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Insights into Editorial: Changes in 1971 abortion law, and why India feels it necessary

Insights into Editorial: Changes in 1971 abortion law, and why India feels it necessary

Ensuring_Safety_And_Well-Being_OF_Women

Context:

The Union Cabinet cleared a long-pending change to the Medical Termination of Pregnancy Act, 1971 that raises the legally permissible limit for an abortion to 24 weeks from the current 20 weeks.

The Union cabinet has done well to approve a Bill that seeks to amend India’s outmoded abortion law.

Following the efforts of the Health Ministry, the change also accepts failure of contraception as a valid reason for abortion not just in married but also in unmarried women.

Significantly, this provision applies to unmarried women and therefore, relaxes one of the regressive clauses of the 1971 Act — single women couldn’t cite contraceptive failure as a reason for seeking abortion. It also has a provision to protect the privacy of the person seeking abortion.

Background:

The Ministry of Health and Family Welfare proposed the amendments in the termination of pregnancy bill after extensive consultation with various stakeholders and several ministries.

The move aims to increases the access of women to safe abortion services, taking into account the advances made in medical technology.

Recently, several petitions were submitted to the Courts, seeking permission for aborting pregnancies at a gestational age beyond the current permissible limit on grounds of foetal abnormalities or pregnancies due to sexual violence faced by women.

What changes does the Medical Termination of Pregnancy (Amendment) Bill, 2020 bring in?

  • It increases the maximum permissible gestation age for abortion to 24 weeks, with the provision that for pregnancies that are between 20-24 weeks opinions will be required from two doctors rather than one.
  • This has been specially done keeping in mind “vulnerable women including survivors of rape, victims of incest and other vulnerable women (like differently-abled women, Minors) etc”.
  • The upper gestation limit will not apply in cases of substantial foetal abnormalities diagnosed by a Medical Board.
  • The composition, functions and other details of the Medical Board are to be prescribed subsequently in Rules under the Act.
  • This clause has been put to keep such cases out of courts; the government deemed a Medical Board should examine the various aspects of the case and take a call.
  • The original draft of the Bill had included the contraceptive failure clause only for married women, which, the Health Ministry has now felt, would have left unmarried women, on whom social pressures to abort are more acute, at the mercy of quacks.

Why is the change in law significant?

  • Despite a sustained government push over years, contraceptive use in India is not very popular.
  • According to a 2018 study by the Guttmacher Institute, 50% of pregnancies in six of the larger Indian states — Assam, Bihar, Gujarat, Madhya Pradesh, Tamil Nadu and Uttar Pradesh — are unintended.
  • Data from the National Family Health Survey 4 show that just 8% of couples in the country use modern contraceptive methods; only 53% use any method at all.
  • It found that 55% pregnancies in Assam, 48% in Bihar, 53% in Gujarat, 50% in Madhya Pradesh, 43% in Tamil Nadu and 49% in Uttar Pradesh are unintended.
  • According to a 2016 study published in The Lancet by the Guttmacher Institute and the World Health Organization, an estimated 56 million abortions took place globally each year between 2010 and 2014.
  • In 2015, a study in The Lancet Global Health, also by Guttmacher Institute and IIPS, estimated that 15.6 million abortions were performed in India in 2015.
  • This translates to an abortion rate of 47 per 1,000 women aged 15-49, which is similar to the abortion rate in neighbouring countries.
  • The number of pregnancies ranged from 1,430,000 in Assam to 10,026,000 in Uttar Pradesh.
  • Estimation of unintended pregnancies is important because many of them result in abortions and the availability of cheap and safe abortion services is one of the indicators of a robust health system.

Its Matter of her right:

The MTP Act, 1971 was replete with unclear language, which resulted in doctors refusing to perform abortions even within the stipulated 20-week gestation limit.

Women had to seek the approval of the judiciary, which, by most accounts, did not always come in time.

“As a result”, notes a 2015 study in the India Journal of Medical Ethics, “10 to 13 per cent of maternal deaths in India are due to unsafe abortions”.

Introducing the proposed law, the MTP Bill 2020 “will help reduce maternal mortality”. Extending the gestation period to 24 weeks is a significant step in this regard.

The proposed amendments include substitution of certain sub-sections, insertion of certain new clauses under some sections in the existing Medical Termination of Pregnancy Act, 1971, with a view to increase upper gestation limit for termination of pregnancy under certain conditions and to strengthen access to comprehensive abortion care, under strict conditions, without compromising service and quality of safe abortion.

Concerns in the proposed Bill:

One of the criticisms of the MTP Act, 1971 was that it failed to keep pace with advances in medical technology that allow for the removal of a foetus at a relatively advanced state of pregnancy.

Moreover, a number of foetus abnormalities are detected after the 20th week, often turning a wanted pregnancy into an unwanted one. The proposed MTP law intends to address such medical complications.

But matters related to women’s agency over her womb get complicated by the social milieu in parts of the country: The ante-diluvian preference for a male child keeps sex determination centres in business in spite of their illegal status.

There are concerns that a more liberal abortion law can aggravate this state-of-affairs. The litmus test of the proposed MTP law’s claims to being women-centric lies in addressing all such concerns.

According to 2017 data, 59 countries allowed elective abortions, of which only seven permitted the procedure after 20 weeks like Canada, China, the Netherlands, North Korea, Singapore, the United States, and Vietnam.

Conclusion:

The Medical Termination of Pregnancy (Amendment) Bill, 2020 is for expanding access of women to safe and legal abortion services on therapeutic, eugenic, humanitarian or social grounds.

It is a step towards the safety and well-being of the women and many women will be benefitted from this.

Recently several petitions were received by the Courts seeking permission for aborting pregnancies at a gestational age beyond the present permissible limit on grounds of foetal abnormalities or pregnancies due to sexual violence faced by women.

The proposed increase in gestational age will ensure dignity, autonomy, confidentiality and justice for women who need to terminate the pregnancy.