Analysis I US court strikes down right to abortion; what’s the scene in India?

In India, the Medical Termination of Pregnancy (MTP) Act, 1971, was amended in 2021 to allow abortions up to 24 weeks of pregnancy in special cases. Prior to this amendment also, abortion had been legal for up to 20 weeks.

However, those advocating women’s reproductive rights point out that while abortion may be legal under certain conditions, access to medical services, the stigma associated with abortions and lack of awareness are big barriers.

Unsafe abortions

According to the United Nations Population Funds’ State of the World Population Report 2022, which was released in March, unsafe abortions are the third leading cause of maternal mortality in India, and close to eight women die from causes related to unsafe abortions every day.

Between 2007 and 2011, 67 percent of the abortions in India were classified as unsafe, the report pointed out.

New norms

The MTP (amendment) Act, 2021, says that while all women can abort pregnancy up to 20 weeks, with the opinion of one doctor, others such as survivors of sexual assault or rape or incest, minors, women with physical or mental disabilities or in cases of foetal abnormality, the opinion of two doctors are needed for abortion—up to 24 weeks.

Abortion is also permitted for up to 24 weeks for women whose marital status changes (widowhood and divorce) during pregnancy and during disaster-like situations. Also, there is also a provision for a state-level medical board determining the request for termination of a pregnancy longer than 24 weeks in cases of foetal anomalies.

Unmarried women allowed safe abortion

Importantly, while, earlier, the Act permitted termination of pregnancy by only a married woman in the case of failure of contraceptive method or device, with the amendment, unmarried women can now seek safe abortion services on grounds of contraceptive failure.

However, many women look up to illegal clinics and quacks because of the stigma, said Dr Sarada M, consultant obstetrician and gynaecologist with Yashoda Hospitals in Hyderabad.

The moral-legal debate on abortion has never attracted much interest. In the country, the debate has largely been about to what extent abortion should be legalised, she says.

For instance, should women possess an unrestricted and absolute right to abortion?

“Besides acknowledging the failure of contraception, MTP is now available to any woman or her partner, replacing the old provision for only married women or their husbands,” she said.

“Still, in India, the stigma attached with abortion forces many women to hide it,” Sarada said.

Shocking statistics

Poonam Muttreja, executive director of the Population Foundation of India, cites the findings by the fifth round of the National Family Health Survey (2019–21).

It showed that only 55 percent of abortions in India are carried out by a doctor and more than one-quarter (27 percent) were performed by the woman herself at home.

A majority of the abortions (53 percent) were performed in private hospitals, resulting in high costs, making the service inaccessible for marginalised communities.

The Rural Health Statistics (2019-20), released by the Union health ministry last year, on the other hand, showed that there is a shortfall of nearly 70 percent obstetricians and gynaecologists.

“This severely limits women’s access to safe abortion services,” said Muttreja. “Certain state-mandated conditionalities for abortion also mean that women often do not have full rights over their own bodies, and the power mostly lies with doctors and the state apparatus.”

According to Debanjana Choudhuri, a gender and climate specialist, while the Indian law makes a provision for legal abortion till a specified time period, there may be a lack of a good system to implement it properly.

“Unsafe abortion remains one of the leading causes of maternal mortality in our country, indicating that the law is inadequate,” she said.

‘MTP Act heavily protectionist’

Choudhuri says that the MTP Act is heavily medicalised and protectionist in approach. “It does not offer abortion as a choice to women and the final say is with doctors or lawmakers,” she said.

Another barrier is its conflation with Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act, 1994, aimed at preventing sex selection and female foeticide.

“While the Act is also a very important law, on ground, largely owing to a lack of awareness even among doctors, there is a lot of denial of abortion services and people also tend to believe abortion is illegal,” she added.

There are many instances, Choudhuri pointed out, where a woman has to do many court rounds in order to get access to abortion because the law isn’t seamless and has many complications.

“Due to these reasons, many seek unsafe abortion practices in secrecy, and this can only be changed when the law becomes seamless and every woman can seek abortion in a hassle-free manner,” she said.

Empowering nurses, AYUSH doctors a solution?

As there are many challenges that need to be addressed, especially in terms of ensuring universal access to the service, experts like Muttreja believe that expanding the provider base to include trained nurses, and auxiliary nurses-cum-midwives and AYUSH doctors to assist in abortions up to 12 weeks, in line with WHO recommendations, could go a long way.

“That said, India's abortion regime is quite liberal, compared to many other countries. America, and the rest of the world where women don't have abortion rights, could learn a lot from India,” she said.

Dr Aradhana Singh, senior consultant, obstetrics and gynaecology with Fortis hospital in Noida, too, stressed that the amendments in the Indian MTP Act are more liberal and helpful for the women genuinely seeking abortions to maintain their mental, physical and emotional health.