The government on Wednesday, 13 October, notified new rules under which the upper limit for termination of a pregnancy has been increased from 20 to 24 weeks for certain categories of women, according to news agency Press Trust of India.
In a move forward for women’s health, on 17 March, the Rajya Sabha passed the Medical Termination of Pregnancy (Amendment) Bill, 2020.
This bill seeks to extend the upper limit permitting abortions for special categories of women - including rape survivors, victims of incest, disabled women and minors- to 24 weeks. “This is long overdue, but we are glad to have it,” said Dr Nozer Sheriar, former Secretary-General of the Federation of Obstetric and Gynaecological Societies of India
Here’s why this is historic.
India's maternal mortality ratio per 100,000 live births was 35,000 in 2017 as per UNICEF records and according to our Union Ministry.
37.6 per cent of these were from unsafe abortions - despite abortion being legal since 1971 under the Medical Termination of Pregnancy Act.
Women’s health, in particular, their sexual and reproductive healthcare is often complicated by societal taboos and inequality of status.
“We are very happy with the amendments but we wish they had done more. Where is the woman’s voice? This Bill is still provider-centric.”Dr Nozer Sheriar, former Secretary-General of the Federation of Obstetric and Gynaecological Societies of India
FIT breaks down the news, the controversies and why you should care.
‘A Step Forward’: India & Abortion
In an earlier interview with FIT, Dr Nozer Sheriar, former Secretary-General of the Federation of Obstetric and Gynaecological Societies of India, said that abortions were the third most common cause of maternal mortality after postpartum haemorrhages and infections.
As per a 2018 Lancet study, India has 47 abortions per 1,000 women in the age group of 15-49. Thousands of women face preventable death due to a lack of affordable, accessible contraceptive options, social stigma and a lack of awareness of laws. Abortion has been legal in India for 47 years now since the Medical Termination of Pregnancy Act (MTP Act) came about in 1971 but it is yet to become a woman’s right.
For Dr Nozer, who has worked on India’s MTP Act, 1971, this is a vital step to improving our abortion laws and reducing the number of unsafe abortions.
Poonam Muttreja, Executive Director of Population Foundation of India adds,
“The MTP Amendment Bill acknowledges the abortion needs of unmarried women for the first time and is a step forward in ensuring universal access to safe abortion services for women and girls.”Poonam Muttreja
She adds, “The enhancement of the upper gestation for special categories of women (survivors of rape, women with disabilities etc) and in cases of fetal abnormalities is also a much-needed resolution for the numerous cases we see in courts today.”
On passing the Bill, Union health minister Harsh Vardhan tweeted, “The bill will protect the dignity and rights of women.”
Explained: MTP Amendments & Why We Need to Push for More
While reproductive justice experts hail the move, the Bill still lacks a rights-based approach – making it mandatory for women to justify abortion, riddled with accessibility issues.
“We have no complaints but wish we had done more. Where is the woman’s voice? This is a Bill for women’s health, do we still think women lack the good sense and the autonomy to make these decisions for themselves?”Dr Nozer Sheriar, former Secretary-General of the Federation of Obstetric and Gynaecological Societies of India
Dr Sheriar says that there were comprehensive proposals to the amendments, of which a few have been granted in the Bill.
- The Bill looks at increasing the gestational age,
- extensions to end the pregnancy of a birth defect with the caveat of a committee or a board’s approval.
“This is extremely difficult in practice and to implement given the numbers of women vis-a-vis providers we are talking about. I feel that wasn't necessary,” adds Dr Sheriar.
- The Bill includes confidentiality for women who need to terminate a pregnancy.
- It allows an abortion on the advice of one doctor up to 20 weeks, and two doctors in the case of certain categories of women between 20 and 24 weeks.
- It also allows unmarried women to terminate a pregnancy.
“I’m very glad to have the confidentiality, that’s something we pushed for. I don’t see why it’s necessary for two opinions for 24 weeks especially if we are trusting one for 20 weeks,” asks Dr Sheriar.
A bit of history here: Being involved in the MTP Bill from the very beginning means Dr Sheriar has a “birds-eye view” of every aspect of it. He shares how the committee proposing amendments to the ministry worked on them from 2006 to 20012 and they were out in 2014. However, the negative reaction meant it has finally taken almost 7 long years to come through. “For example, we have been working to include unmarried women and we’re glad that has come through,” he adds.
He adds that while they are happy, we need to push for more.
- A big issue is that the Bill is still too provider-centric.
“From a public health perspective, we wanted to widen the provider base. There is a total mismatch between the number of women who want abortions and the people who can provide it. It is a fact that we have self-managed abortions in India. I don’t want to mar the celebration but we needed to increase the provider base in the public sphere.”Dr Nozer Sheriar, former Secretary-General of the Federation of Obstetric and Gynaecological Societies of India
Dr Sheriar asserts that we are talking about women’s rights. “I know there was some controversy around this but currently we don’t have enough OBGYNs who can serve women. But we have skilled birth attendants and ASHAs and I don’t know why we cannot train them to do an abortion.”
“80 per cent of women in India undergo a medicated abortion alone. Instead of going to the chemist alone why can’t she go to an attendant who has studied this. Self-managed abortions are a reality and she does not often have other options,” he adds.
Still, Muttreja adds that the “bill presents an opportunity for decentralizing and expanding the base of legal abortion providers to include those providing only medical abortion services. This would particularly help ensure safe abortion services are available to the most vulnerable and remotely-located women.”
More Women’s Autonomy
"We wanted on demand in the first trimester,” says Dr Sheriar. “I understand the fears of sex-selection but this is taking away women’s rights.”
“When we talk about ensuring women have reproductive rights, we must give them the complete autonomy in the first trimester of pregnancy and allow abortion on request up to 12 weeks. I believe it is only then that a woman will truly be able to exercise her reproductive choices and make the best decisions for herself.”Dr Nozer Sheriar, former secretary general of the Federation of Obstetric & Gynaecological Societies of India (FOGSI)
- Sex Selection & Abortion
Female foeticide and abortion have a complicated relationship. Sex-selective abortion is the practice of terminating a pregnancy based on the predicted sex of the infant. The Pre-Conception and Pre-Natal Diagnostic Techniques Act was enacted in 1994 to ban sex-selective abortion and stop female foeticide. However, abortion and female foeticide are often thought of in combination by the general public.
So, will giving complete autonomy to women to choose whether they want to continue with their pregnancy worsen the female foeticide rate in India?
“When one thinks of abortion, they think it is being done to kill the female foetus. One has to note that 80 percent of abortions in India take place within the first 12 weeks, within days after the person finds about their pregnancy. It is medically not possible to determine the sex of the foetus within this time frame. Therefore, complete autonomy should be granted,” says Souvik Pyne who works with YP Foundation, an NGO that works for reproductive rights, among other issues.
Dr Sheriar adds that “sex-selection anyway does not happen in the first trimester.”
Still, for now, India’s abortion laws are one of the most progressive in the world.
“The future lies in the complete autonomy of the woman and abortion on demand.”Dr Sheriar
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