India weighs update to 1970s abortion law

http://www.bbc.co.uk/news/world-south-asia-33880392

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Last month, the plight of a 14-year-old rape survivor seeking to terminate her pregnancy renewed the debate surrounding India's abortion laws.

The girl, whose case was being considered by the Supreme Court, was 24 weeks pregnant.

Current laws allow abortion only at up to 20 weeks of pregnancy.

The 44-year-old law allows abortion for women not as a right but only if doctors are of the opinion, taken in "good faith", continuing the pregnancy involves substantial risks for the physical and mental health of the mother or of foetal abnormalities developing.

Two qualified doctors must agree for an abortion at between 12 and 20 weeks of pregnancy.

And a woman can have an abortion after 20 weeks only if her life is at immediate risk.

The issue came to the fore in 2008, when a Mumbai couple, Niketa and Haresh Mehta, asked the Bombay High Court to allow them to abort their 26-week-old foetus, which had been diagnosed with a heart defect.

It rejected the plea, and Mrs Mehta suffered a miscarriage a few weeks later.

The Mehtas' doctor, Nikhil Datar, then filed a petition in the Supreme Court, seeking reconsideration of the 20-weeks limit.

This petition was joined by two other women whose foetuses had been discovered to have abnormalities.

Countries such as the UK and Spain allow abortion after 20 weeks, if certain criteria are met.

"Many women come for ultrasound check-ups for anomalies late, which is common in our society that has a large rural or poor population," says Dr Datar, a practicing gynaecologist and obstetrician in Mumbai.

"In many cases foetal abnormalities can only be detected or confirmed after 20 weeks, after which doors of legal abortion are closed to the woman."

Following these petitions, in 2014, India's Ministry of Health and Family Welfare prepared a draft amendment to the law, which provided for abortion at up to 24 weeks.

Significantly, it also allowed a woman to seek and undergo abortion "on request" in the first 12 weeks of pregnancy.

'Too scared'

As researcher Shweta Krishnan wrote, the draft bill recognised a woman's right to self-determination and autonomy and represented a shift in the focus of the law from the healthcare provider to the woman undergoing abortion.

In another change, the earlier act allowed for abortion, at up to 20 weeks, in case of failure of contraception on the part of the "married woman or husband" for the purpose of "limiting" the family - but the draft bill omitted the word "married", recognising the reality of pregnancy outside marriage among young women or widows.

It also mandated maintaining the patient's confidentiality.

"Women may take time for various reasons," said Vinoj Manning, executive director, Ipas India, a non-profit organisation that advocates for women's rights in this area.

"Some are raped at home and are too scared to talk about it.

"If the amendment takes place, the vulnerable women, including survivors of rape, can benefit, and not go through the trauma of going to courts.

Many women in such situations would rather have an illegal abortion after 20 weeks, entailing a serious risk to their life, than have the child.

The provision in the draft bill that caused a stir in the medical community was that it allowed practitioners of alternative medicine, as well as nurses or midwives, to conduct abortions.

The Indian Medical Association opposed this provision, arguing such practitioners would not be able to handle emergencies or complications that might arise during abortion procedures.

Sex-selective abortions

The World Health Organization has said involving health workers can help reduce the number of deaths arising out of unsafe abortions, which it estimates account for 9% of all maternal deaths in India.

"Like allopathic [mainstream] doctors undergo training and certification for abortion, similarly non-allopaths and nurses and midwives can undergo training and certification to conduct first-trimester [at up to 12 weeks] abortions," said Ravi Duggal, author of the Abortion Assessment Project.

Other opposition to the draft bill comes from activists against sex-selective abortions.

The 2011 census showed the child sex ratio had dropped to 914 girls to 1,000 boys from 927 girls to 1,000 boys in 2001.

Activists believe there would be significantly more sex-selective abortions if the amendment comes into force.

Dr Neelam Singh, who runs Vatsalya, a non-profit group based in Lucknow, suggests in pregnancies over 20 weeks, a district or state-level committee or board of experts should decide on abortion based on the merits of each case.

But other doctors say such committees would only increase bureaucracy and trauma for the vulnerable woman.

In the case of the 14-year-old rape survivor, the Supreme Court issued a "flexible" order, deciding if a team of doctors and psychologists were of the view an abortion would save "her life", including her mental wellbeing, the procedure could go ahead.

The 2014 amendment may help strike the balance between safe abortion and acknowledging the vulnerability of a pregnant woman.

Menaka Rao is a Mumbai-based freelance journalist.