Abortion rights for all women: With 70% shortfall of gynos, can health sector deliver safe service?

The Supreme Court’s landmark judgment making unmarried women also entitled to seek abortion in 20-24 weeks is expected to bring transition in gynecological services in the healthcare industry. Calling the distinction between married and unmarried women “unconstitutional”, the apex court has ruled that all women are entitled to safe and legal abortion under the Medical Termination of Pregnancy (MTP) Act 1971.

After this judgement, gynecologists foresee an increase in the number of cases of abortion which in turn will lead to an increased business. “With this new verdict, we do see an increase in the number of abortions. It is essential that abortion be covered under insurance. This new law will also give impetus to creating abortion centres and upgradation in healthcare infrastructure for abortions. Abortions have serious implications hence building proper infrastructure is the need of the hour,” said Dr Archana Dhawan Bajaj, Gynaecologist, Obstetrician & IVF specialist, Medical Director, Nurture Clinic.
 
Industry experts call for a boost in the healthcare infrastructure and as well as manpower. According to the Rural Health Statistics (2019-20) released by the Ministry of Health in May 2021, there is a shortfall of almost 70 percent for obstetricians and gynecologists.
 
"This (shortfall) severely limits women’s access to safe abortion services. A majority of the abortions are performed in the private sector resulting in high costs making the service inaccessible for marginalized communities,” said Poonam Muttreja, Executive Director, Population Foundation of India, a national non-profit organisation (NGO) working on gender issues. “Besides making the law more rights-based, we also need to improve the capacity of service providers, and provide a better quality of care, so that abortion is accessible for the most disadvantaged groups of women,” Muttreja said. 
 
Muttreja called for addressing the fact that regardless of its legal status, abortion facilities are inaccessible to a large chunk of our population. After last year’s amendment, the termination of pregnancy can be performed only by doctors with a gynecology or obstetrics specialization, she said.

Doctors claim that the move will also positively impact the economy at large. “The move will save women’s lives and will prevent loss of working days both adding to the economy. Morbidity related to complications caused by illegal abortions done by quacks lead to heavy medical costs either by the person or insurance company,” said Dr. Rahul Manchanda, Senior Consultant and Head Gynaecology Endoscopy Division, PSRI Hospital.
 
The SC held that the artificial distinction between married and unmarried women cannot be sustained and that women must have the autonomy to have free exercise of these rights. Women rights activists have welcomed the move calling it progressive. While abortions have been legal since the Medical Termination of Pregnancy Act, of 1971 was enacted, women were not given the absolute right to abort. 
 
“The decision to go forward with abortion was up to the doctors, women had little agency in the matter. While the MTP Amendment Act, 2021 allowed unmarried women to get abortions and extended the gestational limit in limited circumstances (abortion due to contraceptive failure), it still falls short of being rights-based legislation. We have been unable to prevent unsafe abortions and uphold the rights of those who need abortions. We hope that this judgment could be a step towards making our abortion regime more liberal and pro-women,” said Muttreja.
 
 Anubha Rastogi, an independent lawyer, said that this ruling interprets the provisions of the MTP Act - which otherwise exclude women on grounds of their marital status from accessing MTP from 20-24 weeks -  in a progressive manner and questions the unreasonable classification made by this law. “This interpretation is the law of the land and will ensure that single women seeking MTP beyond 20 weeks cannot be refused on grounds of the narrowness of the law,” said Rastogi.