MTPs: An Opinion In Two Parts (I)

She felt the dull pain of something poking around her innards. It seemed surreal to her, the whole experience. She wanted him to stop, but she knew the rhythm inside her would soon cease, ending the wordless terror. A lone thought dully throbbed in the back of her mind – I hope, no, I know I’m doing the right thing.

He straightened up and looked at her very composedly, and, as their eyes met, she knew. It was over.

Medical Termination of Pregnancy. Also known as an Induced Abortion*. What I would selfishly call a woman’s inalienable right.

The propagation of the species is achieved by union of a male and a female. However, it is within the female that conception occurs, and it is the female’s role to carry the foetus, birth it and raise it in a manner she sees fit. The male’s role is seemingly limited – although he may choose to expand it, if he so likes. For instance, a lioness does not require a male for much more than copulation, and the male chooses to isolate himself from the pride once he finishes having his fun. However, a human male normally stays united with the female and chooses to assist her in providing for and raising their children. It remains, however, primarily the female’s role to ensure healthy development of the child. She carries it, births it, feeds it and croons to it in infancy, and she provides warmth and affection for it through its lifetime. Ideally, the male participates in equal measure in this respect, but it is a more uncommon situation.

I believe it to be the choice of the woman to have a child, and to choose to not have it, if she so pleases. It is the decision of the woman, and society or the State should not interfere in it, or impede the process of her acting on that decision.

If a woman chooses to have children, she is invariably considered socially responsible. She does not make that decision lightly – taking into consideration everything from financial to emotional resources.

If a woman chooses to not have children, there should ideally be no social pressure that coerces her to reconsider that decision or, worse, reverse it against her will. The operative word here is apparently ‘ideally’. In addition, the State should not play a role in denying to her the security and facilities she needs to act on her decision. Especially in a so-called democracy, where the Government apparently serves the needs of the people. However, if you’ve been keeping up with the news lately, you’ll know that the Pro-life vs. Pro-choice debate has been given a good knock on the head by a certain republican government that seems to be the only thing in this world more confused than I am. That’s saying something.

Undigressing, if I have done one thing consistently through my life so far, it has been criticizing my country. No country is perfect, but India seems to be the embodiment of everything that could possibly be wrong, from stunted inter-personal relations to a glaring lack of civic sense. The proverbial last nail in the coffin is the exceptionally mixed-up government that fails up to live up to the expectations of even the most hardened cynic. I have not exactly viewed this nation in the best light.

That said, something that at first took me a little by surprise is the Medical Termination of Pregnancy Act, 1971.

This Act effectively legalizes abortion (i.e., the doctor doesn’t get caught under the Indian Penal Code) under certain circumstances. It is rather liberal and broad-based, compared to a lot of other policies out there. It has certain requirements for the number of Public Health Centres (PHCs) in an area (the only Government-licensed institutions permitted to perform abortions), and it directs the government to actively promote family planning and welfare, by increasing awareness of numerous methods of contraception. It also has provisions to secure the privacy of the woman. Essentially, the Act seeks to encourage women to seek legal abortions instead of the quack next door.

In 2002, India was reported to have an abortion rate of 2.8% (of all pregnancies), the highest rate that year being 58.2% in Russia. From 1995 – 2005, the number of reported abortions have been a little over 14 million.

It seems almost too good to be true. If that’s what you ended up thinking (presuming, of course, that you happen to be Pro-choice), you would be right. This is all good on paper.

If you read up a little on the Act, you’ll find that, however liberal and kind it may be to the woman compared to a lot of other countries where the ‘issue of abortion’ is a heated political debate, it still suffers from the same flaws that a lot of ‘Indian’ policies do.

  1. The Act has requirements for the number of PHCs, but they are not prevalent on absolute terms. There are a number of State regulations that interfere with its free function. For instance, there is a requirement of a blood bank within 5 km distance from a PHC – while well-intentioned, this regulation is just as obtuse and obsolete as a lot of other well-intentioned ones. The Act does not provide for blood banks, and there should thus be no external regulations interfering in the same.
  2. The Act only states that a “registered medical practitioner” perform the procedure – it does not have requirements of qualifications and/or qualities. A lot of these PHCs are staffed by doctors that wouldn’t be hired by any respectable private clinic, and the conditions in these Care Centres are far from safe. There should be prescribed standards of facilities so that these centres are expected to maintain a minimum quota of beds, working staff, instruments and their disinfection, and so on, and can charge only a stipulated amount based on the facilities they happen to provide.
  3. The Act allows for a legal abortion in the case of contraceptive failure, and also under circumstances where a woman’s socio-economic conditions may be affected by the pregnancy. This is a very forward-thinking clause that indicates the government’s recognition of the sheer terror and mental anguish of an unwanted pregnancy. Unfortunately, the clause on contraceptive failure applies only to married women. This, in effect, displays a government endorsement of only marital intercourse, and does not allow for termination of unwanted pregnancies from pre-marital intercourse. “Sex after marriage” is as prosaic as washing bloody bed sheets in public after the suhaag raat, and the presence of such an endorsement in a law displays continuation of that conservative thinking. This narrow thought-scape is also reflected in many other governments who maintain a stringent policy on abortion due to the belief that making it more accessible might encourage wanton sex acts among the populace. What people do in their bedrooms is a private and moral matter, and is completely out of the jurisdiction of a governing body. It is the place of the government to only provide measures and infrastructure to support any possible decision the citizenry makes, and not to resolve their moral questions for them.
  4. The Act requires only the consent of the pregnant woman, in the case of a healthy adult, but demands written consent from a minor’s legal guardian. Again, while well-meaning, this fails to consider the lack of communication in families on such ‘taboo’ issues. A girl who gets pregnant before the age of 18 is not viewed with much indulgence by her family, under normal circumstances. While there are understanding parents who handle the issue in a much more mature manner than the minor could, there are also abusive and broken homes where the minor may not exactly receive the best support she needs at that time. Since the Act requires the medical practitioner to make the woman aware of her rights under the MTP Act when she approaches an institution for an abortion, these rights should be reachable for anyone thinking they require an abortion. Such a decision is not taken lightly by anyone, including a minor, and any issues that society may have with such a liberalization of services must be counteracted with age-appropriate sex education.
  5. The conditions under which an abortion may be performed are all to be determined by one or more registered medical practitioners. Only when the judgement is in favour of an abortion does the consent of the woman or a guardian come into question. That is, the power to determine the necessity of the procedure is vested with the practitioner and not the woman, which completely negates any purported emancipation of women by the law! This could be a factor behind women seeking illegal abortions.

On that subject, while the recorded figure of a little over 14 million is as reported by the government, the actual figure taking into account estimates of the number of illegal abortions (ranging from 2 to 6 million, which is logically an understatement) is at least 17 million.

Most of the women approaching PHCs for legal abortions happen to be urban, middle-class females who are educated and use abortions more as a measure of family planning than anything else – an admittedly indiscriminate application the government did not intend to encourage, but which seems to be prevalent considering only around 36% of married women use contraception as a method of family planning. Also, nearly every woman admitted to hospitals pending infection/sepsis from an illegal abortive procedure happens to be a part of the rural and uneducated class.

These facts bring to light the increased need for open discussion on unnecessarily taboo issues like contraception, and reinforce the necessity for sex education in a country apparently teeming with people like the proverbial ostrich with its head in the sand, and a purportedly well-intentioned government that can’t stop tripping on its shoelaces. When these are issues concerning everyone, what is the need to be awkward or ‘socially conscious’? The country’s society is as far from healthy as possible, if it declares such relevant issues inappropriate for public discussion or even normal social discourse/intercourse. Why do you try to maintain a dispassionate or impersonal tone when conversation shifts to the politics of sex?

Incidentally, if you believe that the issue of abortion should be resolved as looking at the best interests of the unborn child (Pro-life), think about this – most adults are barely capable of rearing children ‘the right way’. We all make mistakes, and the ones that affect our children prove to be the most costly. How could an unmarried woman just building her career, or a student who isn’t even financially independent, possibly give what she believes to be the best care for a child she never intended to have? If you believe that a woman should birth the child and give it up to foster care, you have no understanding of the female psyche that is permanently scarred when parting with her children, even those she didn’t ‘want’. Don’t preach to me about the value of human life, if you can’t respect the rights of the woman involved.

* There’s a small difference here that most people seem to be inclined to overlook – one which at least I consider important, if solely for semantic purposes. An abortion is the termination of fetal development before sufficient passage of time for it to survive independently (originally around 28 weeks from conception – now, with better medical facilities, around 20 weeks, approximately), and subsequent expulsion of fetal material from the uterus. There are two kinds of abortions:

  1. Spontaneous Abortions, which are also termed Miscarriages. This is essentially a natural termination of pregnancy due to, say, errors in genetic material or a medical condition of the mother and so on.
  2. Induced Abortions, which are referred to as MTPs. This is using one of various methods to intentionally arrest fetal development.

A miscarriage is involuntary, whereas an abortion is voluntary. When you want to say, “She lost the baby when she had that near-fatal accident,” please do me a favour and use the word “Miscarriage”. I know that the difference is as fine a line as that between “marriage” and “wedding”, and isn’t all that much of a discrimination at all, but the different words used are to help get the message across, and not to make a slightly more aware (or, perhaps, nitpicking) listener feel very, very disoriented. Then again, perhaps I shouldn’t expect others to be as particular about it as I am.


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