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Special Report – The Abortion Law conundrum

Summary:

An adult woman requires no other person’s consent except her own.

Abortion law is also known as medical termination or pregnancy amendment bill 2014. This piece of legislation has become the centre point of controversy amongst the health activists and allopathic doctors. New draft of the medical termination of pregnancy amendment bill 2014 wants to allow nurses, midwives, practitioners of Ayurveda, Unani and Homeopathic medicine to perform abortions using both medical and surgical methods. This means Medics with little or no training in modern surgical practice will be performing operations that could involve life endangering situations. Many in the medical fraternity are alarmed by this move. The activists have demanded the withdrawl of the MTP bill 2014.

Section 3 of the principal act replaces the term registered medical practitioners with the word registered healthcare providers widening the ambit of the health service but at the same time raising questions on the safety of the Women reproductive health.

India has an embarrassing maternal mortality record. Every two hours a woman dies in an abortion performed unsafely or unscientifically. Medical infrastructure and sanitization of operation rooms is also poor. Conditions are worse in rural areas.

Those in favour of the proposal cite the WHO’s safe abortion guidelines which say that training and enabling midwives to perform safe abortions will benefit large numbers of people in remote parts of the country. Nearly 50% of abortions are performed at home or by untrained practitioners. Over 5800 women die every year due to unsafe abortions. This amendment bill will bring back street practitioners into the legal fold, train them and help monitor Healthcare services. The government has also been defending its move citing the positive outcomes of such moves in some parts of the country.

Worldwide an estimated 22 million unsafe abortions are performed every year. This is a result of range of factors including the legal status and social stigma of abortion and a lack of access to safe abortion services.

In India abortion has been legalised since 1971. However, shortage of good facilities and untrained practitioners, particularly in rural areas, forced many women to go for unsafe abortions. This has contributed to high maternal mortality rate throughout the country. It is estimated that there are 6 to 7 million abortions happening in the country every year and 50% of them are unsafe.

Allopathic doctors fear the amendment could lead to a spike in female foeticide, encourage abortions and discourage contraception. The draft bill also goes against the 2 rulings of the Supreme Court which strictly prohibit such practices.

In the Poonam Verma Vs Ashwin Patel case the SC observed “A person who does not have a knowledge of particular system of medicine but practices in that system is a quack and a mere pretender to medical knowledge or skill”.

The Doctor Muktiyar Chandra Vs state of Punjab case judgement checks non allopaths from prescribing the allopathic drugs.

This draft abortion law also speaks about another amendment and that is raising the ceiling of the abortion from20 to 24 weeks of pregnancy. This is amendment is considered more progressive, acceptable and there is a larger consensus on this. The doctors even say that the health ministry should promote and emphasize on contraceptive methods to prevent unwanted pregnancies and not medical termination. This means that the focus of the family planning programme has to be contraceptive and permanent methods of sterilization after completing the family. Experts also feel that the abortion should be done only by a registered medical practitioner as this amendment may increase sex selection abortion in the country. It will also reverse the efforts made so far to improve the child sex ratio at the same time putting the women’s lives at risk due to repeated pregnancies and deliveries.

The role of midlevel health workers in increasing manifold in the health care system both in the developing countries and developed nations. Countries like Europe, Vietnam, US and South Africa have allowed the midlevel workers to carry out abortions.

It is almost like an open secret in India that contractual Ayush doctors practice alternate modern system of medicines. They have also been performing as the sole incharge of primary health care centres particularly in rural area. The new amendment bill aims at equipping them with modern facilities and training to carry out acute and emergency health care services. Nurses in India are not allowed to prescribe drugs.

There is also an unanswered question regarding which council will register the cases in case of negligence. There are also ambiguities present over the Drug Controller act on this issue.