Daily Current Affairs – 27th February, 2017

Medical Termination of Pregnancy Act

Introduction

Health being a major issue of concern in India has areas like abortion and medical termination where lack of clarity and societal discourses that has resulted in many divergences. Especially abortions being a sensitive issue, pro-choice versus pro-life remain at the centre of an often acrimonious ethical, legal, theological and political debate across the world.

Issue:

• Pro-choice: are proponents who support choice of child bearer and hence support the cause of abortion at will.
• Pro-life: are proponents who support life in consideration i.e. the foetus which is considered life from the women’s womb itself.

In India, pro-life versus pro-choice debates are confined primarily to academia, as the abortion narrative has been determined by the Medical Termination of Pregnancy (MTP) Act.

Pro-Choice:

• This pro-choice endowment was a need based public health strategy aimed at the alarming increase in the population growth before the 1970s.
• It was also targeted towards preventing maternal deaths from illegal abortions, carried out by back-alley abortionists. India was the first country to launch a family planning programme in 1952.
  • The idea of this programme was to promote the use of contraceptives to delay or space out a pregnancy.
  • Whatever the family planning programme has tried over the years through different marketing strategies has only made a small dent.
  • Sterilisation remains the permanent method of contraception, after she or the family has decided on the desired number of children.
• Unfortunately, legalised abortion has become a convenient standby, as a woman can cite contraceptive failure to abort an unwanted pregnancy.
• Beyond the actual cases of true contraceptive failure, the easy access to abortion services has perhaps promoted a certain amount of irresponsibility, with women’s rights often over-riding discussions on the rights of the unborn child.

Misuse of Pro-choice:

The next saga in India’s abortion narrative was the mis-utilisation of the pro-choice endowment provided by the MTP Act.

• Son-preference saw voiceless women being coerced to determine the sex of the baby. The upsurge of selective abortion of female foetuses was accompanied by an explosion of imaging technology.
• Indian towns without life-saving healthcare services invariably have at least one ultrasound clinic.
• The profusion of ultrasound clinics and sex-selective abortion hastened the decline of the sex-ratio. So alarming was the decline that the Pre-Conception and Pre-natal Diagnostic Techniques Act (PCPNDT) had to be legislated.

Pre-Conception and Pre-natal Diagnostic Techniques Act (PCPNDT)

The PCPNDT denunciated the use of ultrasound scans, and placed regulations that often superseded the medical utility of ultrasound during pregnancy.

• For millions of women, the ultrasound revolution contributed to providing her one of the treasured moments during her pregnancy.
• It provided an opportunity to see her growing baby. Nowhere were guidelines prepared for pre-test counselling, to prepare her for an adverse report when the ultrasound detected an abnormality in the baby.

Public Health Strategy:

In the evolution of the down-to-earth public health strategy on abortion in India, the rights of the unborn child emerge in the ethically disturbing and medically unresolved issue that a pregnancy cannot be terminated after 20 weeks.

• The 20-week line is drawn on the understanding that there is a possibility of the foetus to survive and be viable outside the womb after this period.
  • The line is from Western data, and might be absolutely irrelevant to a woman in a remote area in India.
  • But this line places women in trouble, as it is not widely publicised. Few women and families are aware that a pregnancy cannot be terminated after this period, unless it is likely to threaten the life of the mother.
  • As a significant number of Indian women register late for ante-natal care, there is no option to terminate a pregnancy if something wrong is detected. In the same way, several birth defects are detected after 20 weeks.
• Women are left unprepared for the consequences, frequently carrying a pregnancy to term, with the distressing knowledge that something could be wrong with the baby.

Remedials:

• The benefits of the MTP Act to women in India are precious, but they have to be backed up with an appropriate socio-cultural and regulatory environment.
• There is a need for aggressive education on planned parenthood, and on the risk that women undergo when they use abortion as a means of contraception.
• Sonologists have to get together to ensure that counselling is provided to a mother before she undergoes a scan.

Conclusion: