Medical Termination of Pregnancy Act, 2021

Recently, the Medical Termination of Pregnancy (Amendment) Bill (MTP), 2020 received the President’s assent and has become law.

• Voluntarily terminating a pregnancy is a criminal offence under the Indian Penal Code, 1860
• The Medical Termination of Pregnancy (MTP) Act, 1971 allows for aborting the pregnancy by medical doctors (with specified specialisation) on certain grounds.
• The MTP Amendment Act 2020 amends the 1971 Act, which regulates the terms under which a pregnancy may be terminated.
• The amendment bill was introduced in Lok Sabha on March 2, 2020, and passed on Mar 17, 2020.
  • The bill amends the MTP Act 1971 to increase the upper limit for termination from 20 to 24 weeks for certain categories of women,
  • It also removes this limit in the case of substantial foetal abnormalities but constitutes Medical Boards at the state level to give clearance to such abortions
• Reasons behind the amendment:
  • A large number of cases filed before courts seeking permission for aborting pregnancies beyond the 20-weeks on the grounds of foetal abnormalities or pregnancies due to rape
  • With the advancement in medical technology, pregnancies now can be safely terminated well beyond the existing limit of 20 weeks. So, there is a scope to increase the upper limit for terminating pregnancies.

Assessing the cases of ‘abortions’ in India

• Around 15.6 million abortions take place in India every year, but most of these are expected to be unsafe.
• As per the National Health and Family Survey (2015-16), only 53% of abortions are performed by a registered medical doctor and the balance is conducted by a nurse, auxiliary nurse midwife (ANMs), dai, family member, or self.
• Unsafe abortion is the third largest cause of maternal mortality in India.
• Debate around Abortion laws in India rely essentially on deciding after what point of pregnancy does life begins in the foetus? At what point does the foetus’ life become important and it becomes the state's responsibility for its protection?

Where do the issues lie?

Though, India has legalized abortions as opposed to many other countries. However, even after all these efforts for liberalizing abortions, the subject has often been viewed and subsequently critiqued from various perspectives. These issues vary from:

• lack of access to safe abortions
• Act’s overlap with other acts such as the Pre-Conception and Prenatal Diagnostic Techniques (PCPNDT) Act 1994and the more recent Protection of Children from Sexual Offences (POCSO) Act, 2012

Key features of the MTP Act, 2021

1. Changes proposed in conditions for terminating a pregnancy at different gestational periods:

2. Termination due to failure of contraceptive method or device:

• • MTP Act allows termination up to 20 weeks only for married women in case of failure of contraception. The 2020 amendment allows unmarried women as well.

3. Medical Boards:

• • All state and union territory governments will constitute a Medical Board.
  • The Board will decide if pregnancy may be terminated after 24 weeks due to substantial fetal abnormalities.
  • Each Board will have a gynecologist, pediatrician, radiologist/sonologist, and other members notified by the state government.

4. Privacy:

• • A registered medical practitioner may only reveal the details of a woman whose pregnancy has been terminated to a person authorized by law.
  • Violation is punishable with imprisonment up to a year, a fine, or both.

Key concerns regarding the Act

1. Conditions for termination of pregnancies
   • There are two differing opinions with regard to allowing abortions.
2. Terminating a pregnancy is the choice of the pregnant woman and a part of her reproductive rights.
3. The state has an obligation to protect life and hence should provide for the protection of the foetus.
4. Medical Board to decide termination after 24 weeks
   • Time frame for Medical Board’s decision not specified
   • Invades privacy of woman involved
5. Categories of women who can terminate a pregnancy between 20-24 weeks not specified. The central government will notify these categories.
6. It is unclear that if transgender persons will be covered
7. Unavailability of qualified medical professionals to terminate pregnancies
   • The All-India Rural Health Statistics (2018-19) indicates that there is a 75% shortage of qualified doctors and gynecologists. This shortage may continue to limit the access of women to safe abortion services.
8. Fear of judgment from medical practitioners in case of unmarried women seeking termination of pregnancy becomes a major hurdle that deters these women from visiting a professional.

Conclusion

The amendment is a step towards the safety and well-being of women. Public health experts have welcomed the government’s decision. The Bill acknowledges the abortion needs of unmarried women for the first time and is a progressive step in ensuring universal access to safe abortion services for women and girls.