MTP law amendments set to allow abortion up to 24 weeks


Forty years after medical termination of pregnancy (MTP) was legalized in the country, access to safe abortion still remains a distant dream for many.
NEW DELHI: Fresh fears about risks to women’s health by allowing Ayush doctors to conduct abortion and ambiguity on the proposed extension of gestation period may force the government to keep the Medical Termination of Pregnancy (MTP) amendment bill out of Parliament in the upcoming monsoon session.Already embroiled in a debate on patient safety versus access to healthcare with the addition of ayurvedacharyas, homoeopaths and nurses to conduct MTP, the bill is now witnessing a new dispute with a recent a study in an international journal pointing towards “contradictory” amendments to the law posing risk to women’s health.

However, putting aside concerns over the proposed changes to the 1971 law, authorities involved in drafting the new law said the proposed amendments would extend the gestation period from 20 weeks to 24 weeks for “special categories”, which is likely to include single women with unwanted pregnancy, disabled and other vulnerable women.

Besides, the law would also allow abortion any time during the pregnancy for “selective” foetal abnormality, which cannot be detected during the 20-week gestation period.

Currently, the law allows medical abortion till 20 weeks of pregnancy.

“A law is an Act of Parliament. Once the amendment bill is passed in Parliament, the ministry will frame rules to define each and every category. Clarity will come with rules,” an official said. He added that even in case of allowing Ayush doctors to conduct medical termination of pregnancy, rules will ensure such doctors or paramedical staff receive “required training”.

The health ministry has worked out changes to the Medical Termination of Pregnancy (MTP) Amendment Bill. The revised bill proposes to allow Ayush doctors to conduct non-invasive procedures on women seeking to terminate pregnancy. The draft bill will soon be sent to the Cabinet.”We have made revisions to the earlier draft and proposed that Ayush doctors who are registered healthcare specialists be allowed to carry out non-invasive procedure, which would mean prescribing medicines etc,” a senior health ministry official told TOI.
Another key amendment seeks to increase the period for abortion to 24 weeks from the present 20 weeks.

The government’s proposal, originally formulated taking a cue from a study conducted by Population Council, is aimed at increasing access to safe abortion by expanding the number of healthcare providers.

Estimates show around 7 million abortions are conducted in India every year and over 50% of them are said to be illegal.

Initially, the government had decided to allow midwives and Ayush doctors to do even invasive procedures for abortion, but dropped it following mounting objections from allopathic practitioners, particularly Indian Medical Association (IMA) and Federation of Obstetric and Gynaecological Societies of India (FOGSI).

IMA, a pan India voluntary organization with a membership of 2.5 lakh allopathic practitioners, said even the latest move can put patients at risk as well as allow unethical practices and sex selective abortions.

“MTP is a procedure meant to be conducted by an allopathic doctor only. It is not possible to allow restricted practice. How will the government monitor whether a person is conducting abortion through medicine or doing invasive procedures,” says IMA secretary general Dr KK Aggarwal.

According to Dr Aggarwal, abortions by a non-MBBS doctor can lead to critical medical conditions arising out of excessive bleeding or incomplete abortions, which can be difficult to handle.

Ministry officials say FOGSI members were part of the consultations and initially supported the amendments. However, FOGSI has maintained that it changed its position after a thorough discussion.

“Expanding the number and type of providers able to legally perform abortion services, including manual vacuum aspiration (MVA) and medical abortion (MA), could greatly expand women’s access to safe abortion and save many lives each year,” Population Council said in a note on the issue.

The World Health Organisation (WHO) also seems to endorse the government’s proposal. A technical and policy guidance for health systems by WHO released in 2012 states, “Abortion care can be safely provided by any properly trained health-care provider, including mid-level providers….(e.g. midwives, nurse practitioners, clinical officers, physician assistants, family welfare visitors, and others) who are trained to provide basic clinical procedures related to reproductive health…”

Traditionally, mid-wives have played a key role in catering to urgent medical needs, especially attending to pregnant women for child delivery or even for abortion, in rural areas and villages that lacked medical facilities. Though with time government health centres and private players reached many such villages, mid-wives continue to exist and attend to many emergencies even today.

The government’s proposal to involve Ayush doctors has also found support from the women and child development ministry, National Commission for Women and other women’s groups.

 

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