In the ongoing pro-life vs pro-choice debate, I believe the government of India is walking a fine line, keeping the health and well-being of the mother as paramount.
The Medical Termination of Pregnancy Act of 1971 took over 50 years to be updated and many aspects of it were modernised in the amendment of 2021.
The intent of the government during the framing of the amendment of the Medical Termination of Pregnancy Act in 2021 was clear — to keep up with the changing times. All women, irrespective of their marital status, should have access to safe abortion in the legally allowed time frame with dignity, autonomy, confidentiality and justice.
Statistics show that the number of deaths from unsafe abortions has been alarmingly high with over 13 women dying every day in India due to unsafe abortion practices. Forty-four per cent of the 48.5 million pregnancies that occur annually in India are unintended and approximately 16 million (77 per cent) of these unintended pregnancies result in abortion. About 800,000 unsafe abortions occur in India every year and 10 per cent of them result in maternal deaths. Sustainable Development Goal 3.1 pertains to reducing maternal mortality ratio. Thus, the need to address the changing social norms and amendments of laws.
The MTP Act has come up for discussion again in recent times due to an ongoing case in the Supreme Court where the petitioner is fighting for her right to terminate a pregnancy after 20 weeks.
At no point, can anyone diminish the emotional, mental and physical impact of the decision to end the life inside one’s womb. It is a decision that can never be considered easy. The right to life and liberty that has been extended to every Indian citizen in our Constitution also covers the reproductive choices of women. Keeping this in mind, the Act extended the period of safe abortion from 12 weeks to 20 weeks, and added a provision that enabled even unmarried women to undergo abortion safely, keeping them away from untrained quacks and clinics with lax safety standards. The difficulties of treating complications that arise out of unsafe abortions were on the rise and when the procedure is illegal, it compounds the medical difficulties that can arise like incomplete abortions resulting in extreme blood loss, perforations in uterus, post abortion infections or septicaemia, lack of access to antibiotics, thus causing great economic and social loss. The new amended law was aimed at a significant reduction in these issues, and the efforts to provide information about their reproductive rights even at the grassroots level will continue to empower women.
Under special circumstances, abortions are now also allowed between 20 and 24 weeks and the approval of a medical board is needed for pregnancies which have crossed the safe period of 24 weeks.
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However, the right to termination of pregnancy has to be looked at from the lens of medical safety as well. While the government recognises a woman’s autonomy over her body, it also understands and acknowledges the medical implications of the choice of a late period termination.
After speaking to several practising doctors in this field, some things are clear. The expulsion procedure of a foetus becomes more difficult once the bones of the foetus are formed, posing a high risk to the mother. Whether the termination of pregnancy is done vaginally or through a surgical procedure, it remains complex as the cervix is neither soft nor is the uterus thin. Keeping this in mind and also understanding that anomaly scans are done at 11 weeks and then 20 weeks, 24 weeks has been thought to be a sufficiently long and safe period for elective abortion.
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Another aspect to keep in mind is foetus viability and this debate continues to rage on. As the pregnancy progresses, the foetus continues to develop. Many advanced super speciality units believe that the foetus viability is quite high after 28 weeks but has a good chance of survival even at 24 weeks. In such a situation, many doctors don’t want to terminate a pregnancy unless the reasons are very strong. This does not take away from a woman’s agency to keep the pregnancy or abort it, but it simply makes the choice more informed and nuanced, allowing her free will till a certain safe period and after that adding more administrative and medical provisions to it.
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In the Indian context, the foetus in the womb is called a “jeev” (a being). Life is precious and must be treated so. It is believed that a time of 20 weeks in all cases and 24 weeks in exceptional cases is long enough to decide what it is that a woman would like to do. Beyond that time frame, termination of pregnancy poses a risk to her health. The medical practitioner in charge of her case also gets cautious and the procedure of termination is not free of genuine threat to the mother. Lastly, the foetus in the womb has, by this time, developed a heart and brain and starts to feel and is at an age where it can survive in special neonatal care units. The MTP Act in place at present represents the best balancing act between being pro-life and pro-choice.
The writer is a lawyer and national media panellist, BJP
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October 16, 2023 at 02:22PM
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