The Cabinet briefing on the afternoon of 29 January ended with some breaking news – news that all women’s sexual and reproductive health and rights (SRHR) advocates have been waiting to hear for almost ten years now. Prakash Javadekar announced that the Cabinet had approved the long pending amendments to the Medical Termination of Pregnancy Act, 1971, and spoke about the positive impact that it would have on women’s reproductive rights in India.
As advocates, gynaecologists and staunch supporters of women’s right to choose, we appreciate this progressive and visionary step for women.
I am delighted that the government will be easing gestation limits in cases of rape and foetal abnormalities. While I believe that it would be prudent to reach conclusions about the impact these amendments on the health and lives of women only after we see the bill, it is also critical for the government to consider all the recommendations that experts have provided over the years, over a number of consultations.
What Women Need: Full Autonomy in 1st Trimester; More Qualified Providers
In this regard, while there is no doubt that these amendments have the potential to address a number of challenges that women face while accessing abortion services in India, I would like to draw attention to, and invite the government to consider two crucial aspects that impact access.
First, when we talk about ensuring women have reproductive rights, we must give them the complete autonomy in the first trimester of pregnancy and allow abortion on request up to twelve weeks. I believe it is only then that a woman will truly be able to exercise her reproductive choices and make the best decisions for herself.
Second, it is critical that we increase the number of qualified providers in the country, so women are not compelled to go to unsafe ones, and put their bodies, health and lives in danger.
Studies by some of the most credible organisations in the world have clearly shown that we have an estimated 15.6 million abortions that take place in our country every year, mostly through medication abortion. A majority of these, which is about 12.5 million, are taking place outside of health facilities — public or private. The harsh reality is that there is a limited pool of qualified doctors and a huge unmet need that has hampered access under the current legal framework. If we truly want to increase access for women, it is critical that we address the lack of providers.
Solution to Dearth of Qualified Providers
Evidence shows that most abortions are medication abortions in the first trimester. I believe we can easily cater to these women by expanding our provider base to include those who are or can be qualified to medication abortion.
Our government has expressed its commitment to reach the last mile by setting up 150,000 wellness centres across the country under Ayushman Bharat, which will be staffed with mid-level providers.
We can increase access for millions of women by allowing mid-level providers in the public sector, particularly at points of contact where they are reaching out to women through PHCs, CHCs and the wellness centres.
In fact, the World Health Organisation (WHO), in a 2015 evidence-based guideline, recommended and supported the provision of medication abortion in the first trimester by both doctors of complementary systems of medicine, and nurses.
This is also not the only solution to the dearth of providers in the country. If we make a small change in the MTP Rules to allow all MBBS doctors to provide medication abortion, this in itself will make a significant difference. By not tapping into the potential of these doctors and nurses who can provide a service as great and safe as medication abortion – we are doing a great disservice to the women of our country.
Will the Bill Set a Precedent For the World to Follow?
The amendments to the law are definitely a step in the right direction. At a time when some of the most powerful countries in the world are seizing control from women over their bodies and lives, our government is taking a positive step to ensure their right to choose.
I am hopeful, as always, that this Bill will set a precedent for the world to follow as we did in 1971.
(The author is a gynaecologist and the former Secretary General of the Federation of Obstetric and Gynecological Societies of India. He is a Member, Technical Advisory Group, SEARO, WHO and the Board of Directors, Guttmacher Institute. This is an opinion piece. The views expressed above are the author’s own. The Quint neither endorses nor is responsible for them.)
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