MTP Act new amendment: 5 main concerns
M3 India Newsdesk Oct 28, 2021
In line with the progress in the field of medical science, the amended Medical Termination of Pregnancy Act 2021 has expanded access to safe and legal abortion services on multiple grounds ensuring comprehensive care and privacy. This article summarises the amended act- pathbreaking changes that have been made and highlights the specific concerns about the act.
The Medical Termination of Pregnancy Act, 2021: A historic move
In a ground-breaking effort to provide universal access to reproductive healthcare, the Medical Termination of Pregnancy (Amendment) Act, 2021, became effective on September 24, 2021. The modification amends were done to Section 3 of the Medical Termination of Pregnancy Act to increase the maximum time period for medical termination of pregnancy to 24 weeks, from the current 20 weeks, for specific groups of women specified in the MTP Rules. 'Vulnerable women,' such as rape victims, will be one of these groups.
Parliament approved the Amendment Bill on March 16th of this year. The Bill's Statement of Objects and Reasons said the following:
"With the passage of time and advancement of medical technology for safe abortion, there is a scope for increasing upper gestational limit for terminating pregnancies especially for vulnerable women and for pregnancies with substantial foetal anomalies detected late in pregnancy. Further, there is also a need for increasing access of women to legal and safe abortion service in order to reduce maternal mortality and morbidity caused by unsafe abortion and its complications."
Changes in the new amendment
Section 3 details the circumstances under which certified medical practitioners may terminate pregnancies. However, Section 4 specifies that no pregnancy termination shall be performed in accordance with this Act at any location other than:
- A hospital founded or maintained by the government; or
- A location already authorised by the government for the purposes of this Act.
According to Section 3:
“A pregnancy may be terminated by a registered medical practitioner-
(a) Where the length of the pregnancy does not exceed twenty weeks” if such a medical practitioner is “of the opinion, formed in good faith, that
- The continuance of the pregnancy would involve a risk to the life of the pregnant woman or of grave injury to her physical or mental health; or
- There is a substantial risk that if the child were born, it would suffer from any serious physical or mental abnormality."
(b) Where "the length of the pregnancy exceeds twenty weeks but does not exceed twenty-four weeks, in case of such category of woman as may be prescribed by rules made under this Act, not less than two registered medical practitioners" have to opine as stated above.
Explanation 1 —For the purposes of clause (a), When a pregnancy develops as a consequence of the failure of any device or technique used by a woman or her spouse to restrict the number of children or avoid conception, the pain caused by the pregnancy may be considered grave damage to the pregnant woman's mental health.
Explanation 2 —For the purposes of clauses (a) and (b), When a pregnant woman alleges that her pregnancy was induced by rape, the anguish produced by the pregnancy is considered to represent a grave injury to the pregnant lady's mental state.
The term "married lady or her husband" is replaced with "woman or her partner" in the revised law. As a consequence of this, more lenient measures will be adopted.
Medical opinion
- According to the amendment, a single doctor's opinion would be needed for abortions up to 20 weeks, and two physicians' opinions will be required for abortions between 20 and 24 weeks.
- They must believe that continuing the pregnancy poses a significant danger to the pregnant woman's life or severe damage to her bodily or mental health; or that there is a considerable chance that the child will be born with any major physical or mental defect.
Medical board
The medical board will include:
- A gynaecologist
- A paediatrician
- A radiologist or sonologist
- Additional members as the state government may specify
The MTP rules will define their duties and other specifics in the future.
Confidentiality of identity
The identity and other personal information of the woman whose pregnancy is terminated must not be disclosed to anyone except those who are permitted by law; and anybody who violates this article will be penalised by imprisonment for up to one year, a fine, or both.
Advantages of the Act
- After the twentieth week, many foetal abnormalities are found, transforming an otherwise desired pregnancy into an undesirable one.
- Typically, the foetal abnormality scan is done between the twentieth and twenty-first weeks of pregnancy. If this scan is delayed and a fatal problem in the foetus is discovered, the 20-week window closes. This proposal would allow for the termination of a pregnancy following the discovery of a foetal anomaly at 20 weeks.
- The legislation will help rape victims, sick women, and women under the age of 18 in terminating unwanted pregnancies lawfully.
Notably, the Act extends to unmarried women as well, repealing a discriminatory clause of the 1971 Act that prevented single women from claiming contraceptive failure as a reason for seeking an abortion. Allowing unmarried women to terminate pregnancies medically while preserving the privacy of the individual seeking an abortion would provide women with the reproductive rights to which they are entitled.
Concerns about the Act
- The viability of the foetus has always played a significant role in determining the legality of abortion control. Viability refers to the time period during which a foetus is capable of surviving outside the womb. This 'viability' increases naturally as technology develops, infrastructure is improved, and medical treatment is administered by competent professionals.
- At the moment, viability is expected to take about seven months (28 weeks), although it may occur sooner, even at 24 weeks. As a consequence, abortion during late pregnancy may endanger the foetus' viability.
- Despite their illegal status, sex determination centres continue to operate since male children are preferred. There are concerns that more permissive abortion legislation will aggravate the problem.
- Critics of the legislation have noted that it fails to address the continuing healthcare crisis caused by the pandemic. In light of this, and India's chronic physician shortage, they believe that forcing women to seek the opinion of two practitioners and a medical board before undergoing some kind of abortion is unfair.
- Concerns have also been raised by disability organisations, which we shall explore later.
Fifty-nine nations have allowed elective abortions in 2017, with just seven countries (Canada, China, Netherlands, North Korea, Singapore, United States, and Vietnam) permitting the procedure beyond 20 weeks. In India, abortion is stigmatised, even among physicians. Doctors have reportedly refused abortions on "moral" grounds or asked women to bring their husbands or parents with them. This is particularly important when abortion is sought for reasons other than a woman's physical health, as defined by the MTP Act, but because it may result in harm to her mental health, this is also protected by the Act, as these studies indicate.
The MTP Amendment Bill 2020, which comes 50 years after the groundbreaking MTP Act of 1971, is an evolutionary milestone that addresses some of the difficulties presented by India's 15.6 million abortions per year.
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Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.
The author is a practising super specialist from New Delhi.
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