Report & Recommendations
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Advances in Methods of Emergency Contraception
Experience With Liberalised Abortion Services
– Dr V K Manchanda Commissioner, Maternal Health, MOHFW, GOI

Government of India set up the Shantilal Shah Committee in 1964 to decrease the highmaternal morbidity and mortality associated with illegalabortions, which, after deliberating on a wide range of evidence over 2 years, recommended a broadening and rationalisation of laws related to abortion in 1966.

MTP Bill was introduced in Rajya Sabha in 1969, referred to Select Joint Committee Review and finally passed as the MTP Act in 1971 and implemented in April 1972. Main objective of MTP Act of India is reduction maternal morbidity due to illegal unsafe abortions.

According to Section 3, Subsection (2) of the MTP Act, pregnancy may be terminated for the following indications:

    a) As a health measure, when there is a danger to the life or risk to physical or mental health of thewoman including rape and failure of contraception.
    b) On humanitarian grounds, such as when pregnancy arises from a sex crime like rape or intercourse with a lunatic woman, etc and
    c) Eugenic grounds when there is a substantial risk that the child, if born, would suffer from deformities and diseases.

According to Section 3, Subsection (2), for pregnancies up to 12 weeks. the certification of one qualified doctor is sufficient but for pregnancies between 12-20 weeks, two doctors must give their approval. Termination by medical methods of abortion is approved by GOI till 49 days of gestation.

The necessary qualification of a medical practitioner registered with the State are broadly defined in Section 2, Clause (d) of the MTP rules:

    a) Postgraduate degree or diploma in Obstetrics and Gynaecology.
    b) Registered before commencement of the Act with over 3 years experience in the practice of Obstetrics and Gynaecology.

    Figure 1.4.1
    Trend in Raported MTPs

    c) Registered after commencement of the Act if:

    • 6 months of housemanship in Obstetrics and Gynaecology.
    • Experience in any hospital of over one year in this field or a place where pregnancy can be terminated
    • Assisted in performing 25 MTPs in a Government hospital or a recognised training institute.

Only registered practitioners of modern system are permitted to perform MTPs under the act. Place where pregnancy can be terminated include:

    a) A hospital established or maintained by the Government.
    b) A place for the time being approved for the purpose of this Act by the Government.

Annual number of reported MTPs was 6,49,388 and MTP centres were 9645 in the year 2000. Reported number of MTPs and MTP centres has remained stagnant during the last few years.

Reliable countrywide data on unsafe abortions are not available. Estimated safe and unsafe abortions ICMR Study, 1989) are 6.1 and 13.5 per 1000 pregnancies. Unsafe abortions according to ICMR 1989) and FOGSI (2001) are about 4 and 6.7 million respectively.

Reasons cited for unsafe (illegal) abortions in India are inadequate access (shortage of MTP clinics due to delay in recognition of private clinics and lack of trained manpower /equipment in Government health facilities), lack of privacy and confidentiality, lack of information or knowledge about availability of services and dangers of unsafe abortions, cost of services, social values and prejudices and women’s role in decision-making.

The Reproductive and Child Health (RCH)
Programme has been started in India to improve abortion services. Some of the related objectives of RCH programme are :

    a) Increasing the availability of Safe MTP services
    b) Equipping newer Primary Health Centres and private clinics
    c) Providing hands-on training to doctors in public and private sector
    d) Hiring specialists and trained doctors to perform MTPs in equipped facilities
    e) Provide IEC and counseling services

    Some of the MTP Act amendments which are in pipeline are:

    1) Change in definition of lunacy.
    2) Delegation of powers to approve private clinics to District Committee headed by CMO.
    3) Increase in punishment for violation of Act to untrained providers, trained providers at unauthorized place and to owners of unauthorized clinics.

National Population Policy 2000 recognizes that, even though abortion is legal, there are barriers limiting women’s access to safe abortion services. It provides for:

    a) Educational campaign targeting women, families and adolescents
    b) Making abortion services accessible by increasing availability, enhancing affordability, ensuring confidentiality and providing compassionate abortion care
    c) Adoption of ‘the state of the art’ technologies that are safe and easy e.g MVA (Manual Vacuum Aspiration), not necessarily dependent on anaesthesia and non-surgical techniques

Simple and safe methods have been introduced e.g MVA and Medical methods. MVA can be used for termination of early pregnancy up to 8 weeks. A pilot project is under implementation in 8 States.

MTP Act is recognised as one of the progressive social legislations. Focus till now has been mainly on implementation of the MTP Act. While this is to continue, thrust is now on provision of Safe Abortion Services for preventing maternal deaths.

"In circumstances where abortion is not against the law, health systems should train and equip health service-providers and should take other measures to ensure that such an abortion is safe and accessible. Additional measures should be taken to safeguard women’s health". Agreement signed by Government of World at United Nations General Assembly Special Session, June, 1999).

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Introduction | Overview of the Consortium
Current Status of Medical Abortion | Consensus Issues & Recommendations
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