the draft of the Medical Termination of Pregnancy (Amendment) Bill put forth by the Ministry of Health and Family Welfare, and pass the amendments at the earliest, thereby freeing women from subjective and arbitrary interpretations of the Act.

Questions

1. Termination of Pregnancy is a debate between Pro-choice and Pro-life. In the lieu of recent amendments proposed, examine the morality behind allowing the termination of pregnancy beyond 20 weeks.
2. What measures could to be taken to reduce the unsafe abortions leading to increased maternal mortality and morbidity?
   

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