For many women, it is the time (gestation period) that is crucial, and not who does the abortion. The prospect that they can get rid of the burden of a deformed foetus, if detected till six months of pregnancy, is a huge comfort
The growing demand for a re-look at the present Medical Termination of Pregnancy Act from a modern perspective has forced the Government to come up with a draft Bill for an amendment to the law. The proposed amendments are to allow abortion up to 24 weeks instead of the present 20 weeks (five months). It would also allow homoeopaths, ayurveda doctors, midwives and nurses to perform abortions.
The draft Bill has kicked up a huge storm in the medical fraternity, while the women in general are feeling relieved. For many women, it is the time (gestation period) that is crucial and not who carries out the abortion on them. The prospect that they can get rid of the burden of a deformed foetus — without a brain or a kidney — if detected till six months of pregnancy is a huge comfort.
Not many women were aware of this law on abortion that prohibits termination of pregnancy beyond five months till Mumbai’s Niketa Mehta approached the courts seeking legal approval for abortion in the 24th week as her unborn child was detected with serious congenital heart ailment. Ms Niketa feared that it would suffer for life. However, in the absence of a provision in law, the courts felt her case could not be made as exceptional. Her petition was rejected by the Supreme Court. A few days later, she suffered natural abortion.
In fact, any abortion between 12 and 20 weeks is not an easy affair for doctors and patients. Medical termination of pregnancy between this period is allowed only if there is a danger to the life or risk to the physical or mental health of the woman, or when pregnancy is due to rape and failure of contraception or sterilisation. It is also allowed on humanitarian grounds, such as when pregnancy arises from a sex crime or intercourse with a lunatic woman or of unmarried girls under the age of 18 with the consent of their parents. And, on grounds when there is a substantial risk that the child, if born, would suffer from deformities and diseases. However, the length of pregnancy cannot exceed 20 weeks in order to qualify for an abortion. The opinion of two doctors is necessary for abortion between 12 and 20 weeks. Only registered medical practitioners as prescribed by the MTP Act are authorised for medical abortion. And they must have surgical and emergency back-up.
But not all women go to courts seeking permission. A huge majority of women go to quacks and midwives who, through crude methods, help them get rid of the unwanted pregnancy. For several desperate women, it hardly matters who performs the abortion and how. As long they are free from the burden of unwanted and defected pregnancy, they are happy.
The Government is possibly progressing in a direction to allow more medically-trained hands to carry on MTPs as long as they have the licence to abort and the experience to save life — be it ayurveda or homoeopath doctors, nurses or adequately trained midwives.
Even for allopathic doctors, MTP can be done only by a registered medical practitioner having undergone six months housemanship or three years of post-graduate training in obstetrics and gynaecology, or any registered medical practitioner who has conducted 25 cases of MTP in approved institution. MTPs for pregnancy less than 12 weeks’ duration can be done by one medical practitioner, but if the duration of pregnancy is more than 12 weeks but less than 20 weeks then two medical practitioners have to consult each other and certify that if pregnancy is not terminated, it may endanger the life of that woman or mental or physical injury or pregnancy will give rise to congenital defect in child.
For quite some time, there has been a thinking going among the policy planners to train homoeopaths and paramedical staff to handle emergency health issues like normal child-delivery and heart attacks on their own at remote locations where access to doctors is zero. It was being thought that in complicated situations, they could at least stabilise the patient and send them to medical centres. The same thinking perhaps is now reflecting in the draft MTP Bill — that to provide access to health care and reduce maternal mortality in training the traditional form of medical practitioners in modern medicines and possibly equipping them with a licence to abort.
Successive Governments have been tight-gripped with abortion laws to prevent female foeticides in the country given the fact the girl child sex ratio has been on a decline. But even as concerns remain over the dwindling sex ratio, it seems better sense has prevailed to help women.
Several cases can be narrated by doctors: Foetus without kidneys and brain surviving only through umbilical cord which cannot be cut prematurely in the absence of the law. So, the ‘who’ and ‘how’ are immaterial for such women. ‘When’ is crucial.