‘The ratio of doctors and abortions is totally skewed’

CEO of Ipas Development Foundation dwells on the challenges faced while making amendments to MTP Act

June 10, 2019 01:49 am | Updated 01:49 am IST - Vancouver

The issue of women’s reproductive rights has taken centre stage globally with the restrictions implemented by Donald Trump’s administration on aid given to organisations that work in the field of abortion. In India, abortion has been legal since 1971. However, the debate here has been on the Medical Termination of Pregnancy (MTP) Act that sets a 20-week limit for abortion and activists have been pushing hard for its amendment. On the sidelines of the Women Deliver conference in Vancouver, The Hindu spoke to Vinoj Manning, chief executive officer of the Ipas Development Foundation (IDF), who was part of the expert committee appointed by the government to draft amendments to the Act. Excerpts:

Why is India’s MTP Act termed as archaic?

The law was formed in 1971. That’s when they legalised abortion. At that time, it was landmark legislation globally as [fewer] than 17 countries had an abortion law as liberal as India. Abortion is not a women’s right in India. It is still a doctor who decides whether she gets an abortion. But it is pretty liberal because the wise men and women on the board decided to have that one clause which said that contraceptive failure among married women is a ground for abortion. This almost made it universally available.But in 1971, the only method of safe abortion was an invasive procedure called Dilation and Curettage (D&C) which required anaesthesia. Today, the World Health Organization (WHO) and the Indian guidelines demand that D&C should no longer be there because newer methods have come in like the manual vacuum aspiration and the electric vacuum aspiration which are outpatient procedures. So, what was an in-patient procedure requiring anaesthesia, blood transfusion back up etc. became irrelevant. But unfortunately, the law did not keep pace with time.

The draft amendment is yet to be tabled. Where is it stuck?

In 2008, the government of India recognised the gap and set up an expert committee group to look at amendments that were trying to address problems such as the implementation of the law and the requirements specified in the Act in terms of facilities and providers. One of the amendments was to bring in mid-level providers like nurses and Auxiliary Nurse Midwives due to the availability of medical abortion. The second amendment was to look at abortion on the grounds of some foetal anomalies, not all. The third point was to offer abortion for vulnerable women like single women, rape survivors, women with disabilities and minors by extending the gestation limit to 24 weeks.The draft was tabled in 2014, but received a huge backlash from the medical community because of this the mid-level provider's point. So, it came to a standstill there.

Would the mid-level providers change anything on the ground?

India has 15 million abortions a year and there are only 45,000-odd gynaecologists. The existing Act says that any gynaecologist can provide abortion services. But for an MBBS doctor to carry out an abortion, he or she needs to undergo a 12-day training during which five hands-on cases have to be done. There are 90,000-odd MBBS doctors who have undergone such training. Even if you add the number of gynaecologists and the MBBS doctors, the ratio is totally skewed. Ipas Development Foundation (IDF) has been providing the training to MBBS doctors in order to help expand the provider base within the law. WHO recommends mid-level providers and more than 17 countries including Bangladesh, Pakistan, Nepal, Cambodia, South Africa, Sweden have them. There is Indian research, too, that has proven the efficacy of mid-level providers.

Will the amendment see the light of the day any time soon?

The government is relooking at moving ahead without the mid-level provider clause since it realises that there is a need and there is immense pressure from the courts as well. Hopefully, this amendment will happen, but it will happen without the mid-level provider clause.

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