Yashaswi
Pros
Cons
1. In the context of poor quality abortion care in the public sector. the same exacting standards
should be applied as in the private sector and subject to the same audit procedures that are
expected of the private sector.
2. Another area of potential abuse of woman’s reproductive rights is the mandatory reporting of
post-abortion contraceptive use required by MTP regulations (Form 2), which the State may
use to compel abortion providers to achieve family planning targets. Such monitoring often
results in a form of coercion of women seeking abortion, especially in the public sector.
3. A woman has to justify that her pregnancy occurred despite her having tried to prevent it or
that it had been intended but circumstances changed or made it unwanted later. The reality
may be that the pregnancy was unwanted from the start, but to justify abortion within the
legal framework, the woman may feel she has to say it was contraceptive failure, creating an
environment of falsehood
4. The act provides conditional access to abortion with the final decision resting with the
provider. Though the act allows providers to interpret the conditions permitted in the act
liberally yet women have to give an explanation that fits within one of those conditions
5. if abortions can be safely performed at any gestational age in case of ‘foetal abnormalities’,
the same can then be done for other reasons as well. Hence, women should be allowed to
terminate their pregnancies without the restriction of an upper gestational age in case they are
survivors of sexual abuse or experience such changes in their lives that make the pregnancy
unwanted at any stage
6. The POCSO Act, 2012 directs any person, including a medical practitioner, who has
knowledge that a sexual offence has been committed against a ‘child’, to report it to the
special juvenile police unit or the local police. Failure to report may lead to imprisonment for
six months or fine or both. Such mandatory reporting is in conflict with the provisions of
confidentiality under the MTP Act. Adolescent girls may be reluctant to seek legal abortion
services due to fear of their partners/husbands being arrested in case of consensual sex or due
to fear and power dynamics in case of abuse where the perpetrator is a family member or
someon e in position of power. Girls would also be concerned about their own identities
being revealed
7. While doctors are bound to maintain confidentiality of a patient, the administrative and
clinical support staff at the hospital are not under a similar statutory obligation. Therefore, if
they want to, they may be able to ascertain and disclose the identity of a woman who has
availed an abortion at the hospital
8. The pills that are used for medical abortions are covered under Schedule H of the Drugs
Rules, 1945 (popularly called Schedule H drugs) which means, that, by law, they may only
be sold upon production of a valid prescription from a registered medical practitioner. The
Drugs Rules, 1945 stipulate that pharmacy that dispenses any Schedule H medication is
required to maintain records of all drugs prescriptions dispensed at the store including the
name and address of the patient (in this case, the pregnant woman). Unlike the admission
register, certified opinion and consent forms, however, the pharmacists’ sales records are not
‘secret documents’ and are open to inspection by a multitude of persons.
9. A provision was inserted in MTP Act which now prohibits any registered medical
practitioner from revealing the name and other details of a woman who has availed an
abortion to anyone except a “person authorised by any law.”
Issue of Ethics in medical termination of pregnancy
The patient is the decision maker in most of the cases
The provider is in a dilemma.
On case of medical issues provider can manipulate patient to undergo abortion.
Social issues
Abortion becoming a normal thing hence motivating unsafe sex habits in younger people.
Couples might use it as a method to space between children or family planning without
understanding long term psychological or physiological effects.
RIght of the unborn child and moral issues associated with it.
The child has as much right to life as the mother and in case of not being able to defend itself a
need of moral regulation and laws to protect fetal life.
The UN declaration on the Rights of the child maintains that “the Child by reason of his
physical and mental immaturity, needs special safeguards and care including appropriate
legal protection before as well as after birth”.
Nutan
Abortion touches social, religious, economic and political aspects. Its impact on the society seen
can be looked at both in a positive and a negative manner.. By the nineteenth century many
nations passed laws banning abortion. It wasn’t until late in the twentieth century when the
women rights were given importance and after many awareness movements that some
nations, including the US, began to legalise abortion.
cons of mtp:
1. Those who are pro-life are against abortion and believe that since life begins at conception,
abortion is parallel to murder as it is the act of taking human life.
2.Abortion is in direct disobedience of the idea of the sanctity of human life and that no civilized
society permits any human to harm or take the life of another human.
3.Their basic premise is that for women who demand complete control of their body, control
should include preventing the risk of unwanted pregnancy through the responsible use of
contraception or, if that is not possible, through self-restraint.
Pros:
When it comes to those who favor medical termination of pregnancy, they point to the argument
that MTP represents a woman’s “right to choose” whether to continue her pregnancy or
terminate it.
In India, which is a country with immense social baggage supplemented by societal evils such as
illiteracy and poverty, the impact of the MTP Act should be judged in the context of
changing social circumstances, values and attitudes.
Another aspect that the teenagers who become mothers have harsh prospects for the future such
as leaving the school, health issues, inadequate prenatal care combined with social stigma.
The legalising of MTP Act has obviously had a positive stimulus upon the omen in need of
MTP and has shown reduced incidence of suicide and betterment of health and safety.
The MTP Act currently contains explanations to section 3 stating that terminations for rape and
contraceptive failure are permissible because the anguish caused by each constitutes a “grave
injury to her physical or mental health.” The MTP Act needs to be recognised that a
diagnosis of fetal impairment could likely produce distress constituting a severe injury to
mental health and that such an exception must exist during the entire pregnancy period, since
certain fetal anomalies cannot be detected within the stipulated 20th week period of
pregnancy.
Abortion includes various social, ethical and financial issues. Thus it can be concluded that a
mother's right is limited to have a termination of pregnancy. It is on the shoulders of the law
to take care of the independence and freedom of the mother as well as the life of the unborn.
The medical community and society needs to offer love and support to women with
unplanned pregnancies and to assist them in finding empathetic alternatives to abortion.
Lucy:
● Medical termination of pregnancy Act, 1971 amended in 2020.
1. Increased gestation limit from 20-24 weeks for special categories
(rape surviviors, minors, victims of incest, differently abled women,
and other vulnerable women).
2. Requirement of second medical opinion for termination of
pregnancy from 20-24 weeks of gestation.
3. Upper gestation limit to not apply to cases of fetal abnormalities
diagnosed by a medical board.
4. Confidentiality clause- the name and particulars of a woman whose
pregnancy has been terminated cannot be revealed except to a
person authorized by law.
5. Extended MTP services under the failure of contraceptive clause to
unmarried women to provide access to safe abortion based on a
woman’s choice irrespective of marital status.
● Personal opinion/questions:
1. why an increased gestation limit for only special cases and not for
all women.
2. If no upper gestational limit applied in case of fetal abnormality does
this mean that in such cases the mother's health and safety is
compromised? If not then why does this not apply for all?
3. Though the amendments in the act seem to be about giving women
the choice, I feel that is not the case. Medical practitioners still have
an upper hand on deciding if one can access MTP services.
Safa
CONS:
The MTP Act allows for termination of pregnancy up to 20 weeks (by new amendment 24) of
pregnancy. In case termination of pregnancy is immediately necessary to save the life of the woman,
this limit does not apply (Section 5 of the MTP Act).
The “physicians only” policy for providers excludes mid-level health providers and practitioners of
alternative systems of medicine. The requirement of a second medical opinion for a second trimester
abortion further restricts access, especially in rural areas
The setting up of medical boards which has been done by the Courts while dealing with cases of this
nature has only created further obstacles for women in accessing safe and legal abortion.
While the MTP Act provides a framework for provision of abortion services, the PC&PNDT Act
regulates the misuse of diagnostic techniques for determination of sex of the foetus. Both the laws
have a very clearly defined purpose, however, there is still conflation in the implementation of the
two laws. Due to the stringent implementation of the PC&PNDT Act, many doctors are fear or are
reluctant to provide MTP services due to the possibility of undergoing inspection and facing legal
issues, thus creating great hindrance for accessing safe abortion services
The conflation between POCSO and MTP Acts result in denial of services for consensual as well as
sexual assault of minors. Earlier the MTP Act required the consent of a guardian for a minor and that
still remains, but due to POCSO Act, the mandatory reporting complicates the issue, and providers
are wary of delivering safe abortion services to minors, even in case of assault, ensuing many to
seek unsafe abortions to avoid legal hassles; and to further complicate parents exploiting this to
harass children or their partners with imprisonment of 7 to 10 years.
In India, though abortion is legally permissible under a wide range of situations, the doctor has the
final say. A woman has to justify that her pregnancy occurred despite her having tried to prevent it or
that it had been intended but circumstances changed or made it unwanted later. The reality may be
that the pregnancy was unwanted from the start, but to justify abortion within the legal framework,
the woman may feel she has to say it was contraceptive failure, creating an environment of
falsehood.
Although India’s abortion policy and law are progressive, effective translation into improved access
to safe abortion care is often impeded by misguided and unnecessary practices.
Pros:
1. Legalising abortion leads to safe abortions where women started approaching medical
practitioners.
(however In most states, less than 20% of primary health centres provide abortion
services.Even where they do so, women prefer to seek abortion in the private sector, leading
to under-utilisation of public facilities. Further, the quality of abortion services in both the
public and private sectors is often poor in terms of technique used, counselling, privacy and
confidentiality.)
2. MTP Act recognises the importance of provision of safe abortion services which are
affordable, accessible and acceptable for women who need to terminate an unwanted
pregnancy
Reproductive and Child Health (RCH) is a Government of India's (GoI) National Health
Mission (NHM) flagship programme. RCH aims for reduction of maternal and infant
mortality and total fertility rates and to reduce social and geographical disparities in
access to and utilisation of quality reproductive, maternal, newborn, child and
adolescent health services.It was launched in 2005 .
RCh also ensures provision of safe comprehensive abortion care. In India it is estimated
around 8 % of maternal deaths occur due to unsafe abortion practices. It is likeley for
women undergoing abortion to have reproductive morbidities or mental stress. While
practice of safe abortion aims to decrease the maternal mortality , but the certain
aspects of services induce an ethical dilemma, as they impinge the right of an
individual.
With the above scenarios we aim to express various circumstances a woman may
access the public health centre (PHCs/ FRUs (DHs/SDHs/CHCs) for MTP. A mandate
of 17,000 delivery points fulfill the benchmark as centres being safe for abortions. The
PHC provide services for first trimester abortion after which the cases are referrred to
CHC which are equipped for elaborate procedures.
The amendments in MTP act address various problems in the law. But there are certain
functions that still make the services an ethical confusion.
The issue of confidentiality or privacy is an important clause for providing MTP , but
under certain circumstances it seems violated .
Keeping the physician has highest decision making authority regarding MTP, dismisses
the rights of a woman and her efforts to avail timely abortion services. Moreover since a
second medical opinion was required , it delays access as well as timely service
provision for women.
The public sector regulated abortion centres by mandate of delivery points but due to
poor infrastructure and lack of transparency it is difficult for a woman to judge the quality
of service that is actually provided to her.
RCh aims to have comprehensive MTp care in circumstances of unwanted
pregnancies/contraceptive failure. Even though the act has provisions for such
circumstances, the doctor having final say makes it difficult.
Under the act there is a provision for unmarried or separated women to avail abortions
ervices but can be denied by the hopital on wants of being unmarried . Having no legal
knowledge or lacking detailed information of the act makes the access further difficult .
The mandatory reporting of post abortion cotranceptice impinges the right of women
and requires them to share personal information. In order to attain family planning
targets the
Among all the ethical principles beneficence in healthcare obligates the provider to do
more good than harm . The RCH program needs to consider a broader view of a
womans reproductive choice, psychological health and personal choice when it comes
to reproductive healthcare/ abortion. A subjective analysis of a woman's choice and
personal preference should not be undermined with the belief of the caregiver.
Although recent amendments have made progressive changes to include all spectre of
women , but it still does not grant complete autonomy. India with issues of sex
selectiveabortion, lack of ruarl infrastructure and specialised healthcare makes it difficult
for women to express complete power in decision making as she still need to justify her
choice and wait for an opinion from a specialised team of gynaecologista and radiologist
and pediatri ian to be final decision maker where no one can ensure absence of
personal bias of doctors.
The principle of beneficense, respect of individual and justice should be the drivers of
decision making in delivering reproductive care. The intention of beneficence should not
collide with respect for woman and not treating her as a decision maker and
autonomous body . Ultimately the woman must have complete authority on decision and
safe family planning choices which can be abortion when need arises without being
judged by moral or religious prejudice.
