THE STAUNCH REALITY BEHIND TERMINATION OF PREGNANCIES IN RURAL INDIA

THE STAUNCH REALITY BEHIND TERMINATION OF PREGNANCIES IN RURAL INDIA

Author:  Alweena Scaria
 3 year Law 
Christ(Deemed to be University)
ABSTRACT
Women have resorted to abortions in the recorded history to get rid of unwanted pregnancies, irrespective of religious and legal sanctions, even at great risk to their own lives. Abortions caused are as old as humanity, and take place in all cultures. Even abortions tend to be clouded worldwide with shame, secrecy and confusion even in the twenty first century. Various indications show as to how abortions are rising amongst teenagers in many parts of the world in spite of the view of the consequences. The era since the 1990s has seen major changes in the field of abortion, including the adoption of new legislative measures, the introduction of new technology and sexual abortion issues 1. Some estimate that while about 51% of teenage pregnancies end in live births, 14% result in miscarriage or still birth and 35% end in induced abortions 2. Additional teenagers may become aware of late pregnancy if the risk of abortion is 3-4 times higher as early as in the gestation period, or it may be too late for abortion.

Keywords: Abortion, teenage pregnancy and adolescent termination, Abortion providers and services, Critical analysis.

INTRODUCTION

Owing to its colonial heritage and nice Britain’s act of outlawing abortions between the years 1869 to 1967, Section 312 of the Indian legal code (IPC) disallowed as associate degree evoked act of miscarriage. However, post-independence things modified considerably. In 1952, Asian nation introduced birth control programme to examine its increasing population. In 1964, the Central commission fashioned a committee- below the leadership of the Health Minister of the state of geographical region, Shri Shantilal Shah, to seem into the necessity to usher in changes to the IPC and introduce alternative required legislation to handle termination of pregnancies purposefully. The committee submitted its report in 1966, that concerned deletion of Section 312 of IPC and also the ought to usher in a special law to handle termination of pregnancies. They cited the changes in nice Britain’s abortion laws to support the necessity for India’s abortion laws to be modified. As a result, associate degree exclusive abortion-related legislation- the Medical Termination of gestation (MTP) Act, 1971, came into being.[1]

Abortion (or surgical termination of pregnancy, MTP) has been lawful in India for almost three decades on a wide range of medical and social grounds. More than six million abortions occur in the country per year. Adolescents account for about 6% of abortion seekers, though some hospital-based studies have found that adolescents constitute as much as 20–30% of client load[2]. While changing social norms have seen an increase in pre-marital sexual activity and unwanted pregnancies among adolescents, given the near universality of early marriage in India, most adolescent abortion seekers are married. The MTP Act has been complemented with many rules and laws over the years. as an example, the Union government in 2003 came up with the “MTP Regulations”, that is to be followed altogether centrally administered territories or Union Territories (UTs)[3]. As per the same laws, all the Registered caregiver (RMP), should maintain abortion records and submit them to the Chief medic (CMO). The union government asked
states to imitate and are available up with similar laws to manage abortion procedures. The union government additionally came up with the excellent Abortion Care (CAC) coaching and repair Delivery tips, 2010,  that has been amended in 2014. It aims to coach medical practitioners and workers to confine upon the deaths of mothers from unprescribed evoked miscarriage practices[4]. The Pre-Conception and Pre-Natal Diagnostic Techniques (Prohibition of Sex Selection)  (PCPNDT)Act, 1994, has additionally been wont to supplement abortion laws and laws to confirm that lady kid deaths through misappropriated evoked miscarriages are looked into and avoided within the future[5].

AIM AND OBJECTIVES
1.    To analyse the data based on induced abortions among adolescents and teenagers.
2.    A critical analysis on various abortion laws in India.
3.    Recognise problems associated with Indian laws
4.    Identify remedial measures.

CHAPTER 1- INCIDENCE OF INDUCED ABORTIONS

Abortion incidence is a crucial indicator of women’s would like for safe termination services, and it sheds light-weight on women’s and couples’ contraceptive behavior and their expertise of unintentional physiological condition. The UPAI study provides a comprehensive estimate of abortion incidence that reflects the complete vary of strategies and suppliers that ladies use. In addition to estimating public- and private-sector abortion provision in health facilities, it estimates abortions occurring within the informal sector, as well as MMA provided by chemists and different informal vendors, terminations by undisciplined suppliers and abortions that ladies induce on their own. Our estimation methodology depends on health sector data whenever attainable to avoid the high level of underreporting (often coupled to issues concerning confidentiality and stigma) that typically happens in family surveys that directly raise girls about their abortions.[6] We estimate the annual incidence of abortion in the six states included in this report, from 580,000 in Assam to 3,152,000 in Uttar Pradesh (Table 2.1), using data for 2015. Although absolute numbers reflect population size, among other variables, the rate of abortion — abortions per 1,000 women aged 15–49—allows a comparison of the incidence of abortion across states, reducing the impact of population size. Although we concentrate on midpoint estimates of the abortion rate, we also present lower-and upper-bound figures for each state—a range that represents the inherent uncertainty of the calculation techniques. In Tamil Nadu (32.8) the midpoint abortion rate is
lowest and in Assam (66.2) the highest and other states include-Gujarat (47.6), Bihar (49.4), Madhya Pradesh (57.3) and Uttar Pradesh (61.1).[7]

TEENAGE PREGNANCY

Teenage pregnancy is found double in rural areas, 9.2%, when  compared to urban areas, 5%, in India. The problem lies where these pregnancies does not only make adolescent girls vulnerable, both physically and mentally but puts them and their  babies at risk. These pregnancies are associated with increased risks of miscarriage among women and abortion leading to adverse outcomes.[8]In India, almost 50 per cent adolescents who are married have already given birth to children.  Statistical data shows the prevalence of teenage pregnancies which is found inversely proportional to their levels of education. Almost 20% of the women who got pregnant as teenagers had no schooling.  A higher prevalence of teenage pregnancies at 10.6% are found in the poorest wealth category which tends to lower at 2.5% in the highest quintile. Teenage pregnancies tend to be higher as scheduled tribe communities as compared to other castes.

The trend of early marriages  have been  on the decline were 27 percent of women are married before the legal age of 18 years. The trend can be found rising in West Bengal (44%), Bihar (42%), Jharkhand (39%), and Andhra Pradesh (36%) and lowest in Lakshadweep (5%), Jammu & Kashmir and Kerala (9%). This shows the correlation between high rates of adolescent marriages with low levels of education.What is troubling is the rising rate of anaemia-induced maternal and infant deaths. About 54.1 percent of adolescent girls aged 15-19 are anaemic in rural areas with a slightly higher rate than urban areas. And that is because only 28.1 percent of adolescent expectant mothers ate iron and folic acid tablets, which are vital during pregnancy to prevent anaemia.Similarly, in India at least 42 per cent of adolescent girls are undernourished with a BMI below 18.5. As a direct result, pregnancy in such a vulnerable state perpetuates the cycle of malnutrition, causing neonatal and child deaths.

The national program on adolescent health “Rashtriya Kishor Swasthya Karyakram” (RKSK), was launched in 2014. RKSK provides an impetus to the adolescent health interventions by a renewed focus on community-based health promotion and prevention combined with clinical-based preventive and curative services.Challenges of early marriage, teenage pregnancy, anaemia and high incidence of maternal mortality continues to persist. Poor implementation of the program is probably to blame here. The need of the hour is a comprehensive and convergence among various departments to address all the needs of adolescents. Robust measures and policies to end teenage marriages.
CHAPTER 2

Problems with India’s Abortion Laws and Remedial Measures

The Indian legislation dealing with abortions though novel in its intentions and purpose, suffers from some procedural and legal hindrances that make its application problematic and creates unpleasant consequences as described below-
       Price of Medicines– There are two ways of aborting a baby- through surgical tools or with the help of medicines. Medicines are utilized either orally or through the vagina for terminating an unborn foetus.  Many cases show  how due to cost and various health-related concerns, women go for oral medicines given by doctors specialised in the field. These doctors sell these birth control medicines at extremely high prices taking advantage of a woman’s ignorance and helplessness.[9]The MTP Act attempts to ensure birth control, gives wide-ranging powers to doctors, which is routinely misused by doctors to fill in their pockets. Therefore, the need of the hour is to ensure that oral or vaginal pills used for medical termination of pregnancies should be compulsorily included in the national list of essential medicines, which are to be obligatorily sold at government approved affordable prices for a woman’s convenience.
       The  PCPNDT Act – The PCPNDT Act forbids sex-selective acts that end pregnancy. This was due to the misuse of sonography and other modern technology to assess the unborn child’s gender and abortion it unnecessarily in girl child cases. Of late, law enforcement agencies have misused the PCPNDT Act to clamp down on all abortions because they believe that, by clamping down on abortions in general, they will be able to save female children who are routinely aborted at birth. Doctors, too, are wary of abortions because of the potential for litigation under the PCPNDT Act, which provides for harsh punishment for offenders.[10]PCPNDT’s “conflict” with the MTP Act sounds invented.[11]The PCPNDT outlaws all professional acts designed to assess an unborn child’s gender. If any individual / s act on such an unborn child’s gender determination and terminate the pregnancy because the gender of the child was female, such an action shall be prosecuted while the accused individual / s and the doctor and other medical professionals involved shall be disciplined. In comparison, the MTP Act permits induced abortion of unborn children, whether male or female, on grounds such as rape-induced pregnancy, the life of the mother at risk, the infant with any disability, etc. The MTP Act has its very meaning in different from the PCPNDT Act. While the formers help to aid genuine cases of abortion, the latter aims to stop sex determination and sex-selective abortion, MTP Act does not allow sex determination of the child. Thus, it is imperative for law enforcement agencies to understand the purpose behind both the laws and apply it accordingly
        POCSO and MTP acts– The MTP Act gives provisos to minors to terminate their pregnancies with the consent of their legal guardians.
This is intended to ensure anonymity and speed up the pregnancy termination process to ensure problems in health do not affect the minor. On the other hand, the POCSO Act makes it legally mandatory for doctors attending to terminate the pregnancy of minors to disclose these cases to law enforcement authorities of minors being pregnant. Unless the doctor will not mention this and the abortion procedure goes ahead, he/she will also be charged legally. As a result, minors do not choose to go to licensed doctors and visit
quacks or other providers of medical services who may perform abortion in unsafe manner. This defeats the entire intent of the MTP Act that aims to protect the identity of women undergoing induced miscarriage process. The situation in India is even more dire as about half of all brides are minors, who may not get access to best of legal services to terminate teenage pregnancy or may have to risk their life and limb by undergoing unsafe surgery. Therefore, there is a need to look into this friction between the MTP Act and the POCSO Act and get rid of it as this is putting the lives of a lot of young women at potential risk. India is a party to the Convention on the Rights of the Child (CRC), a legal instrument established in 1992 by the United Nations to look at child welfare[12]. Children should not be permitted to be a part of any sexual activity that is neither intentional nor normal, according to the CRC. It was designed to shield children from sexual predators and rackets. But, the CRC did not recommend a complete curtailment of children’s sexual autonomy. It sought to simply protect children from being sexually exploited. This was also cited by the Justice Verma Committee in their final report in 2012 on amending India’s criminal justice system to deal with rapes. They cited Article 34 of the CRC to counter POSCO provisions.Therefore, the POCSO Act needs urgent amendments in order to allow consensual sexual activity among minors with an adequate level of secrecy to terminate teenage pregnancies with the least legal resistance possible.
       Need for doctors–India lacks sufficiently licensed and qualified medical practitioners to take care of its looming demands on abortion. This has resulted in pregnant women going for unsafe abortion procedures, which causes about 4000 deaths annually. AYUSH practitioners, auxiliary nurses can be trained to advice oral and vaginal pills to pregnant ladies opting for abortions. This will help bring down the number of deaths due to unsafe abortion procedures as well as help a lot more women avail proper medical services. As suggested in the 2014 MTP amendment bill, this provision would have been no less than revolutionary. However, due to political and administrative reasons, this bill was not passed.
       The disability rights movement-MTP allows for abortion for up to 20 weeks. It is worth noting that the MTP Act was adopted in the 1970s. These days the technology has made huge strides. Deficiencies in pregnant women can not only be found late in pregnancy, but the abortion process has now become much more efficient and safer, particularly late into pregnancy. However, as the MTP Act does not take into account these technological advancements, the application of the law has been scratchy at best. For example, in a 2008 case, when a mother approached Bombay high court to abort her 20 week old foetus, whose heart condition was detected late into the pregnancy, the court while noting the obsolescence of the MTP Act as well as the courts too have not been uniform in the application of the law. This shows that both the law and its application need to be looked into with appropriate course correction. However, a major question that crops up is whether the MTP Act clashes with the disability rights movement in India? The 2008 case cited above deals with the conundrum faced by a certain Nikita Mehta. She was able to discover a heart defect in her foetus of 20 weeks, which could not have been detected beforehand. The defect was incurable. A major opposition against allowing large-scale abortions of fetuses with incurable defects is that it hampers the rights of such specially-abled children. Article 21 of the constitution allows everyone the right to life with respect and dignity. However, as cited by many parents, it is difficult in a country like India to take care of specially-abled children. India has never been considered disabled friendly. There is clear lack of fiscal and infrastructural means to take good care of the differently abled. In fact, many scientists and researchers have not been able to discern if a foetus can be considered a living organism? They have not been able to determine if and when a foetus starts developing emotional and cognitive skills like other -humans. Thus, till better state support comes up, abortion of the differently abled fetuses with incurable ailments may be allowed on a case to case basis depending on the level of disability and the parent’s ability to deal with the same.
       The laws and procees– There have been instances in the past, where the judiciary has been found wanting in its response to abortion petitions. For example, in a certain case, a lady suffering from HIV had to deliver a baby as the judiciary was not expedited enough in dealing with her petition. As a result, the 20 week period was lost and induced miscarriage posed risk to both mother and child. The legal system thus needs to put its act together. In cases of abortion petitions, the whole process of hearing should be fast-tracked keeping in mind the 20 week period to have a safe and legally permissible abortion in India. A special bench may also be constituted to fast-track such trial.
       Need for major policy change- India’s abortion laws and procedures are archaic. They aim to prevent population explosion and guarantee women’s rights but are filled with loopholes and restrictions. Abortions are not a guaranteed right but can be taken up under selective conditions like a child suffering from any physical or psychological impairment, pregnancy being a result of rape, teenagers becoming pregnant etc. This leads to a lot of undue restrictions on women, which must be done away with. The Act must become facilitating and not restricting.

CONCLUSION

Therefore, in conclusion, while India’s abortion laws are indeed meant to help emancipate its women-folk, its application and substantive elements suffer from some serious follies. There is a need to update MTP Act to bring it in consonance with modern day technology and medical methods. There is also a need to amend POCSO Act to do away with its clash with MTP Act. India’s medical and legal infrastructure too needs improvement. Therefore, the need of the hour is for government and elements of civil society to come together and improve the substantive and implementational elements of India’s abortion laws and policy.
References
Report of Ministry of Health & Family Welfare Government of India, Guidance: Ensuring Access to safe Abortion and Addressing Gender Biased Sex Selection, page 6, (February 2015), available at http://www.fogsi.org/wp-content/uploads/2015/12/mtp-guidance-handbook.pdf (Last visited on Jan19, 2020).
INDIAN INSTITUTE OF POPULATION STUDIES, Youth in India: Situation and Needs 2006–2007, available at http://iipsindia.org/pdf/India%20Report.pdf (Last visited on feb 7, 2020).
Livemint, Abortion comes at a steep price in India, November 10, 2017, available at https://www.livemint.com/Science/a5QMsT48DwglFGzgIzIQ6H/Abortion-comes-at-a-steep-price-in-India.html (Last visited on FEB 7, 2020).
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Express, What’s wrong with India’s abortion laws?, December 6, 2017, available at 
http://indianexpress.com/article/gender/whats-wrong-with-indias-abortion-laws/ (Last visited on Feb 7, 2020).
 Vandana Prasad, Contrived Confusions:  No Contradictions Between PCPNDT and MTP Acts, Vol. 50, Issue No. 10 ECONOMIC AND POLITICAL WEEKLY (March 7, 2020).
M. Solapurkar, R. Sangam. Has the MTP Act in India proved beneficial. J. Fam. Welfare. 31(3): 1985; 46–523
B. Ganatra. Abortion research in India. R. Ramasubban, S. Jejeebhoy. Women’s reproductive health in India. 2000; Rawat Publications: New Delhi, 186–225.
S. Jejeebhoy. Adolescent sexual and reproductive behaviour: A review of the evidence from India. Soc. Sci. Med. 46(10): 1994; 1275–1290. [Crossref],
Chapter 5. Sex-Selective Abortion in India: Magnitude, Causes, and Responses, Womens Human Rights and Migration (2017).
Susheela Singh et al., Abortion and Unintended Pregnancy in Six Indian States: Findings and Implications for Policies and Programs, (2018).


[1] Willard Cates, Abortions for teenagers, Abortion and Sterilization 139–154 (1981).


[2] Bela Ganatra & Siddhi Hirve, Induced Abortions Among Adolescent Women in Rural Maharashtra, India, 10 Reproductive Health Matters 76–85 (2002).

[3] Dr. Deepti Shrivastava & Dr. Priyakshi Chaudhry, Study Of Knowledge, Attitude And Practice Towards Planning Of Parenthood Amongst Rural Women Of Central India, International Journal Of Medical Science And Clinical Invention (2015).

[4] Dr. Deepti Shrivastava & Dr. Priyakshi Chaudhry, Study Of Knowledge, Attitude And Practice Tow
ards Planning Of Parenthood Amongst Rural Women Of Central India, International Journal Of Medical Science And Clinical Invention (2015).

[5] Chapter 5. Sex-Selective Abortion in India: Magnitude, Causes, and Responses, Womens Human Rights and Migration (2017).

[6] Chapter 5. Sex-Selective Abortion in India: Magnitude, Causes, and Responses, Womens Human Rights and Migration (2017).

[7] Susheela Singh et al., Abortion and Unintended Pregnancy in Six Indian States: Findings and Implications for Policies and Programs, (2018).

[8] Contextualising teenage pregnancy, Teenage pregnancy 91–108.

[9] Susheela Singh et al., Abortion and Unintended Pregnancy in Six Indian States: Findings and Implications for Policies and Programs, (2018).

[10] Contextualising teenage pregnancy, Teenage pregnancy 91–108.

[11] Dr. Deepti Shrivastava & Dr. Priyakshi Chaudhry, Study Of Knowledge, Attitude And Practice Towards Planning Of Parenthood Amongst Rural Women Of Central India, International Journal Of Medical Science And Clinical Invention (2015).

[12] Dr. Deepti Shrivastava & Dr. Priyakshi Chaudhry, Study Of Knowledge, Attitude And Practice Towards Planning Of Parenthood Amongst Rural Women Of Central India, International Journal Of Medical Science And Clinical Invention (2015).
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