Legal Pregnancy

Procedural delays to conduct MTP lessened

The Medical Termination of Pregnancy Act was first enacted in the year 1971 to legalize and regulate the conditions of termination of pregnancy. This was the first step to legalize abortions which were performed by quacks and which instilled fear in the minds of pregnant woman. The key features of the Medical Termination of Pregnancy Act, 1971 were as follows:

1. It indicated when pregnancy could be terminated i.e. unto twenty weeks of pregnancy.
2. It specified the indications when termination of pregnancy could be done.
3. It indicated that only a qualified registered medical practitioner as defined under the Act could conduct termination of pregnancy and relied upon the Indian Penal Code for punishment if conducted by any other.
4. It also indicated that termination of pregnancy could be done only in a place established, maintained or approved by the Government.

Thus it did help to legalize and regulate the termination of pregnancy and really did much for upliftment of women. Gradually, with an increasing number of centers and with new problems cropping up, the Act was amended and passed on December 18, 2002.Essential features of the amendment are as follows: -

• In the amended Act, the word "mentally ill person" covers a wider variety of mental diseases and disorders than the word.
• lunatic" of the Principal Act.
• In the amended Act, recognition of a place for the purpose of carrying out MTP is now at district level rather than the state capital and hence procedural delays should be less.
• In the Principal Act, there was dependence on IPC to enforce discipline. In the amended Act, the punishment is incorporated in the Act itself.

Social Implications Of The Act:

Govt. of India has enacted much social legislation since independence. In practice we find that these very good social legislation have remained in the books and the govt. is not able to implement these laws. Take for example the antidowry bill or the Child marriage bill or the antisati bill. Child marriages still takes place. The MTPA is the only social legislation that has found wide acceptance without any resentment. Unwanted pregnancy is a social stress in all societies. Before the MTP act, unwanted pregnancy was managed by resorting to illegal abortion, infanticide or deserting the newborn in lonely places. Now with the MTP act, the social fears are considerably reduced and the urban and the rural community have taken advantage of the Act. Patters of sexual and reproductive behaviour have changed significantly over the years. Most important change is the increase in the premarital sex in all societies. There is also an increase in the out of wedlock births. There is increasing freedom enjoyed by the teenagers in social life. This often results in increased teenage pregnancy. The tragedy is that physiologically and anatomically there is a trend towards earlier maturation while process of social development is lagging behind. Young boys and girls are exposed to knowledge and information, and values not shared by parents or older members of the family.

The impact of the MTP act should be judged in the context of changing social values and attitudes. The social implications of MTP in unmarried girls and MTP in married woman are different. MTP in married woman is not considered as a social stigma, whereas MTP in unmarried girls is not easily accepted and hence girls are taken to other distant places for MTP, and hence the girl's social future is not destroyed. This social legislation has certainly reduced incidence of suicide in these women because they can seek safe abortion under the law. The health of the woman has also shown improvement because of the MTP facilities. The acceptance of the family planning methods after MTP has also increased. It is paradoxical that though the community is taking the advantage of MTP services, they want to maintain secrecy and not let the neighbor about it.

Here negative aspects of the MTP Act have also to be considered. Though the MTP services are now available in rural areas, we are not sure of its effectiveness and safety. The high-risk cases are not recognized and MTP is performed in such cases without adequate back-up services. This results in immediate complications and long-term morbidity in term of infertility, menstrual disturbances and pelvic inflammatory disease (PID). These long-term complications may have social implications in form of broken marriages, divorce, and promiscuity. Mehlar, Director General of WHO has said, "because of serious effects of legalized abortion on the health and reproductive capacity of women, upon the stability of family and upon the morality of country specially its youth, it should be carried out only in a hospital and that to by a gynecologist."

How true are the words in context of the present situation in India? The Govt. must see that MTP is done by trained surgeons only and that to in a hospital set-up. Gynecologist must also share some blame for MTP complications. The young girls and women come to the gynecologist at any time for MTP. This is because they do not want to inform the parents or other family members about it. Some deaths on operation table have been reported because of the practice of performing quick MTP without proper checkup. It is necessary that gynecologist do not perform MTP at unearthly hours and without proper facilities to fight complications if they do arise. The Indian MTP act is most liberal in practice, it almost amount to "abortion on demand"

It is said that termination of pregnancy is performed on flimsy ground such as 'approaching examination'. 'Marriage in the family', 'going on a tour or vacations', etc. It is said that medical fraternity encourages such unnecessary terminations more often for financial reasons. It is necessary to check this trend of pregnancy termination on flimsy grounds. It is often not realized that to frequent and unnecessary pregnancy termination can result in infertility and PID. Though the MTP act was never thought to be used as a method of family planning it is unfortunately used as an alternative to regular methods of family planning by many women. It is the social responsibility of obstetricians to counsel all patients coming for MTP about the use of some contraception. It should be emphasized that contraception use is much safer than MTP. The use of emergency contraception (EC) by women should be encouraged in time of contraceptive accidents or failures. At present easily available methods for emergency contraception is oral contraceptive, and intrauterine device. The Obstetrician must remember that some woman coming for MTP may be HIV positive if they are used to multiple partners or their husbands/ partner is used to multiple sex partners. There is a risk of STD/HIV transmitted to medical and paramedical staff if precautions are not taken. It is debatable whether HIV testing should precede all MTP procedures. The Govt. of India has banned pre natal sex determination test for selective female feticide and violation of law is punishable with fine and imprisonment. The centers for pre natal test facilities have to be certified by govt. agencies. These laws are enacted to reduce selective female feticide which is a good objective, it is not clear if these laws have reduced MTP procedures for selective female feticide. These social legislations succeed only if there is will nit he part of the community and the medical people. The social purpose of these laws will not be served unless the medical people and the community co-operate in its implementation.