Medical Termination of Pregnancy (Amendment) Bill, 2020

WOMEN/ GOVERNANCE

Topic:

• GS-2: Mechanisms, laws, institutions and Bodies constituted for the protection and betterment of these vulnerable sections(women)

Medical Termination of Pregnancy (Amendment) Bill, 2020

 Background

• Voluntary Termination: Under the Indian Penal Code, 1860, voluntarily terminating a pregnancy is a criminal offence.
• Specific Law: The Medical Termination of Pregnancy Act (MTP), 1971 allows for aborting the pregnancy by medical doctors (with specified specialisation) on certain grounds.
• Various Conditions for Medical Termination: Under the 1971 MTP Act, a pregnancy can be terminated until 20 weeks after conception, on the advice of two doctors, if it will harm the mother, cause grave injury to her mental or physical health (including rape and failure of birth control measures) or in the case of foetal abnormalities or to save woman’s life.
• Systemic push towards illegal service providers: If the pregnancy has gone over 20 weeks, then women has to seek legal course to terminate the pregnancy. The slow judicial process is thus pushing her to depend on illegal service providers for termination of unwanted pregnancies
• Argument for amendments in MTP: Several Writ Petitions have been filed by women seeking permission to abort pregnancies beyond 20-weeks due to foetal abnormalities or rape. It is also argues that with the advancement of medical technology, there is a scope to increase the upper limit for terminating pregnancies 

Do You Know?

• A 2015 study by India Journal of Medical Ethics noted that 10-13% of maternal deaths in India are due to unsafe abortions – the third-highest cause of maternal deaths in India.
• In India, an estimated 15.6 million abortions were performed in 2015. This translates to an abortion rate of 47 per 1,000 women aged 15–49
• Currently, slightly fewer than one in four abortions are provided in health facilities.
• According to a study, about 67% of the countries in the world (which have a federal law regulating pregnancy) require authorisations by at least one health care provider to undergo an abortion.
• The World Health Organisation does not specify any maximum time limit after which a pregnancy should not be terminated

Key Highlights of the Amendment Bill

1. Time Limit for terminating Pregnancy

2. Termination due to failure of contraceptive method or device: 

• Under the Act a pregnancy may be terminated up to 20 weeks by a married woman in the case of failure of contraceptive method or device.  
• The Bill allows unmarried women to also terminate a pregnancy for this reason.

3. Medical Boards:  

• All state and union territory governments will constitute a Medical Board.   
• The Board will decide if a pregnancy may be terminated after 24 weeks due to substantial foetal abnormalities.   
• Each Board will have a gynaecologist, paediatrician, radiologist/sonologist, and other members notified by the state government.

4. Privacy

• A registered medical practitioner may only reveal the details of a woman whose pregnancy has been terminated to a person authorised by law.  
• Violation is punishable with imprisonment up to a year, a fine, or both.

Merits of the bill

• Upholds Dignity of Women: The bill fulfils its professed aim of ensuring “dignity, autonomy, confidentiality and justice for women who need to terminate pregnancy”
• Institutional & Organised Abortion services: The lacunae in the older enactments led to many quacks and unqualified persons running illegal abortion clinics endangering the lives of many women. It is expected that the new amendments will help tackle these issues and bring more abortions into the organised domain, wherein qualified medical practitioners can take decisions and perform safe abortions.
• Destigmatizing pregnancies outside marriage: The Bill also applies to unmarried women, thus removing a regressive clause of the 1971 Act which said that unmarried women could not ask for an abortion citing contraceptive failure as a reason. The bill replaces “any married woman or her husband” with “any woman or her partner” thereby destigmatizing pregnancies outside marriage.
• Safeguards Reproductive Rights of women: Allowing unmarried women the right to legally terminate an unwanted pregnancy with a provision to protect her identity will confer reproductive rights to women.
• Reduces Maternal Mortality Rate: The bill increase women’s access to legal and safe abortion services which in turn will reduce maternal mortality and morbidity caused by unsafe abortions and associated complications

Concerns/Criticism

1. Ethical Dilemma:

• One opinion is that terminating a pregnancy is the choice of the pregnant woman, and a part of her reproductive rights.  
• The other opinion is that the state has an obligation to protect life, and hence should provide for the protection of the foetus. 
• Across the world, countries have set varying conditions and time limits for allowing abortions, based on factors such as foetal viability (the point at which the foetus may survive outside the womb), foetal abnormalities, or risk to the pregnant woman.  

2. Beyond 24 weeks

• The Bill allows for termination of pregnancy after 24 weeks only in cases where a Medical Board diagnoses substantial foetal abnormalities. 
• This implies that for terminating pregnancies due to rape that have crossed the 24-week limit, there is no change in the process: the only recourse is to get permission through a Writ Petition.

3. Time frame for Medical Board’s decision not specified

• The Bill allows for the termination of pregnancy after 24 weeks based on the opinion of the Medical Board in the case of substantial foetal abnormalities. The Bill does not provide a time frame within which the Medical Board must make its decision. 
• Termination of pregnancies is a time sensitive matter, and delays in decision-making by the Medical Board may result in further complications for the pregnant woman

4. Unclear if transgender persons will be covered

• Some medical studies have shown that there may be cases where persons who identify as transgender (and not women) can become pregnant even after receiving hormone therapy to transition from female to male, and may require termination services. 

• Since the Act and the Bill only provide for termination of pregnancies in the case of women, it is unclear if transgender persons will be covered under the Bill.

5. Unavailability of qualified medical professionals to terminate pregnancies 

• The All-India Rural Health Statistics (2018-19) indicates there are 1,351 gynaecologists and obstetricians in community health clinics in rural areas across India, and the shortfall is 4,002, i.e., there is a 75% shortage of qualified doctors. 
• The shortage of qualified medical professionals may continue to limit the access of women to safe abortion services.  
• Note that as per the National Health and Family Survey (2015-16), only 53% of abortions are performed by a registered medical doctor and the balance are conducted by a nurse, auxiliary nurse midwife, dai, family member, or self

6. Prejudice against persons with special needs:

• The special classifications of “serious physical or mental abnormalities” and “substantial foetal abnormalities” also reek of societal prejudices against persons with special needs.

Connecting the dots:

• Reproductive rights of a women vs Rights (if any) of an unborn child