Context: Recently, Argentina’s Congress legalised abortions up to the 14th week of pregnancy. The MTP Bill was passed in Lok Sabha in March 2020, and is likely to be brought before Rajya Sabha during the ongoing Budget Session.
Background

• Medical Termination of Pregnancy Act (MTP): The MTP Act of 1971 was framed in the context of reducing the maternal mortality ratio due to unsafe abortions. 
• It allows an unwanted pregnancy to be terminated up to 20 weeks of pregnancy and requires a second doctor’s approval if the pregnancy is beyond 12 weeks. 
• Further, it only allows termination when there is a grave risk to the physical or mental health of the woman or if the pregnancy results from a sex crime such as rape or intercourse with a mentally challenged woman.
• The amendment too continues this legacy of hetero-patriarchal population control, which does not give women control over their own bodies. 

Medical Termination of Pregnancy (MTP) Amendment Bill, 2020

• The Bill amends the Medical Termination of Pregnancy Act, 1971.  
• Time limit and grounds for terminating a pregnancy:  The Act specifies the grounds for terminating a pregnancy and specifies the time limit for terminating a pregnancy.

The Bill amends these provisions. 

• Termination due to failure of contraceptive method or device: Under the Act a pregnancy may be terminated up to 20 weeks by a married woman in the case of failure of contraceptive method or device.  

The Bill allows unmarried women to also terminate a pregnancy for this reason.

• Medical Boards:  All state and union territory governments will constitute a Medical Board.   
• The Board will decide if a pregnancy may be terminated after 24 weeks due to substantial foetal abnormalities.   
• Each Board will have a gynaecologist, paediatrician, radiologist/sonologist, and other members notified by the state government.
• Privacy: A registered medical practitioner may only reveal the details of a woman whose pregnancy has been terminated to a person authorised by law.  
• Violation is punishable with imprisonment up to a year, a fine, or both.

Issues with the proposal

• In the context of the current healthcare budgetary challenges, this proposal to set up infrastructure across the country to regulate medical termination of pregnancies is both financially unsound and practically impossible.
• India’s healthcare system has neither the financial investment nor the infrastructure to sustain the operation and functioning of medical boards in every state and UT.
• Due to the weak healthcare infrastructure in the country, it would be practically impossible to constitute these boards with the requisite specialists.
• Even where they are set up, the accessibility of such boards for pregnant persons, especially those living in rural areas, remains a major challenge.
• More importantly, subjecting people to multiple invasive examinations is a grave violation of their rights to privacy and dignity.
• Requiring pregnant persons to navigate a bureaucratic web of authorisation will inevitably lead to delays and thereby impede access to safe and legal abortion services.

Poor public financing and privatisation of healthcare

• At 1.6 per cent of GDP in 2019-20 India’s current level of public financing of health is one of the lowest in the world
• This has meant that most health expenditure in the country is out of pocket (OOP) — borne by patients themselves.
• OOP expenditure on healthcare is recorded at 58.7 per cent as per the National Health Accounts in 2016-17.
• The central government has preferred to incentivise private players to set up or offer services, instead of building infrastructural and professional capacity.
• Privatisation drives up costs of care and the handing over of public facilities to the private sector can have catastrophic consequences.
• They additionally remain non-accountable to state authorities in terms of affordability or transparency for instance, through Right to Information enquiries, or to uphold fundamental rights like non-discrimination in treatment or employment, or even the fundamental right to health.
• The National Sample Survey Organisation (NSSO)’s 75th report shows that less than 20 per cent of the population is covered by health insurance in India.
• According to the National Health Profile 2017, India has only one doctor for roughly 10,200 people in the public sector.

Concerns

• Autonomy for women over their own bodies: While the current Bill provides that safe abortions can be performed at any stage of the pregnancy in case of foetal “abnormalities,” it fails to consider any other reason such as personal choice, a sudden change in circumstances due to separation from or death of a partner, and domestic violence.
• Thus, it is not based on any request or isn’t at the pregnant person’s will but on a doctor’s opinion.
• Unsafe abortions: In such circumstances, women usually resort to unsafe methods of abortion. Unsafe abortions are the third largest cause of maternal deaths in India.
• Biased boards: Medical boards can rely on the facts of the case but personal beliefs could impact the medical board’s opinion, which is one of the biggest challenges in having a third-party opinion on a decision which is very personal.
• The proposed amendment still requires one doctor to sign off on termination of pregnancies up to 20 weeks old, and two doctors for pregnancies between 20 and 24 weeks old. 
• Abortion rights are central to a woman’s autonomy to determine her life’s course. Neither the state nor doctors have any right to deny a woman a safe abortion. Doing so means that women are not being treated properly as adults who are responsible for their own choices.

Road Ahead

• Poor public health infrastructure and absence of specialists across the country have meant that most abortions do not happen in the public sector, but at private centres or at home. With overwhelming shortfalls in specialist availability, especially in rural and scheduled areas, it would be impossible to constitute boards with requisite specialist representation as contemplated under the MTP Bill.