|Year : 2017 | Volume
| Issue : 1 | Page : 1-2
Proposed amendments in the Medical Termination of Pregnancy Act in a nutshell
Department of Forensic Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India
|Date of Web Publication||17-Jan-2017|
Department of Forensic Medicine, Regional Institute of Medical Sciences, Imphal, Manipur
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Phanjoubam M. Proposed amendments in the Medical Termination of Pregnancy Act in a nutshell. J Med Soc 2017;31:1-2
As per the Medical Termination of Pregnancy (MTP) Act, 1971, MTP is the lawful abortion of a fetus, and it empowers a woman to decide whether to continue her pregnancy or terminate it. It is a liberal law which enables registered medical practitioners to terminate a pregnancy for social and sociomedical reasons, as well as for reasons of danger to the health of the mother. It spared women from "inflicted pregnancy" and "forced motherhood."
This Act was amended in 2002 and some of the salient points include changing of the word "lunatic" to "mentally ill person;" MTP only in government hospitals or a place approved by the government or a district level committee constituted by that government with the chief medical officer or district health officer as the chairperson of the said committee, termination of a pregnancy only by a registered medical practitioner; punishment of the owner of a place which is not approved for MTP; requirement of a single doctor's opinion as to whether a termination is indicated for fetus <12 weeks; agreement of two registered medical practitioners where the length of pregnancy is 12-20 weeks; termination of pregnancy at any stage by a single registered medical practitioner in a case where he is of the opinion formed in good faith that termination of a pregnancy is immediately necessary to save the life of a pregnant woman, etc.
On October 29, 2014, the Ministry of Health and Family Welfare released a draft of the MTP (Amendment) Bill 2014,  which proposes changes that could initiate a shift in the focus of the Indian abortion discourse from health-care providers to women by including mid-level and nonallopathic health-care providers. The Bill proposes changes that clarify the legal status of medical and surgical abortion, and simultaneously attempt to improve the base of health-care providers. The changes are based on the findings of a project undertaken by the Population Council between 2006 and 2011. It was found that abortions conducted by trained mid-level health-care providers are as safe and acceptable as those conducted by physicians.  While this study was supported by the Federation of Obstetrics and Gynecological Societies of India, the findings were found inadequate by the Indian Medical Association, which rejected the inclusion of nonallopathic and mid-level health-care providers in abortion care (the Economic Times (November 6, 2014). However, this proposal is also based on the evidence-based recommendations made by the World Health Organization in its updated guidance for safe abortion.  The evidence is consistent both in the developing and developed countries, with the inclusion of nurses and midwives having improved access to abortion, particularly in remote areas where doctors are not always available. 
The current law, in choosing to protect doctors acting in good faith, forces women to justify their abortions.  It also makes them dependent on the doctor's interpretation of the law.  This is particularly true of women who are not explicitly covered by the 1971 MTP Act, for example, unmarried women or sex workers. In a society in which sexual agency outside the marital relationship is severely criticized, the lack of certainty of access to abortion services renders women vulnerable to exploitation. The amendment bill, by recognizing the need of unmarried women to seek abortion, specifically removes this barrier. In addition, the clause ensuring privacy increases the chances of women opting for legal abortions. By requiring doctors to provide abortions on request during the first trimester, it allows women to demand abortions without having to justify their needs. This choice will also empower married women, who because of the lack of gender equality within marital relationships, are forced to endure sexual violence and then undergo an abortion to limit the size of their family.  The Abortion Assessment Project also revealed that doctors in public sector hospitals sometimes refuse to perform abortions unless women undergo sterilization concurrently.  The 1971 MTP Act does not include such a clause and such coercion is illegal, but with doctors acting as the final gatekeepers of abortion, it becomes hard for women to negotiate this barrier. The new amendment could give women the agency to demand abortion without facing such coercion. However, the extension of the gestational age is likely to engender ethical debates, as it did when Niketa Mehta's plea for an abortion at 24 weeks was discussed in the Bombay High Court in 2008.  While the court denied her plea, the National Commission for Women reviewed the case and in 2013, recommended that abortion be allowed up to 24 weeks, keeping in view that modern medical technology can detect some fetal anomalies only after the 20 th week.  Moreover, sex-selective abortion should not become a deterrent factor in the extension of the gestational age. While second-trimester abortions are assumed to be the result of sex determination, there is no real evidence to suggest such a connection in the majority of cases.  Moreover, stronger enforcement of the Preconception and Prenatal Diagnostic Techniques Act, 1994, which prevents the use of medical technology for sex determination, should remove the opportunity for sex-selection without restricting access to abortion in the second trimester.
To conclude, effective implementation of the latest amendments may help in reducing "maternal mortality" and "morbidity" and may also prevent wastage of pregnant women's strength, health, and above all life. Moreover, it can also contribute to preventing a heinous crime against humanity, i.e., "female feticide."
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