Health ministry to keep amendment on allowing abortion in 24 weeks unchanged

India’s Medical Termination of Pregnancy (Amendment ) Bill 2014, which proposed to increase the upper limit of legal abortion from 20 to 24 weeks, will not be diluted to restrict women from seeking safe abortions.

Rumours about the Bill being diluted started after the Prime Minister’s Office sent the final draft back to the health ministry asking for “more stringent” measures against sex-selective abortions banned under the Pre-Conception and Pre Natal Diagnostic Techniques (PC-PNDT) Act, after 19 female foetuses were found near the clinic of a homeopathy practitioner in the Sangli district of Maharashtra.

The key changes proposed in the new MTP Bill are relaxing the upper limit of legal abortion from 20 to 24 weeks; widening the provider base to train auxiliary nurse midwives (ANMs), nurses, and ayurveda, homeopathy and unani practitioners to perform early-stage abortions; and removing the need to seek a second opinion from a doctor for second-trimester pregnancies.

With the Supreme Court also ruling against abortions in late stages of pregnancy, the fear is that the government will not allow late-stage abortions by health practitioners other than clinicians.

“There is no question of dilution. The MTP (Amendment) Bill is back with the Health Ministry and discussions have started on stringent control of sex-selective abortions . We’ll be redoing the note and sending it back (to the PMO),” said Union health secretary CK Mishra.

The proposed amendments are being keenly tracked following several girls and women, many of them rape survivors, moving court to be allowed to abort after the legal upper limit of 20 weeks.

Despite a ban on sex selection and determination, India’s child sex ratio (0-6 years) has been steadily declining, from 945 girls/1,000 boys in 1991 to 927 in 2001 and 919 in 2011, shows Census data.

“Though both Acts regulate abortion, the two are completely different. PNDT is a regulatory Act to prevent misuse, while the MTP Act focuses on women’s rights and safety. Both are strong Acts, but as for all laws, implementation is the key,” said a health ministry official who did not want to be named.

Unsafe Choices

World
■ 56 million induced abortions each year
■ 22 million unsafe abortions
■ 47,000 women die of unsafe abortions
■ 5 million women are disabled from unsafe abortions

India
■ 6.4 million induced abortions each year
■ 3.6 million unsafe abortions
■ 3,520 women die of unsafe abortions
■ No data on disabilities after unsafe abortions

Source: World Health Organization; The Abortion Assessment Project India

“There was need to amend the 1971 MTP Act because new techniques have made abortion safe even in late stages of pregnancy,” said the official.

“Comprehensive MTP amendments must be passed by the Parliament to provide early and safe abortion to girls and women, remove barriers to access and enable those in vulnerable situations to exercise their rights,” said Vinoj Manning, Executive Director, Ipas Development Foundation, an NGO that works to access to increase safe abortion services.

The Indian Medical Association (IMA) is against abortions being taken out of the purview of clinicians to include healthcare providers. “Medical abortion medicines are not over-the-counter drugs, they are scheduled medicines that should be given by a registered doctor because they may have side effects,” says Dr KK Aggarwal, national president, IMA.

Critics say physicians are simply resisting losing business to other providers. “Under the proposed Bill, after training — and only after — ANMs can give medicines to terminate pregnancies up to seven weeks, and nurses and alternative practitioners up to nine weeks. Surgical abortions will continue to be done by registered physicians,” says the ministry official.