Relevance: GS-2: Government policies and interventions for development in various sectors and issues arising out of their design and implementation.

Key Phrases: Family planning, Maternal health issue, Medical Termination of Pregnancy Act, 1971, Medical Termination of Pregnancy Amendment Act, 2021, World Health Organization, Maternal deaths, Induced miscarriage, Population control, Protection of Children from Sexual Offences (POCSO) Act, 2012, Health-Care providers, Reproductive injustice.

Context

• Recently, two women public health practitioners who have studied and worked in India and the United States have voiced their solidarity with women in both countries for their abortion rights.
• The abortion debate in America. A majority of Americans say abortion should be legal in all or most cases, but many are open to restrictions; many opponents of legal abortion say it should be legal in some circumstances
• Netizens on social media in India claim that the country is more progressive than the U.S. on abortion rights.

What is abortion?

• An abortion is a medical procedure that ends a pregnancy. It is a basic healthcare need for millions of women, girls and others who can become pregnant. Worldwide, an estimated 1 in 4 pregnancies end in an abortion every year.

Various reports on Abortion with special focus on India

• According to the World Health Organization
  • six out of 10 of all unintended pregnancies end in induced abortion (the deliberate interruption of an ongoing pregnancy by medical or surgical means).
  • Around 45% of all abortions are unsafe, almost all of which (97%) take place in developing countries.
• Unsafe abortions are the third leading cause of maternal mortality in India, and close to 8 women die from causes related to unsafe abortions each day, according to the United Nations Population Fund (UNFPA)’s State of the World Population Report 2022. Between 2007-2011, 67 per cent of abortions in India were classified as unsafe
• The recent round of the National Family Health Survey 2019-2021, shows that 3% of all pregnancies in India result in abortion. More than half (53%) of abortions in India are performed in the private sector, whereas only 20% are performed in the public sector — partly because public facilities often lack abortion services. More than a quarter of abortions (27%) are performed by the woman herself at home.
• As per a nationally representative study published in PLOS One journal in 2014, abortions account for 10% of maternal deaths in India.
• In another a fact-finding study published in The Lancet in 2018, 73% of all abortions in India in 2015 were medication abortions, and even though these may have been safe — many of these are illegal as per the MTP Act, if they occur without the approval of a registered medical practitioner. Another 5% of all abortions were outside of health facilities with methods other than medication abortion. These risky abortions are performed by untrained people under unhygienic conditions using damaging methods such as insertion of objects, ingestion of various substances, abdominal pressure, etc.

Issues with the Laws and Rules regarding Abortion in India:

• The MTP Act, first enacted in 1971 and then amended in 2021, certainly makes ‘medical termination of pregnancy’ legal in India under specific conditions. However, this Act is framed from a legal standpoint to primarily protect medical practitioners because under the Indian Penal Code, “induced miscarriage” is a criminal offence. This premise points to a lack of choice and bodily autonomy of women and rests the decision of abortion solely on the doctor’s opinion. The MTP Act also only mentions ‘pregnant woman’, thus failing to recognise that transgender persons and others who do not identify as women can become pregnant.
• Moreover, the acceptance of abortion in Indian society is situated in the context of population control and family planning. But, most importantly, after more than 50 years of the MTP Act, women and transgender persons face major obstacles in accessing safe abortion care.
• These are seven examples:
  • First, they may not even be aware that abortion is legal or know where to obtain one safely.
  • Second, since the MTP Act does not recognise abortion as a choice, they need the approval of medical professionals even in the first few weeks of the pregnancy
  • Third, unmarried and transgender people continue to face stigma and can be turned away from health facilities, forcing them to resort to unsafe care.
  • Fourth, mandatory reporting requirements under the Protection of Children from Sexual Offences (POCSO) Act, 2012 law against child sexual offences, impact privacy and hinder access of adolescents to safe abortion services.
  • Fifth, many are still coerced into agreeing to a permanent or long-term contraceptive method as a prerequisite for getting abortion services.
  • Sixth, health-care providers may impose their own morality by insisting on ‘husbands’ or ‘parental’ consent for abortion. Even women seeking abortion care in health facilities are often mistreated and not provided medications for pain relief;
  • Seventh, despite laws prohibiting sex determination, the illegal practice persists. The mushrooming of unregulated ultrasound clinics in India continues to facilitate the illegal practice of sex determination, resulting in unsafe abortions and female foeticide.
• It is a testament to class and caste divides when netizens talk of being ‘progressive’ when, 50 years after the MTP Act, women continue to die due to unsafe abortions. Passing one law and assuming the job is done is far from “progressive” when so many face a lack of access, systemic barriers, social norms and cultural preferences, and even criminal liability.

Way Forward:

• There is an urgent need in our country to shift the discourse on abortions from just being a family planning and maternal health issue to one of a sexual health and reproductive rights issue. The situation in India shows that one law alone is insufficient and we must raise the bar on reproductive justice.
• Comprehensive sexuality education which aims to develop and strengthen the ability of children and young people to make conscious, satisfying, healthy and respectful choices regarding relationships, sexuality and emotional and physical health.
• Prevention of unintended pregnancy through use of effective contraception, including emergency contraception
• Also, there is need for improvement of health systems to ensure good quality and respectful abortion care.
• As the focus on abortion rights in the U.S. turns into rage, we call upon all to self-reflect and to stand in solidarity with people in the U.S. and other places where reproductive rights are in jeopardy. Reproductive injustice anywhere is a threat to the lives of people everywhere.

Source: The Hindu

Mains Question:

Q. “The amendment to the abortion laws retains the notion that the state must intervene in what is a woman’s absolute right.” Critically Analyse.