INTRODUCTION
Abortion is an essential component of sexual and reproductive health care. It constitutes a reproductive choice of a woman to either continue with or terminate her pregnancy. But is it so easy to realize such freedom of choice? Amidst the age-old social stigma backed by poor legislation in India, women are often rendered helpless to access abortion care even in the worst of situations. Abortion remains stigmatised in India, even within the medical fraternity, as IndiaSpendreportedin September 2020. In such a scenario, the availability of safe abortion care to the vulnerable women becomes even far moredifficult.
The national rape-related pregnancy rate is5.0%per rape among victims of reproductive age (aged 12 to 45). Only 11.7% of these victims receive immediate medical attention after the assault, and 47.1% do not revieve any medical attention related to the rape. A total 32.4% of these victims do not discover their pregnancy until they have already entered the second trimester and only 50% are able to undergo abortion.
THE MEDICAL TERMINATION OF PREGNANCY (AMENDMENT) ACT, 2021
The MTP (Amendment) Act, 2021aims to ease the pain of such rape victims and facilitates the termination of the unwanted pregnancy upto a period of 24 weeks. The upper gestational limit has further been removed in case of pregnancies accompanied by substantial foetal abnormalities. The amendment is a welcome step in addressing the physical and mental health issues concerning pregnancy in ‘vulnerable’ women, including rape victims. For a better understanding, the amendments in the MTP Act have been summarisedbelow.
Amendments made via the MTP (Amendment) Act, 2021 Setting up of MedicalBoards Section 2 of the MTP Act, 1971 has been amended to provide for the definition of “Medical Board”. Subsection 2D of section 3 further provides that the Medical Board shall consist of a Gynaecologist, Paediatrician, radiologist and such other members as may be notified in theOfficial Gazette by the State Government or Union territory. The powers of such a medical board have been prescribed under subsection 2C of Section 3 of the MTP (Amendment) Act, 2021.
‘Termination of pregnancy’defined The ‘termination of pregnancy’ has been defined under Section 2 (e) of the MTP (Amendment) Act, 2021 as “a procedure to terminate a pregnancy by using medical or surgical methods”.
Single Registered Medical Practitioner’s opinion sufficient to terminate pregnancyofless than 20 weeks Earlier, the opinion of at least two registered medical practitioners was required to terminate a pregnancy between 12 – 20 weeks. Now, Section 3 (2) (a) of the MTP (Amendment) Act, 2021 has been amended and seeking a second medical opinion has been done away with for terminating a pregnancy of less than 20 weeks.
Upper Limit for Termination of Pregnancy Extended to 24weeks The prodigious change sought to be achieved by the recent amendment is to allow for the termination of pregnancy upto 24 weeks in case of rape victims. Section 3 (2) (b) of the MTP (Amendment) Act, 2021 aims to relieve such rape victims from the extended mental trauma of birthing a child conceived out of sexual abuse.
Medical Board to have the final say in case of substantial foetal abnormalitiesSection 3 (2B) has an overriding effect on subsection (2) of the MTP (Amendment) Act, 2021. VideSection3(2B),iftheMedicalBoardhasdiagnosedsubstantialfoetal abnormalities in a particular pregnancy, then the provisions of subsection (2) relating to the length of the pregnancy shall not apply to the termination of pregnancy by the medicalpractitioner. In other words, the upper gestational limit in such pregnancies have been removed subject to the diagnosis of the Medical Board.
Anonymity of the women undergoing abortion
Reinforcing Puttaswamy judgement, the right to privacy of the women undergoing abortion has also been recognized. Section 5A of the MTP (Amendment) Act, 2021 restrains the medical petitioner from revealing the particulars of any woman undergoing abortion except to a person prescribed by law.
CONCLUSION
The MTP (Amendment) Act, 2021 is no doubt, highly ambitious at streamlining the abortion laws in case of irregular pregnancies. However, the implementation of this Act can itself prove to be a challenge in the coming times. The formation of the Medical Boards in various states has been left at the hands of the State governments without any strict plan for action. Adding another layer of barrier for availing abortion care will only create further delay in terminating such pregnancies.
Furthermore,theamendmentsfailtoaddressthechallengesthatwereearliersoughttobe covered under the Medical Termination of Pregnancy Bill, 2014.The vulnerablewomen should have been given access to medical procedures from the earlier weeks of pregnancy for safer termination of such pregnancies. Since90%of such women seek abortion before 12 weeks gestation, training village-level healthworkers (auxiliary nurse midwives) and nurses to prescribe simple abortion pills could have helped to render safe services to the doorsteps of vulnerable women and, in case of complications, lead to timely referrals. Although the MTP (Amendment) Act, 2021 aims to do certain things right, the actual implementation of the amendments remains to be seen in future.