Abortion in India

[1] The Medical Termination of Pregnancy Regulations, 2003 were issued under the Act to enable women to access safe and legal abortion services.

[2] In 2021, MTP Amendment Act 2021[3] was passed with certain amendments to the MTP Act 1971, such as women being allowed to seek safe abortion services on grounds of contraceptive failure, an increase in gestation limit to 24 weeks for special categories of women, and opinion of one abortion service provider required up to 20 weeks of gestation.

Unsafe abortion[7] was defined by the World Health Organization (WHO) as "a procedure for termination of a pregnancy done by an individual who does not have the necessary training or in an environment not conforming to minimal medical standards."

The alarmingly increased number of abortions taking place put the Ministry of Health and Family Welfare (MoHFW) on alert.

Unsafe abortion is the third largest cause of maternal mortality leading to death of 10 women each day and thousands more facing morbidities.

[14] The Medical Termination of Pregnancy (MTP) Act, 1971 provides the legal framework for making CAC services available in India.

The Government took cognizance of the challenges faced by women in accessing safe abortion services and in 2006 constituted an expert group to review the existing provisions of the MTP Act to propose draft amendments.

The proposed amendments to the MTP Act were primarily based on increasing the availability of safe and legal abortion services for women in the country.

These categories of Indian System of Medicines (ISM) practitioners have Obstetrician and Gynecology (ObGyn) training and abortion services as part of their undergraduate curriculum.

In addition, it has also been recommended that Auxiliary Nurse Midwives (ANM) posted at high case load service delivery points be included as legal providers of MMA only.

These recommendations are supported by two Indian studies[15][16] that conclude abortions can safely and effectively be provided by nurses and AYUSH practitioners.

The Government of India has taken several measures to ensure the implementation of the MTP Act and make CAC services available to women.

The Comprehensive Abortion Care: Training and Service Delivery Guidelines 2018, Ministry of Health and Family Welfare, Government of India states that MA drugs can be used by a client at home at the discretion of the provider.

The results from this study were published in Lancet Global Health journal in December 2017 in the form of a paper titled "The incidence of abortion and unintended pregnancy in India, 2015".

This dated method is an invasive medical procedure which requires "the use of anesthesia for removing products of conception using a metal curette",[30] often running the risk of hemorrhage or uterine infections.

WHO and FIGO issued a joint recommendation which stated that properly equipped hospitals should abandon curettage[31] and adopt manual/electric aspiration methods.

Additionally, women with illness arising out of miscarriage shall, on production are also entitled to paid leave of up to one month on submission of relevant medical proofs.

[36] Unsafe abortions is a common recourse for most women in the country, including in the rural pockets, due to various social, economic and logistical barriers.

[37] Despite India's extensive efforts to improve maternal and reproductive health, wide geographical disparities exist between its urban and rural population.

The said Act prescribes stringent punishment graded as per the gravity of the offence, with a maximum term of rigorous imprisonment for life, and fine.

Although the Act safeguards the life and rights of children, it fails to differentiate between 'consensual sex' and offence and also does not address the grey area of 'early marriage'.

As the act fails to differentiate between offense and consent, it poses a huge barrier to access to sexual and reproductive health services for adolescents.

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.

Even government posters for "awareness generation" of the public with respect to sex determination have been found to use the terminology of "bhroon hatya" or "foeticide" rather than "abortion" — a term that indicates a homicidal criminal activity of taking "a life".

The campaign provides a platform to address the issue of sex selection while protecting women's right to safe, legal abortion services in India.

[41] The nationwide lockdown imposed from 25 March onwards in an effort to combat the COVID-19 pandemic, adversely impacted contraceptive and safe abortion access.

As a fallout of lockdown due to COVID-19, over 20 million couples in the country were deprived from availing contraceptives and terminating unintended pregnancies.

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).

While a number of orders permitting termination are based on the opinion of the medical board and the jurisprudence already laid down in previous cases, there have been some groundbreaking judgments in the past years also, which have been highlighted.

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.