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On September 1, a new law called the “Heartbeat Act” came into force in Texas, US, which effectively bans abortions if foetal heartbeat is detected. Though no time is specified, experts say this law would make abortions after six weeks illegal. The restrictive law also incentivises people to sue anyone suspected of helping a pregnant woman obtain an abortion. This is a retrograde step. This harks back to pre-1971 India, when we didn’t have the Medical Termination Act and most abortions were done illegally, by quacks, leading to higher mortality among women.
Abortion is legal in India under some circumstances and illegal in others. If the person getting an abortion is an adult, then you need no parental or spousal approval. The law varies for unmarried girls, rape survivors and married women, but with rising foeticides and infanticides, it was deemed illegal to detect the sex of the foetus, thereby decreasing the rate of abortion.
The National Family Health Survey (NFHS 2015-16) says only 20 per cent of abortions are in public sector facilities and 52 per cent are in private. Further, “only 53 per cent of abortions were performed by registered medical doctors. The rest were done by midwives, auxiliary nurses or dais [traditional birth attendants], as we call them in the villages”.
India needs specialists for the medical boards that sanction post-24-week abortions — gynaecologist, paediatrician, radiologist or sonologist. While the country continues to face a shortage of doctors, we are nowhere near identifying areas in clinical care that can be delegated to health workers with varied qualifications and experience.
Restrictive abortion laws like the one introduced in the US may lead to more incidence of maternal mortality. The average maternal mortality ratio is three times higher in countries with more restrictive abortion laws (223 maternal deaths per 100,000 live births) compared to countries with less restrictive laws (77 per 100,000 live births), according to the World Health Organization. Although India’s abortion policy and law are progressive, its effective translation into improved access to safe abortion care is just as critical.
The writer is Founder Chairman and Neonatologist, Cloudnine Group of Hospitals, Bengaluru. Views are personal
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