In the landscape of reproductive healthcare, recent cases have brought to light critical challenges and opportunities for reform in India. The Bombay High Court’s authorisation of foetal reduction for a 26-week pregnant woman facing foetal anomalies, and Supreme Court’s view that the foetus has a right to live – are a poignant reminder of the complexities and ethical considerations surrounding medical termination of pregnancy (MTP) laws in our country. And these landmark decisions highlight the urgent need for legal and policy reforms, even after the recent amendment to the MTP Act. It also underscores broader issues relating to contraception, prenatal care and equitable access to essential healthcare services.

The Medical Termination of Pregnancy Act has undoubtedly played a pivotal role in safeguarding women’s reproductive rights, but there’s room for reform.

The recent case of a 26 week pregnant lady in Mumbai exemplifies the challenges faced by women seeking specialised reproductive healthcare outside government facilities. A 37 year old, 26 weeks pregnant woman having a severely abnormal foetus approached me for MTP. She was permitted to undergo MTP by the permanent medical board. But the law allows it only at the government hospitals which are already overburdened. There is a certain sector of the society who may wish to access private hospitals for their healthcare needs. Simply disallowing private sector hospitals to carry out MTPs even though having capabilities and infrastructure similar or sometimes better than government hospitals, is hugely restricting the rights of the woman to access healthcare of her choice. Albeit, such procedures must be allowed to be conducted only at specialised centres under strict quality control, they cannot be simply disallowed to even apply for a license to do these procedures.

Empowering private healthcare providers

One of the key takeaways from this case is the pivotal role that private healthcare providers can play in offering specialised maternal-foetal care. The authorisation of foetal reduction at Cloudnine Hospital underscores the urgent need to empower and collaborate with private healthcare institutions to ensure equitable access to essential reproductive services.

By expanding the scope of authorised facilities to include reputable non governmental hospitals with advanced clinical expertise, we can bridge existing gaps in healthcare delivery and offer women comprehensive options for reproductive care. At the same time, we must ensure stringent quality control. It must be mentioned that instead of having adversarial attitude to private sector, reporting of errors, and learning through them for continuous quality improvement is the way to go. Even the UK’s National Health Services is utilising services from private providers to fulfil unmet needs in healthcare delivery.

Universal prenatal testing and informed decision-making

A critical component of comprehensive reproductive healthcare is universal prenatal testing. Initiatives like Non-Invasive Prenatal Testing (NIPT) help detect foetal anomalies early, enabling informed decision-making and timely interventions. Ideally, prenatal testing should be mandatorily offered to all couples in India, with collaboration between private hospitals and government agencies to establish standardised protocols for prenatal screening and care. By prioritising early detection and intervention, we can improve maternal and foetal outcomes and ensure that women receive the support and information they need to make informed healthcare decisions.

Prioritising maternal health and well-being

At the heart of discussions on reproductive healthcare is the fundamental principle that every mother has the right to safe childbirth and comprehensive prenatal care. It is imperative that we prioritise maternal health by providing the necessary resources, support, and medical interventions to ensure positive outcomes for both mothers and newborns. At the same time, a woman’s right to terminate the pregnancy also needs to be addressed equally seriously. Neither the society nor the law should marginalise her for going through an abortion. The basic premise that she is doing something unnatural or against the norms of a patriarchal society should be eliminated. Instead she is a victim of unfortunate circumstances compelling her to terminate the pregnancy. Unsafe abortions are the fifth common cause of maternal mortality in the world. So availability of legalised abortion services is the soultion. We must remember the maternal mortality and morbidity is one of the most important indicators in the millennium development goals.

Advocacy and collaborative efforts for reform

As advocates for reproductive rights and healthcare, we must continue to raise awareness, engage policymakers, and collaborate with healthcare professionals to drive meaningful reforms. Modernising MTP laws, empowering non-governmental hospitals, and prioritising prenatal testing and helping women to make informed decisions are critical steps towards creating a more equitable and compassionate healthcare system for women across India. These recent cases serve as a catalyst for broader discussions on improving reproductive healthcare standards and ensuring access to essential services for all women.

In conclusion, the authorisation of foetal reduction at a private hospital underscores the urgent need for comprehensive reproductive healthcare reforms in India. By modernising MTP laws, empowering private healthcare providers, prioritising prenatal testing, and supporting maternal health and well-being, we can create a future where every woman receives the care and support she deserves throughout her reproductive journey. Let us seize this opportunity to advocate for change and champion the cause of comprehensive reproductive healthcare for women across our nation.

(The writer is a Senior Consultant Gynaecologist at Cloudnine Group of Hospitals, a patient rights activist, & was involved with the Bombay HC case. Views are personal.)