Last week, the Union Cabinet approved amendments to the Medical Termination of Pregnancy (MTP) Act of 1971, which aim to strengthen women’s reproductive rights and prevent unsafe abortions in India. In an effort to provide comprehensive, legal, and safe abortion services, the MTP (Amendment) Bill 2020 proposes to raise the upper limit of pregnancy termination from 20 weeks to 24 weeks for women–including rape survivors, victims of incest, differently-abled women, and minors, among others–and accepts failure of contraception as a valid reason for abortion in married and unmarried women. It is slated to be presented to the Parliament in its ongoing session. Deemed as a progressive reform that “will ensure dignity, autonomy, confidentiality, and justice for women who need to terminate pregnancy”, officials have stated that they hope this will help reduce women’s reliance on informal and riskier channels for abortion that can endanger their lives.
While the bill is surely a step in the right direction, it does come with certain caveats. It introduces the requirement of approval from two doctors for termination of pregnancy between 20-24 weeks, and the need to secure the permission of a medical board if the termination is due to fetal abnormalities. Such conditionality, however, can risk alienating many women, especially those from marginalized sections and rural communities with limited resources and poor access to basic services. In India, where factors such as severe social stigma, lack of information about abortion rights, high prices of contraceptives, and reluctance of medical practitioners to perform abortion already have a significant impact on women's reproductive rights, it becomes imperative to analyze such policies within this context to determine whether they can truly deliver on their lofty promises.
There is a rising incidence of abortions in India. A 2015 study published in The Lancet Global Health found that approximately 15.6 million abortions were performed in the country that year. Of those, 3.4 million abortions (22%) were obtained in health facilities, 11.5 million (73%) abortions were medication abortions done outside of health facilities, and 0.8 million (5%) abortions were done outside of health facilities using methods other than medication abortion. The study also estimated the incidence of unintended pregnancy in India and found that of 48.1 million pregnancies, about half were unintended. Despite the existence of family planning programs in India since 1952 and numerous government schemes and plans related to reproductive health, the sensitive nature of the subject in the country–coupled with lack of awareness among women, and unclear and contradictory laws governing this issue–have led to a steady deterioration in the accessibility, affordability, and quality of sexual and reproductive healthcare.
In India, oral contraceptive pills (OCP), condoms, Intra-Uterine Devices (IUD), and male and female sterilization are provided through the public sector, while injectable contraceptives are available in the private sector. However, the contraceptive prevalence rate (CPR) in India remains poor–reports show that just 47.8% of couples in the country use modern contraceptive methods; only 53% use any method at all; and female sterilization still continues to be the most commonly used contraceptive method. There is also a high unmet need for safe abortion services, with the public sector accounting for only one-quarter of facility-based abortion provision. Since the public sector is the primary source of health care for rural and poor women, such limitations significantly reduce women's access to quality healthcare. This, coupled with various factors such as the absence of competent health professionals in rural areas, unaffordable costs at hospitals in the cities, limited understanding of the legality of abortion, reluctance to obtain services from known neighbourhood clinics, and lack of confidentiality can force women to opt for abortion outside accredited abortion centres. Women who are further marginalized on account of caste, poverty, tribal status, disability, sexual orientation or gender identity are even more distanced from the prospect of accessing sexual health services.
Inconsistencies in law also significantly hamper access to services. For example, the Protection of Children from Sexual Offences (POCSO) Act of 2012 criminalizes all sexual contact for persons less than 18 years of age. This runs contradictory to government schemes like Rashtriya Kishor Swasthya Karyakram (RKSK) and the Adolescent Reproductive and Sexual Health Programme (ARSH) clinics, which attempt to spread awareness about sexual health and services to adolescents. Doctors assigned to ARSH clinics could thus become wary of addressing queries around homosexuality, and further stigmatize adolescents with non-heterosexual orientations. Similarly, while the MTP Act makes it mandatory for doctors to keep patient records confidential, POCSO makes it compulsory to report any sexual activity involving minors to the police. This can serve as a major deterrent for adolescent girls seeking abortions after having consensual sex with their partners and can compromise the ability of professionals to provide any sexual health counselling or services to adolescents, even in times of crisis.
In such a restrictive operational environment, a mere four-week extension of the gestation period cannot be hailed as India's great move towards becoming a pro-choice society. The government is already applauding its progressive efforts, stating that this decision will help the country join a select club of nations that allow abortion until 24 weeks of pregnancy. However, the real impact of such measures will only be realized when comprehensive efforts are simultaneously taken to remove barriers that keep women from accessing sexual and reproductive health services.
This would entail serious reform and investment in not just the public health sector, but also in the legal and education systems, to ensure that the most vulnerable are protected. Safe abortions and reproductive rights can be promoted by normalizing sex as a natural biological process and help eliminate shame surrounding sexual relations, which often deters women’s use of abortion facilities. The establishment of accountability mechanisms is also crucial to encourage women to avail such services when required.
As for the bill itself, amendments must be clear and intentional with their wording to protect against any potential distortions or subjective interpretations of the law. It will also make the process less cumbersome, since frequent appeals to the judiciary will be rendered unnecessary. Though the bill is a welcome step forward, especially at a time when the world is witnessing a shocking return to regressive sexual and reproductive attitudes, sustained efforts are required by the government to help internalize and propagate the importance of a woman’s agency, her choice, and her right over her body. Only then can we hope to call ourselves a progressive, pro-choice society.
References:
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Sharma, Neetu Chandra. (February 4, 2020) ‘Keeping up with medical advancements, India moves towards liberalization of abortion rules’ Livemint. Retrieved from: https://www.livemint.com/news/india/india-soon-to-have-liberal-abortion-rules-11580756559537.html
Sharma, Neetu Chandra. (January 29, 2020) ‘Cabinet okays bill to raise upper limit for abortions to 24 weeks’ Livemint. Retrieved from: https://www.livemint.com/news/india/cabinet-approves-mtp-amendment-bill-11580292606660.html
Singh, Susheela et al. (2015) ‘The Incidence of Abortion and Unintended Pregnancy in India’ The Lancet Global Health, Vol.6 Issue 11. Retrieved from: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(17)30453-9/fulltext?elsca1=tlxpr
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