The Medical Termination of Pregnancy (MTP) in India

Syllabus: GS2/Health

Context

• Some doctors express ethical discomfort about performing abortions, especially as the pregnancy progresses.
  • Concerns intensify in cases of advanced gestation, where Foetal viability debates emerge.

About

• Foetal Viability Debate: Viability refers to the point at which a fetus can survive outside the womb, but no definitive moment exists.
  • As pregnancy advances, the fetus’s right to life grows stronger, making viability a contentious issue in legal and ethical discussions.

India’s Legal Stance on Abortion

• The Medical Termination of Pregnancy (MTP) Act permits abortions in specific predetermined situations.
• Before the enactment of the MTP Act in 1971, the medical termination of pregnancy was governed by the Indian Penal Code (IPC).
  • Most of these provisions aimed at criminalising abortions, except where the procedure was done in good faith in order to save the woman’s life. 
  • The provisions failed to make a distinction between wanted and unwanted pregnancies, making it extremely onerous for women to access safe abortions.
• In 1971, the MTP Act was enacted by Parliament as a “health” measure, to decriminalise abortion in certain defined circumstances and under due supervision of registered medical practitioners.
  • A pregnancy could only be terminated under Section 3(2) if it did not exceed 20 weeks. 
  • It laid down that the pregnancy can be terminated on the opinion of one doctor if it is done within 12 weeks of conception and two doctors if it is done between 12 and 20 weeks.
• The 2021 amendment to the MTP Act: Rule 3B permitted abortion up to 24 weeks for women due to change of marital status during the ongoing pregnancy, besides in cases of survivors of rape, victims of incest, and other vulnerable women.
  • It also replaced the word “by any married woman or her husband” with the words “any woman or her partner”, bringing within the fold of the law pregnancies outside marriage institutions.
• After 24 weeks, the MTP Act requires medical boards of expert doctors to be set up by the state government in each district, which opine on whether to allow termination of pregnancy in case of substantial foetal abnormality.

Arguments in favour of MTP

• Bodily Autonomy and Reproductive Rights: Women should have the autonomy to make decisions about their own bodies, the Supreme Court has emphasized the importance of reproductive rights as part of personal liberty.
• Physical Health: If carrying a pregnancy threatens a woman’s health, including conditions like gestational diabetes or eclampsia, abortion may be justified to protect her life.
• Mental Health: In cases where pregnancy exacerbates mental health conditions (e.g., postpartum depression or psychosis), abortion may be necessary to safeguard the mental health of the mother.
• Non-Viable Fetuses: If the fetus has congenital abnormalities or conditions incompatible with life, abortion may be ethically acceptable to avoid prolonged suffering for the child.
• Unplanned Pregnancies: For women facing economic or social hardships, the ability to access abortion services can allow them to avoid further challenges.
• Reduction in Unsafe Abortions: Legal access to abortion reduces the number of unsafe, illegal abortions that often lead to serious health risks or even death for women.

Arguments Against MTP

• Right to Life of the Fetus: Ethical objections argue that the fetus has a right to life, especially as pregnancy progresses and fetal viability increases, making abortion less acceptable.
• Emotional and Psychological Effects: Terminating a pregnancy can have long-term psychological consequences for the woman, including guilt, regret, and emotional trauma.
• Non-Medical Abortions: There is a concern that allowing abortion may lead to its normalization as a method of birth control, rather than a rare and necessary medical intervention.
• Risk of Misuse: There is a concern that abortion laws may be misused, such as for sex-selective abortions or for non-medical reasons, like convenience.
• Negative Impact on Society: Widespread abortion could contribute to a decline in societal values regarding family and the value of life.
• Cultural Beliefs: Cultural norms often view abortion as morally unacceptable, especially when it’s perceived as a violation of the natural order or traditional family structures.

Way Ahead

• Access to Abortion Care: Making MTP pills more accessible and reducing administrative barriers could improve abortion access.
• Improved sex education and viewing abortion as a health service rather than a legal exception might help reduce stigma.
• Empathy in Medical Decision-Making: Doctors are encouraged to treat women with empathy, especially in emotionally and physically challenging situations involving late-term abortions.

Source: TH