Medical board on abortion ‘unfeasible’

The Medical Termination of Pregnancy Act, 1971 provides for the termination of certain pregnancies by registered Medical Practitioners. It is possible to get an abortion under the Act if pregnancy is under 20 weeks.
However, it is subject to several conditions and conducting an abortion without fulfilling the conditions is considered a crime.

Under the MTP Act, the doctor can perform an abortion in the following situations:

If the pregnancy would be harmful to life or physical or mental health of the pregnant woman;
If there is a good chance that the child would suffer from physical or mental abnormalities which would leave him or her seriously handicapped.

Legal and medical experts feel that a revision of the legal limit for abortion is long overdue.
Foetal abnormalities show up only by 18 weeks, so just a two-week window after that is too small for the would-be parents to take the difficult call on whether to keep their baby and for the medical practitioner to exhaust all possible options before advising the patient to take the extreme step.
Since lack of legal approval does not prevent abortions from being carried out beyond 20 weeks, women are put under risk since the abortions then are often conducted in unhygienic conditions by untrained, unqualified persons. It is estimated that about 8% of maternal deaths happen due to unsafe abortions.

Last year, the Union Cabinet approved the MTP (Amendment) Bill, 2020, which allows abortion up to 24 weeks of gestational age for vulnerable categories of women and there is no limit of gestational age in case of pregnancies with substantial foetal abnormalities, diagnosed by a medical board.
The Bill proposes constitution of a Medical Board in every State and UT, which will decide on pregnancies beyond 24 weeks in cases of foetal abnormalities. Each board will have one gynaecologist, one radiologist or sonologist, one paediatrician, and other members prescribed by the State/UT government.
The MTP Bill was passed in Lok Sabha in March 2020, and is likely to be brought before Rajya Sabha during the ongoing Budget Session.

A recent study by the Centre for Justice, Law and Society at the O.P. Jindal Law Global School has revealed that a panel of doctors to decide on termination of pregnancy beyond 24 weeks as proposed in the Medical Termination of Pregnancy Amendment Bill, 2020, is “unfeasible” as 82% of these posts are lying vacant in the country.
The report analysed district-wise availability of specialists, including surgeons, obstetricians and gynaecologists, physicians and paediatricians.
It found that for each of the years between 2015-2019, the shortfall in these posts hovered between 71% to 81.8%. For the year 2019, for a total of 21,296 vacancies in the country, only 3,880 were filled, that is, there was a shortfall of 81.8%.
The data is based on the Ministry of Health and Family Welfare’s Rural Health Survey, which provides details of vacancies filled at secondary healthcare centres. Similar data for urban areas was unavailable.
The shortfall was starker in the northeast where Sikkim, Mizoram and Manipur had a total absence of obstetricians and gynaecologists, and a near total absence of paediatricians. Arunachal Pradesh and Meghalaya had a 100% shortage of paediatricians.

The study flags the constitution of the Medical Boards as draconian and invasive as they strip away autonomy from the pregnant person.
Even if the Boards are set up, pregnant persons who are in more remote areas of the country will incur many costs in travelling and this will add to their financial burden.
This legal reform will make access to abortion more challenging for many people, especially those from marginalised groups.
The World Health Organization also urges nations not to create barriers by including complex authorisation processes and noted that negotiating authorization procedures disproportionally burdens poor women, adolescents, those with little education and those subjected to, or at risk of, domestic conflict and violence, creating inequality in access.

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