GS 2, MAINS: Government policies and interventions for development in various sectors and issues arising out of their design and implementation.
The proposed Bill seeking to amend the Medical Termination of Pregnancy Act (MTP, 1971) after nearly half a century is to be welcomed. Once enacted, the upper limit for terminating special kinds of pregnancies will go up from 20 weeks to 24 weeks — this is a recognition that certain physical and mental conditions can only be identified after the fifth and sixth month of pregnancy.
This approach is in line with what seven other countries — Canada, China, the Netherlands, North Korea, Singapore, the United States, and Vietnam follow. It is based on the yardstick of “foetal viability” — the capability of the foetus to live outside the mother’s womb.
The 1971 law had forced vulnerable and traumatised women in an advanced stage of pregnancy to give birth to a compromised child or seek legal redress, an avoidable process that was fraught with delays and uncertainty.
CHANGES BROUGHT IN BY THE 2020 AMENDMENT:
It increases the maximum permissible gestation age for abortion to 24 weeks, with the provison that for pregnancies that are between 20-24 weeks opinions will be required from two doctors rather than one. This has been specially done keeping in mind vulnerable women including survivors of rape, victims of incest and other vulnerable women (like differently-abled women, Minors) etc.
The upper gestation limit will not apply in cases of substantial foetal abnormalities diagnosed by a Medical Board.
The original draft of the Bill had included the contraceptive failure clause only for married women, which, the Health Ministry has now felt, would have left unmarried women, on whom social pressures to abort are more acute, at the mercy of quacks.
GAPS IN THE RURAL AND INFORMAL SERVICES:
The annual number of abortions in the country is massive — over 15 million, constituting 33 per cent of the total annual pregnancies in the country. Both in urban and rural areas, there is overwhelming reliance on medical termination (as opposed to surgical methods) by ingesting pills from a kit over one to three days.
The 24-week modification will help a niche group of women who discover foetal abnormalities after 20 weeks or belong to defined vulnerable groups. Such women have access to doctors. But there are concerns about those who have no access to doctors — millions of rural women who have never had access to a safe and transparent route to abortion. Victims of incest and rape have to resort to unsafe abortions to maintain secrecy and even married women become desperate to end an unwanted pregnancy for economic reasons.
Given the social and cultural milieu in the country, it is natural for women to rely on informal providers to access abortion pills. If these pills don’t work, the woman goes to or is taken to an unqualified practitioner who usually administers an oxytocin injection, performs a D&C (dilation and curettage) and advises consulting a doctor if bleeding persists. The doctor uses a suction apparatus to evacuate the uterus. But in rural areas, where are the doctors? The procedure costs anything between Rs 2,000 in peri-urban areas to around Rs 10,000 in cities. The distress of a woman from a rural area, who requires an abortion, can only be imagined.
Most families in rural areas believe that sterilisation is the only solution to avoid pregnancy because in India, people do not have adequate knowledge and lack access to reversible methods like IUDs and injectables. Rural Indian women are far behind their counterparts in Bangladesh, Sri Lanka and Indonesia when it comes to awareness of these methods. State family planning departments place too much reliance on the village level workers, ASHAs, who provide condoms and pills to village homes.
ADDRESSING THE MULTIFARIOUS FLAWS:
Once the law permits abortion on demand, the service must be provided free in government-run facilities. Currently, there is a shortage of trained staff and inadequate supplies of both medical kits and suction apparatus in most PHCs. This must improve for the law to be effective. A directory of practitioners authorised to give prescriptions and undertake abortions at specified locations must also be freely available.
Next is the question of differentiating between two abortion-related laws. Entitlements under the existing MTP Act 1971 are much less known than the provisions of the sex selection law (PCPNDT). The two are often confused unnecessarily, exposing women to suspicion, questioning and patronisation. Once the law is amended, it will have to be explained in regional languages, and in a simple manner, to obviate the present state of ignorance, and hubris.
The Constitution guarantees equal protection under law. Universal access to sexual and reproductive health is embedded in the charters of the International Conference on Population and Development, 1994 and the SDGs. India is a signatory to both. Unless every woman in the reproductive age group has the ability to access what the proposed law intends it will remain only a good intention.
Governments have enabled patients from remote villages to benefit from cataract operations and use institutional facilities for deliveries. Medical and surgical abortions must be handled in a similar way for women to be truly empowered.
PREVIOUS YEARS UPSC MAINS QUESTIONS:
“Policy contradictions among various competing sectors and stakeholders have resulted in inadequate ‘protection and prevention of degradation’ to environment.” ” Comment with relevant illustration. (2018)
Explain the salient features of The Constitution (One Hundred and First Amendment) Act, 2016. Do you think it is efficacious enough ‘to remove cascading effect of taxes and provide for common national market for goods and services’? (2017)
Has the Indian governmental system responded adequately to the demands of Liberalization, Privatization and Globalization started in 1991? What can the government do to be responsive to this important change? (2016)
Though 100 percent FDI is already allowed in non-news media like a trade publication and general entertainment channel, the Government is mulling over the proposal for increased FDI in news media for quite some time. What difference would an increase in FDI make? Critically evaluate the pros and cons. (2014)