Abortion law, policy and services in India

Abortion law, policy and services vs. Reproductive health in India

-by

Dr Sayan Das

MPH 8th Cohort, ICMR-SPH,NIE

Background

• IPC 312: Any one voluntarily causing miscarriage to woman with child, other than in good faith for purpose of saving her life is punishable by imprisonment (simple or rigorous) up to 3 years, with /without fine. Women who caused her self to miscarry are also counted.

• IPC 313 (Abortion without consent): Punishable by life imprisonment or up to 10 years with fine

• IPC 314 (death due to procedure): Imprisonment up to 10 years with fine, may be extended to life imprisonment if with out consent.

Background• In 1964: Maternal mortality increases

• Married women under no socio-cultural pressure – seeking abortion service

• Abortion is illegal- opted for unsafe method- maternal mortality

• The Shah Committee appointed by GOI-recommended legislation in 1966- some state wants it to decrease population

• Committee denies it

• In 1971, The Medical Termination of Pregnancy (MTP) Act passed- applied all over India except Jammu & Kashmir in 1972

• Jammu & Kashmir and Mizoram adopted in 1980

GOI: Government of India

The MTP Act (no 34 of 1971)• Can be terminated up to 20 weeks of pregnancy

• Requires a second doctor’s approval- if beyond 12 weeks

• When Conducted -o To save the life of mother or it cause grave physical or mental

illnesso When pregnancy is due to rapeo Contraceptive failure in married womeno Substantial risk that if child born, would be seriously affected with

mental and/or physical disabilityo Written Consent:

By the woman By legal guardian, if women is lunatic or minor

The MTP Act (no 34 of 1971)

• Who can Conduct-o Registered Medical Practitioner with recognize medical

qualification in Clause(b) Section 2 of The Indian Medical Council Act, 1956

o Registered in any State Medical Registero Have training experience as per MTP rules

Experience required as per MTP rulesoUp to 12 weeks

1 years experience in G&O department 6 months of House Surgeon ship in G&OWorked with an RMP- 25 cases done 5 of which by ownBefore commencement of act- minimum 3 years of

experience

oFrom 12 weeks to 20 weeksPG degree or diploma in G&OCompleted 6 months of House staff ship in G&OAt least one year experience in G&O at any Government

Hospital have all facilities

RMP: Registered Medical Practitioner, G&O: Gynecology & Obstetrics

Abortion in 1970-2000• 1972 to 1986: 10% increase in abortion

• In 90s: shows decline trends

• 2/3rd facilities are urban

• Less than 10% of estimated abortion reported

• 2-11 illegal abortion performed per single legal case

• Thus all are not unsafe, when done at unapproved place

• In most states: less 20% PHC provide abortion services

• Both public & private: poor technique, counselling, privacy

• Dilatation & Curettage preferred than vacuum aspiration

Abortion law reform since 2000• Act amended - 2002, Rules and Regulation amended – 2003

• Power shift to district level from state level

• Provision of punishment 2-7 year for provider & owner of unapproved place

• Approval with in 60 days with inspection by CMO/DLC or with in 60 days after rectification of any deficiency found

• Facilities dose not requires onsite management of emergency

• Allow medical abortion facility (up to 7 weeks) RMP dose not need approval from DLC for place Only registered doctor can prescribe Need to follow all rules and regulation under MTP Act

Rules and Regulations formed in 1975 previously, CMO: chief Medical Officer, DLC: District Level Committee

Current law & policy: what is still missing

• Critics on “Physician only”- no other can perform abortion

• 2nd Trimester Cases: “Second opinion” restrict abortion specially in rural area

• Not all public sector provide service- act mandate it

• Approval not required for public sector- poor quality service

• Unregulated private sector- poor quality service

• National technical guideline, 2001 dose not conform with WHO international guidance- poor clinical practice

• 8-15% abortion performed under General Anaesthesia

WHO: World Health Organisation

Abortion law and policy: potential and actual abuse

• 1960: concern is medical & demography

• National Population Policy 2000: talks about reproductive rights & safe abortion- affordable, acceptable, accessible

• Doctor has final say- false environment created by woman

• Though Sec. 3 of MTP Act 1971 dose not say no service to unmarried women, it may be misconstrued to deny of abortion or may require married woman’s husband consent

• MTP Regulations mandate to report post abortion contraceptive use- State may compel provider for family planning target achievement

Barriers in abortion service delivery

• Abortion service neglected, specially in public sector

• Causes unregulated growth of private sector- exploitative in nature

• Often impede by misguided & unnecessary practices

• States differs in interpretation & implementation

• To prevent unsafe abortion, unnecessary procedure added- cause administrative delay in regulatory process (private sector)

• Delay in certification

• Provider: insists consent from husband

• Informal fees in public sector, exorbitant charges in private sector

Abortion & sex determination: different issues

• PCPNDT Act and MTP Act are distinct but almost inappropriately linked- PIL filled in the Supreme Court in 2000- policy review done

• MTP Act may support sex selective abortion

• Abortion up to 12 weeks pregnancy- to prevent abortion following amniocentesis and sonography: Increase illegal abortion

• Reporting identity of woman seeking abortion- confidentiality violation

• Reporting sex of aborted fetus- increase access difficulty

• Expert committee suggest strict implementation of PCPNDT Act

PCPNDT Act: Pre-conception and Pre- natal Diagnosis Techniques Act

Abortion law & policy: the way ahead• Increasing availability and access to safe abortion services

• Creating more qualified providers and facilities, specially in rural areas

• Simplifying the certification process

• De-linking clinic and providers certification

• Linking policy with technology and research and good clinical practice.

• Applying uniform standards for both the private and public sectors

• Ensuring quality of abortion care

• Effective implementation, political will, adequate resource allocation, training, infrastructure support, social inputs based on woman need

• Increase awareness

Safer abortion – Better reproductive health

Thank You