The landscape of abortion rights in India is a complex and evolving one. While a landmark amendment to the Medical Termination of Pregnancy Act in 2021 extended the legal limit for abortion from 20 to 24 weeks, it fell short of establishing abortion on demand as an absolute right. This progress is further complicated by the inconsistent application of these laws across different courts.

However, despite this amendment, the interpretation and application of abortion laws by different courts have resulted in a patchwork of conflicting judgments. This inconsistency leaves women facing a confusing and potentially unfair legal landscape, with their access to safe abortion hinging on their geographical location and the specific judge presiding over their case. The lack of uniformity in legal interpretation poses a significant challenge. It creates uncertainty for women seeking abortions and can disproportionately impact marginalized groups who may have limited access to legal resources or face additional societal pressures.

Conflicting Judgments and Discretionary Powers

In April 2024, the Supreme Court allowed the plea of a 14-year-old minor rape survivor to terminate her pregnancy at 28 weeks[1]. The bench comprising CJI DY Chandrachud and Justice JB Pardiwala overturned the Bombay High Court’s decision, citing fewer risks to the minor’s life with the termination than continuing the pregnancy until full term.

The Judgement may be read here:

In February of 2024, the Supreme Court refused a 32-week pregnant widow’s plea for abortion, despite her severe mental trauma and depression[2]. The court’s decision was based on the medical board’s opinion against the termination, citing no abnormalities in the foetus. The bench, led by Justice Bela M. Trivedi, suggested that the woman could consider putting the baby up for adoption after birth.

The bench stated, “There is no abnormality in the foetus. It is a full-fledged, normal-bodied child. This is not the case we should entertain.” The court emphasized the short duration remaining until the natural birth and mentioned that even the government was willing to facilitate the adoption of the child. According to the medical board, inducing a pre-term delivery could pose significant risks to the woman’s life.

The 26-year-old petitioner argued that the pregnancy was causing her severe mental trauma and depression. Her advocate, Rahul Sharma, highlighted that as a widow, continuing the pregnancy was against her choice and would exacerbate her emotional distress. However, the Supreme Court maintained that it had to consider the well-being of both the woman and the unborn child.

Previously, the Delhi High Court had allowed the abortion but later reversed its decision following medical opinions affirming the foetus’s health. The woman then challenged this reversal, but the Supreme Court upheld the High Court’s final decision. The January 23 order from the Delhi High Court indicated that the absence of foetal abnormalities did not justify the termination of the pregnancy.

Under the Medical Termination of Pregnancy (MTP) Rules in India, a woman is permitted to terminate her pregnancy up to 24 weeks under specific conditions. The Supreme Court’s refusal in this case underscores the legal and ethical complexities involved when considering late-term abortions, especially when the foetus is deemed healthy and viable.

The order may be read here:

The Bombay High Court in June 2024 made a controversial decision regarding a 15-year-old rape victim’s plea to terminate her 28-week pregnancy[3]. Despite the rape, the court denied her request to terminate her 28-week pregnancy due to the high chance of the baby surviving and potential health risks from a late-stage abortion. While acknowledging the trauma of the assault, the court also questioned the nature of the relationship due to the victim being with the man for a while. Ultimately, prioritizing the potential child’s well-being, they ordered the victim to continue the pregnancy in a shelter home, deliver the baby, and receive counselling. This case highlights the difficult legal and ethical dilemmas surrounding pregnancy from sexual assault, especially when the foetus is nearing viability.

In a heart-wrenching case, the Rajasthan High Court in January 2024 rejected a plea from an 11-year-old rape victim seeking medical termination of her advanced pregnancy^[4]. The court’s decision rested on two main points. Firstly, they recognized the foetus’s right to life, considering its developed state at over 31 weeks. Secondly, medical experts advised that an abortion at this stage would be dangerous for both the young girl and the foetus due to her underweight condition and abnormal liver function tests.

The court acknowledged the girl’s difficult situation, with no immediate family to care for her or the baby. They offered her the option to keep the child or pursue adoption through legal channels. Finally, the court referenced similar cases and a recent Supreme Court decision that upheld the rights of a viable foetus, even in situations involving a married woman.

This case presents a complex legal and ethical dilemma. While the court prioritizes the foetus’s right to life, the decision forces an 11-year-old victim to carry a pregnancy resulting from a horrific crime. The court’s efforts to ensure her well-being offer some solace, but the physical and emotional toll on such a young girl remain a stark reality.

The order may be read here:

The Supreme Court of India overturned a Gujarat High Court decision in August 2023 denying a 25-year-old rape victim’s plea for abortion[5]. This landmark case highlights the legal and emotional complexities surrounding pregnancy resulting from sexual assault.

The victim, an Adivasi woman from a remote village, was allegedly raped under false pretences of marriage. At 26 weeks pregnant, she sought permission to terminate the pregnancy through the Gujarat High Court. Despite a medical board’s approval, her plea was dismissed. The Supreme Court, however, took a strong stance. Justices Nagarathna and Bhuyan emphasized the trauma caused by such pregnancies and the burden placed on rape survivors forced to carry them. They argued that continuing the pregnancy would perpetuate the trauma. The Court’s order emphasized the societal pressures surrounding pregnancy outside marriage, especially after rape. It acknowledged that such pregnancies are involuntary and cause immense physical and mental stress. This landmark case reaffirms a woman’s right to bodily autonomy and freedom from forced pregnancy, especially in cases of rape. It also sheds light on the ongoing struggle to balance the rights of the woman and the foetus in such situations.

The order may be read here:

In May 2024, a 20-year-old woman preparing for her NEET exams was denied permission by the Delhi High Court to terminate her 27-week pregnancy^[6]. Citing the foetus’ healthy condition and lack of medical complications, the court ruled against termination as it wouldn’t be legal or ethical. While acknowledging the potential challenges for the unmarried woman, the court prioritized the well-being of both the viable foetus and the mother’s future health. The court offered alternative solutions, suggesting delivery at a reputable hospital and facilitating adoption if the woman chooses not to raise the child.

The judgement may be read here:

The Legal Ambiguity and dilemma

Recent court decisions in India regarding abortion paint a picture of a legal landscape riddled with ambiguity and inconsistency. This lack of clarity creates a labyrinthine experience for women seeking safe and legal terminations, with their access hinging on factors as unpredictable as the judge presiding over their case and the specific state they reside in.

At the heart of the discrepancies lies the struggle to balance the rights of the woman with the potential life of the foetus. In some cases, courts prioritize foetal viability even in harrowing circumstances. The Bombay High Court’s denial of a 15-year-old rape victim’s abortion request, citing the baby’s potential survival, exemplifies this. Here, the court seemingly overlooks the trauma of the assault, prioritizing the foetus over the girl’s physical and emotional well-being. Conversely, the Supreme Court’s landmark decision allowing a 14-year-old rape survivor to terminate her late-term pregnancy shows a more nuanced approach, recognizing the potential harm to the minor in continuing the pregnancy.

The Medical Termination of Pregnancy (MTP) Act of 1971, while a step towards legal abortions, fails to provide a clear roadmap for navigating these complex situations. The Act’s ambiguity surrounding factors like foetal abnormalities, mental health risks, and the gestational limit (24 weeks) leaves room for wide-ranging interpretations. This discretion granted to judges, influenced by personal beliefs and societal values, results in a cacophony of conflicting decisions.

These conflicting judgments underscore the urgent need for legal reforms. A rights-based approach that prioritizes a woman’s bodily autonomy and right to informed reproductive choices is paramount. The MTP Act requires revisions to provide clear and comprehensive guidelines on applying the law. This ensures consistent interpretation across all jurisdictions, eliminating the geographical lottery that currently determines a woman’s access to safe abortion services. Legislative reforms must also address the emotional and mental health aspects of pregnancy, ensuring women facing difficult circumstances like rape or severe mental health issues have clear legal recourse.

Until these reforms materialize, the legal landscape surrounding abortion rights in India will remain a labyrinth. Vulnerable women, especially those in marginalized communities or facing extraordinary circumstances, will continue to be at the mercy of a system fraught with contradictions and societal pressures. The path to safe and legal abortion services in India should not be a gamble – it should be a right, consistently upheld and protected by the law.

Contrasting Approaches to Abortion Rights: India and France

India’s approach to abortion rights presents a mixed picture. The Medical Termination of Pregnancy (MTP) Act, 1971, with its 2021 amendments, offers a legal pathway for abortion access. However, this framework is riddled with ambiguities. The Act lacks clear definitions for crucial aspects like foetal abnormalities and mental health risks, leading to inconsistent court decisions and hindering access for women. Procedural hurdles, provider shortages, and societal stigma surrounding abortion further limit access, especially in rural areas. This forces some women towards unsafe procedures, endangering their health.

In stark contrast stands France. On International Women’s Day 2024, President Emmanuel Macron signed an amendment that enshrines abortion rights in the French Constitution. French legislators approved the constitutional amendment on Monday in a 780-72 vote that was backed by many far-right lawmakers[7].

By enshrining abortion rights in its constitution, France guarantees a high level of legal certainty and stability for women’s reproductive choices. This constitutional right offers significantly stronger protection compared to India’s legislation, making it harder to restrict access in the future. Additionally, France boasts a comprehensive healthcare system ensuring widespread access to abortion services.

While India has made strides with the MTP Act, legislative reforms are crucial to address ambiguities, ensure uniform implementation, and guarantee equitable access for all women. Public discourse also needs to evolve to overcome societal stigma. France’s constitutional approach offers a model for guaranteeing abortion rights, but India’s journey requires continuous efforts to bridge the gap between legal framework and social acceptance.

In essence, France stands as a leader in guaranteeing abortion rights, while India’s journey towards ensuring safe and accessible abortion services for all women continues.

Conclusion: A Path Forward for India’s Abortion Rights

India’s journey towards guaranteeing safe and accessible abortion services for all women remains a work in progress. The current legal landscape is a complex maze of ambiguities and inconsistencies, leaving women’s access to safe abortion services heavily dependent on factors beyond their control.

The recent court decisions highlight the crucial need for legislative reforms. The Medical Termination of Pregnancy Act requires revisions to establish clear guidelines for crucial aspects like foetal abnormalities, mental health considerations, and the gestational limit. This will ensure consistent interpretation and application across the country, eliminating the geographical lottery that currently determines women’s access to safe abortion.

Legislative reforms must also address the emotional and mental health aspects of abortion, ensuring women facing difficult circumstances have clear legal recourse. Striking a balance between a woman’s bodily autonomy and the potential life of the foetus is a complex but necessary task.

France’s recent move to enshrine abortion rights in its constitution offers a powerful model. Such a step would significantly strengthen the legal protection for abortion access in India and make it harder to restrict these rights in the future.

Beyond legal reforms, evolving public discourse is critical. Addressing societal stigma surrounding abortion is essential to ensure safe and legal services are readily available and utilized without fear or judgment.

The path to safe and legal abortion in India should not be a gamble. It should be a guaranteed right, consistently upheld and protected by the law. By prioritizing a rights-based approach that empowers women and prioritizes their reproductive choices, India can move towards a future where all women have equal access to the healthcare they deserve.

[1] https://www.livelaw.in/top-stories/supreme-court-allows-termination-of-28-week-pregnancy-of-14-year-old-rape-survivor-255723

[2] https://thewire.in/law/supreme-court-refuses-to-allow-widowed-woman-to-terminate-32-week-pregnancy

[3] https://www.livelaw.in/high-court/bombay-high-court/bombay-high-court-denies-teenage-rape-victim-abortion-request-231351

[4] https://www.livelaw.in/high-court/rajasthan-high-court/rajasthan-high-court-denies-advanced-pregnancy-termination-minor-rape-victim-foetus-right-to-life-article-21-constitution-247558

[5] https://cjp.org.in/sc-allows-rape-survivor-to-abort-her-foetus-affirms-that-state-should-not-interfere-in-decisions-of-reproduction/#:~:text=On%20August%2021%2C%20the%20Supreme,by%20the%20Gujarat%20High%20Court.

[6] https://www.livelaw.in/high-court/delhi-high-court/delhi-high-court-deny-unmarried-woman-terminate-27-weeks-pregnancy-257345

[7] https://www.senat.fr/leg/tas23-073.html

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Understanding evolution of Indian abortion law

The post Rights-based approach to abortion: The need for legislative reforms appeared first on SabrangIndia.

Abortion laws and the increasing concern for ideas like bodily autonomy, reproductive rights, termination ofpregnancy, reproductive healthcareetc. influenced me to study the subject and write a historical account on abortion laws. This article attempts to explain abortion laws in context of their overview which includes origin, development and current status. Thereafter, it discusses the Medical Termination of Pregnancy Act, 1971 and its subsequent 2021 amendment; a very specific aspect with respect to the Indian legal system. Finally, it enunciates a recent landmark decision of the Supreme Court of India in X vs Principal Health Secretary, NCT of Delhi and comparatively analyses it with Dobbs vs Jackson Women’s Health Organization, a diametrically opposite verdict of the SCOTUS.

An Overview of Abortion laws

The word ‘abortion’ literally means a procedure to end pregnancy or the expulsion of the foetus from the uterus before it has reached the stage of viability (gestational limit) in medical terminology. It forms a part of an umbrella of reproductive rights. Reproductive rights are the privileges and liberties enjoyed by individuals regarding their reproduction and reproductive health. According to WHO, ‘Reproductive rights rest on the recognition of the basic right of all couples and individuals to decide freely and responsibly the number of spacing, timing, information and means to copulate and the right to attain highest standards of reproductive health devoid of discrimination, coercion and violence.’ Some other types of reproductive rights include consensual sterilisation, reproductive healthcare and even access to awareness and education about the same.

Abortion and law in convolution didn’t emerge before the second half of the 20^th century. One of the first instances of the amalgamation of abortion as a basic human right and the State-sponsored legalisation of the same was witnessed when the erstwhile Soviet Union significantly allowed the access to legal abortion way back in 1955. Before that, in the Nuremberg trials of 1948 post World War II, more specifically in United States vs Greifelt and Others, the surrendered and defeated Nazi regime was held guilty of its war crimes by a Military Tribunal and one of them was the coercion of semitic Jew women to terminate their pregnancies. This decision resonates with the popular modern understanding of human rights that indicates that the woman herself is capable of deciding the future of her pregnancy or ‘bodily autonomy’ as it has been consolidated globally. Until now i.e., 2022, 66 nation-States who are UN members have legalised abortion. More importantly, Article 6 of the International Covenant on Civil and Political Rights which has been ratified by most countries accords the right to safe and sound legal abortion in tandem with the right to life. As far as the United States is concerned, its Supreme Court in a liberal 1973 judgement Roe v Wade set a benchmark by constitutionally guaranteeing the right to safe and sound legal abortion. This was recently overturned.

Medical Termination of Pregnancy Act, 1971

In India, the origin of abortion laws can be found in the Medical Termination of Pregnancy Act, 1971 passed by both the houses of Indian Parliament during the tenure of prime minister, Indira Gandhi. It was the first legislation as far as India’s parliamentary history is concerned to ever create a framework that recognised the right to legal abortion publicly and normatively directed the executive to enforce it in hospitals. Though it was a developmental and remedial torchbearer, the Act was not comprehensive and exhaustive enough and lacked the ‘equal protection under law’ factor. Of course, one can defend it by considering the era it regulated and the social structure it catered to.

The Act defined its main purpose to provide termination of pregnancies by Registered Medical Practicians (RMPs). The gestational limit was 12 weeks that required one RMP opinion and 12-20 weeks that required two RMP opinions. Abortion in 12-20 weeks was only accessible if foetal abnormality was such that the chances of the foetus living were negligible. As those were the Article 370 operational times, the Act did not extend to the jurisdiction of Jammu and Kashmir. The Act technically had a very narrow and restrictive purview due to three aspects. The first one being that the abortion facility was limited only to government hospitals managed and run by the State and had no clause to regulate certified and licensed private hospitals in providing legal abortion. Also, the gestational limit to avail a blanket abortion for all women was very low i.e.,12 weeks. And more importantly, the provisions of the Act facilitated legal abortion to only married women which essentially discriminated against unmarried women with only pregnancies caused because of rape being an exception. Also, it was silent on the right to abortion of women below the age of 18 years and their basic reproductive rights and personal liberty pertaining to their pregnancy.

These prevalent anomalies in the legislation resultantly led to the 2021 Amendment Act that altered several provisions of the 1971 Act to widen the ambit of abortion.

Medical Termination of Pregnancy (Amendment) Act, 2021 

This concerned legislation is an amendment to the 1971 MTP Act that is currently functional and governs the termination of pregnancies. Certain changes incorporated in this particular Act are as follows:

The gestational limit necessitating one RMP opinion was increased to 20 weeks and that of two RMP opinions to 24 weeks. It was made inclusive to unmarried women by the usage of words ‘any woman and her partner’. Thirdly, private hospitals were authorised to provide medical termination of pregnancy by mandating them to renew empanelment every five years to maintain the credibility and reliability of the hospitals.

Lastly, abortion in the time period 20-24 weeks was synthesized to include various provisions which formed the Rule 3B of the MTP. Rule 3B of the MTPA allows termination of pregnancy in peculiar cases when there has been a change in the ‘marital status’ of the woman or she has been a survivor of rape or sexual assault and she has suffered any grave or serious mental trauma. Albeit these provisions, there are several demerits of the rule which will be discussed in detail in the commentary on Supreme Court’s landmark judgement X vs NCT.

X vs Principal Health Secretary, NCT of Delhi

A  three-judge judge bench comprising Justices D.Y Chandrachud, A.S Boppana and J.B Pardiwala pronounced a significant judgement on abortion laws in India pertaining to the umbrella legislation of Medical Termination of Pregnancy(Amendment) Act, 2021.Facts- X (anonymity maintained due to right to privacy) an unmarried woman was denied abortion of her pregnancy (20-24 weeks) by Regular Medical Practitioners (RMPs) under Rule 3B of the MTP Act. A petition was filed in the Delhi HC directing the doctors to terminate her pregnancy. The High Court however rejected the petition by adhering strictly to the legislation that Rule 3B of the MTP Act does not provide abortion for unmarried women.

The judgement fundamentally emphasised three aspects while broadening the scope of Rule 3B and legally substantiating the Delhi HC order.

• The eligibility criteria for abortion under the clause ‘change of marital status’ was made inclusive to unmarried and single women recognising her right to individual liberty, bodily autonomy and safe and sound legal abortion under Article 21 of the Constitution. Justice Chandrachud wrote in the judgement that it would be fallacious in not correcting the stereotype that only married women engage in sexual intercourse.
• Exceeding the purview of the factual matrix and expanding judicial thought,thejudgement also shed light on the exception clause of Section 375 of the IPC. It reiterated that rape under Rule 3B includes marital rape for the purposes of MTP Act. ‘We need to understand the lived realities of many women who suffer from sexual violence perpetrated by their husbands’ quotes the judgement. Survivors of rape and sexual assault were already entitled to abortion under the 20-24 weeks category. But the regulations were silent on its marital aspect. This particular judgement consolidates it. So, the child conceived out of forced sexual intercourse within a marriage is eligible for abortion under the Act.

This is the first time after Justice Rajeev Shakder’s path-breaking verdict in the Delhi High Court case challenging the validity of the Section 375 exception was upheld. Justice Shakder’s verdict held the exception to be unconstitutional under Article 14 (equality before law) and 21 (right to life and personal liberty and now the Supreme Court has upheld that judicial opinion. Though it was central to MTP, this could pave the way to its criminalization when the actual hearings in the appeal against the Delhi HC’s split verdict actually begin in February 2023.

Thirdly, it negated every possibility of discrimination among women in seeking sound legal abortion. The verdict essentially opens access to legal abortion for all women irrespective of their marital status, age and consent factor. It also extended the interpretation of ‘grave injury to mental health’ to not only psychological illness but also any unwanted pregnancy. The judgement called into veracity the impugned practice of RMPs in asking for consent of a woman’s family and in-laws. It held that adhering to the core constitutional principles, the woman is herself an ‘ultimate decision maker’ as far as the termination of her pregnancy is concerned. Justice Chandrachud authoring the unanimous opinion also highlights a nuanced legal reasoning as to why the Indian State should value X vs NCT as a judgement. The court very constructively argues that India is obligated to offer comprehensive abortion as the Protection of Human Rights Act, 1993 recognises and hence technically ratifies all the United Nations’ human rights conventions which include the International Covenant on Civil and Political Rights (ICCPR) whose Article 6 acknowledges right to legal abortion as a part of right to life; coincidently the essence of Article 21 of the Constitution.

Dobbs viz a viz X: A Comparative Analysis 

The final part of this article intends to comparatively analyse contemporary judicial opinions in the United States and India as far as abortion laws are concerned and contextually indicate the contradictory legal template by comparing two landmark judgements of the the two apex courts.

Before examining these in detail, one has to understand that the inherent difference between the US and India’s abortion law is that it’s a constitutional right in the former and a legislative right in the latter.

Hence, Dobbs v Jackson Women Health Organization, a draconian 5:4 majority of the SCOTUS overturned Roe v Wade; a 1973 judgement that had conceded abortion as a constitutional right i.e., safeguarded by the Grundnorm (law of the land). As Roe and Planned Parenthood v Casey (1991); another Supreme Court judgement that had fortified Roe’s structure, had constitutional connotations the decision in Dobbs invaded the constitutional right to abortion and its declaration as illegal abrogated the ‘due process clause’ that encompasses 5^th and 14^thAmendments to the US Constitution. Dobbs was predicated on an irrational and frivolous Republican premise that the ‘foetus has life’ with disregard for the individual liberty of the woman and was the direct result of appointing conservative judges by conservative politicians.

Coming back to India, X vs NCT did not contain any element of constitutionalism or fundamental rights because abortion in India was recognized through a legislative enactment by the Indian Parliament and the concerned judgement was pertaining to the MTP Amendment Act, 2021.

Though the unanimous judgement broadens the ambit of Rule 3B considering the three aspects mentioned earlier, it has been partly criticised for ignoring the unnecessary directive of seeking a RMP opinion which negates the bodily autonomy factor and for failing to promulgate right to abortion as a fundamental right under Article 21 as it did with respect to right to privacy in K.S Puttaswamy vs Union of India in 2018 which is well within Supreme Court’s constitutional powers. Though I find the former argument a bit too impractical due to medical and scientific reasons, the latter is something that would have truly redefined abortion law in India and considerably changed the justice delivery mechanism for the aggrieved ones.

The current legal template for abortion laws in India is undoubtedly progressive and landmark. And post the X vs NCT judgement delivered by the apex court, it holds a mandatory value insofar being binding on High Courts and the lower judiciary. But for abortion to be accessible and absolute up to 24 weeks without the interference of the judiciary at every step, an amended legislation of the MTP Act that answers these questions posed by the Supreme Court in a comprehensive manner is necessary to make it a reality.

Image Courtesy: Reuters/Mario Anzuoni

The author is a law student pursuing a 5-year B.A LL.B course at ILS Law College Pune with a special interest in constitutional law, criminal law and human rights
 

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The post Understanding evolution of Indian abortion law appeared first on SabrangIndia.

A Division bench of Madhya Pradesh High Court (Gwalior bench) has set aside an order by a single-judge bench denying permission for aborting a fetus after the woman alleged rape.

An intra court appeal was filed against the August 10 order passed by a single-judge bench refusing permission to abort a fetus more than 12 weeks old, but less than 20 weeks old. The division bench of Justices Sheel Nagu and Deepak Kumar Agarwal allowed the termination of the pregnancy and clarified that allegation of rape is sufficient to invoke section 3 of the Medical Termination of Pregnancy (MTP) Act.

Background

In an order passed on August 10, bench of Justice GS Ahluwalia refused to grant permission for abortion of a fetus more than 12 weeks old, observing that the prosecutrix who alleged rape based on a false promise of marriage, knew fully well the pros and cons of her consensual sex with the accused.

The case was that the prosecutrix was in a relationship with the accused for 4-5 years, and he had promised to marry her on the pretext of which they had physical relationship as well. As the prosecutrix was in love with the accused she relied on his promise and they were having consensual sex. When she got pregnant, and the accused was asked to marry her, he refused. The prosecutrix thus came before the court that on the pretext of marriage the accused was having sex with her, and she should be permitted to terminate her pregnancy.

As per section 3 of the Medical Termination of Pregnancy Act, permission for termination of pregnancy  can be given where the pregnancy does not exceed 12 weeks, or does not exceed 20 weeks, and two registered Medical Practitioners are of the opinion that the continuance of the pregnancy would involve a risk to life of a pregnant woman or a grave injury to her physical or mental health or there is a substantial risk that if the child was born, it would suffer from such physical or mental abnormalities as to be seriously handicapped. The explanation 1 to this provision states that – Where any, pregnancy is alleged by the pregnant woman to have been caused by rape, the anguish caused by such pregnancy shall be presumed to constitute a grave injury to the mental health of the pregnant woman.

The prosecutrix was carrying a fetus of more than 12 weeks and was to be governed by the above-mentioned provision and adjoining explanation. The question the was considered by the court was that whether the sex was consensual or was the consent obtained by misrepresentation of facts.

“The petitioner is a major girl knowing fully well the pros and cons of consensual sex without any precaution. Even the FIR was lodged after it was detected that the petitioner is pregnant… This Court is of the considered opinion that since the petitioner involved herself in a consensual sex knowing fully well about the consequences of such act, and the allegations made in FIR, do not prima facie make out a case of consent obtained by misrepresentation of fact, therefore, under these circumstances, medical termination of pregnancy cannot be permitted,” the court said.

The August 10 order may be read here:

In appeal

The court, in appeal, observed that the prosecutrix was subjected to illicit sexual intercourse by the accused on the false pretext of marriage which will adversely affect the social and mental status of an unmarried girl like the appellant/prosecutrix and her family cannot survive/sustain with dignity in the society peacefully.

The court perused the order passed by the single-judge bench and observed that the court prima facie deemed that the sex was consensual however it failed to consider that whether the promise of marriage was falser from beginning, or was it a case of breach of promise is a fact to be established at trial and the single-judge “ought not to have presumed presence of element of consent as a dissuading factor”.

The court compared the factual matrix of the case to the explanation 1 under section 3 of MTP Act and observed that it is amply clear that the prosecutrix has alleged that she was subjected to rape and the pregnancy arises from the said incident of rape. The explanation clearly states that when a pregnancy is alleged to have been caused by rape, the anguish is presumed to constitute “grave injury to mental health of the woman” which is a valid ground for terminating a pregnancy of less than 20 weeks.

The court added, “Since the period of pregnancy is below 20 weeks and she admittedly is subjected to grave injury to her physical and mental health due to said rape, this Court cannot stand in the way of the prosecutrix in getting her pregnancy aborted/ terminated.”

The court also clarified that under section 3 of MTP Act, if rape is alleged, it is not necessary for the allegation to be proved, which means that the factum of the allegation is sufficient to invoke provisions of section 3 and to allow termination of such pregnancy.

The court thus allowed termination of pregnancy if consent is expressly given and her physical condition is conducive for the same.

The August 28 order may be read here:

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The post Allegation of rape need not be proved to allow abortion of fetus under MTP Act: MP High Court appeared first on SabrangIndia.

The Medical Termination of Pregnancy (Amendment) Bill, 2020 was passed by Lok Sabha in March this year. This bill which was introduced in Lok Sabha by the Minister of Health and Family Welfare, Dr. Harsh Vardhan on March 2, 2020, amends the Medical Termination of pregnancy Act, 1971) MTP Act) which provides for termination of certain pregnancies by registered medical practitioners.

There were some much anticipated amendments that were brought about by this bill; especially the removal of the requirement of opinion of two medical practitioners for termination of pregnancy of 12 to 20 weeks. By this amendment, pregnancy up to 20 weeks may be terminated with the opinion of one registered medical practitioner and termination of pregnancy between 20 to 24 weeks may be terminated with the approval of two such medical practitioners.

Further the amendment also seeks to constitute a Medical Board at the state level which will examine cases where termination of pregnancy is necessary due to the diagnosis of substantial foetal abnormalities and where the upper limit otherwise provided for in the Act, will not apply. Further, the amendment also seeks to impose punishment of up to 1 year or fine or both for disclosing the name and other personal information of a woman terminating her pregnancy, unless revealed to a person authorized by any law.

The text of the amendment bill can be read here.

While some of these amendments have been welcomed, the absence of a vision and perspective behind the proposed law, especially one that is grounded in the recognition of women’s autonomous rights over their bodies and medical choices.The Act is far from being  a rights based legislation; it does not confer termination of pregnancy as a matter of right to women. The Act pre-supposes a medical health condition (danger to woman’s life) which solely determines the need or otherwise behind a woman’s reasoned decision to terminate her pregnancy.

A coalition of organisations including Pratigya, Jan Swasthya Abhiyan, Crea, CEHAT, ASAP, Masum, Haiyya, Common Health, FRHS India along with Jindal Global law School have formulated specific recommendations to make good this lacunae.

The recommendations are as follows:

Termination of pregnancy as a matter of right

The amendment bill section 3 states that , a pregnancy may be terminated by a registered medical practitioner, if length of pregnancy is up to 20 weeks and if between 20 to 24 weeks, then by two medical practitioners, if there is an opinion that the pregnancy would involve risk to the woman’s physical or mental health or to the child’s health. The recommendations suggest that this clause be changed to allow termination of pregnancy at the will of the pregnant woman, up to 12 weeks and based on the opinion of one medical practitioner for pregnancy between 12 to 24 weeks. It further suggests that injury to mental health includes anguish caused by an unwanted pregnancy.

Limitation to termination beyond 24 weeks

Further sub section 2B of section 3 limits consideration of termination beyond 24 weeks only in cases where foetal abnormalities are detected. The document recommends that this requirement be done away with given that that termination of pregnancy can be carried out safely post-24 weeks and there are multiple reasons which could delay access to pregnancy termination services. These include early or forced marriages, lack of knowledge regarding contraception, rape or sexual violence, delay in recognizing the pregnancy, delay in decision making due to lack of autonomy, intimate partner violence, difficult family circumstances, and lack of mobility especially in case of persons with disabilities, or institutionalized persons. A change in circumstances may also lead to a pregnancy becoming unwanted after 24 weeks, such as when there is separation from or death of a partner, or a change in financial situation. 

Argument against constitution of Medical Boards

Further, the document is completely against the constitution of Medical Boards at the state level as they will only cause a hindrance to the process of termination. Instead, the opinion of one gynaecologist (whom the pregnant person has been consulting), in consultation with no more than one other medical practitioner, may be required for abortions only beyond 24 weeks. The document states that the requirement of Medical Boards in order to diagnose substantial foetal abnormalities that necessitate termination violates the rights to dignity, privacy, and decisional autonomy of the pregnant person. Further, these boards would become third-party authorisation causing substantial delay in access to ultimate abortion, thus increasing the threat to the pregnant woman’s life or causing her more trauma. The Boards would also act as a serious barrier for pregnant persons needing their approval since the expert composition required for such a Board may exist only in the metro areas. For those living in rural areas, there would be substantial costs and delays involved. Further, the varied composition of the boards could lead to varied opinions, further delaying the decision making. Also, the board will seem like an inquiry board asking intimidating or humiliating questions to women who may already be reticent due to their circumstances and could prefer unsafe methods for termination than go through these bureaucratic processes.

Opinions of International women’s rights organizations

The document also points to recommendations of international organizations such as the UN Human Rights Special Procedures Working Group on the Issue of Discrimination against Women in Law and in Practice which released a statement in 2017 asserting that any legislative requirements for abortion should not cause delays that would prevent the carrying out of termination before the pregnancy becomes too advanced. Even the World Health Organization acknowledged that third-party authorisation requirements undermine women’s autonomous decision-making.

Safeguarding privacy of women

Further, insertion of section 5A seeks to impose punishment of up to 1 year or fine or both for disclosing name and other personal information of a woman terminating her pregnancy, unless revealed to a person authorised by any law. The document is completely against the disclosure of such details to any person authorised by law since that would be completely antithetical to the woman’s right to privacy.

Expansion of Provider Base

 In order to enable large number of pregnant people to benefit from ―advancement in medical technology for safe abortion, Campaigners have urged that qualified and trained nurses, as well as other suitably qualified healthcare providers, be included in the list of abortion providers to provide early abortion, especially medical method of abortion. Recommendations of the World Health Organization with regard to who can provide an abortion should be seriously considered.

Clashes with POCSO Act

The document points out that under the Protection of Children from Sexual Offences (POCSO) Act 2012, sexual activity between minors (under the age of 18) is a sexual offence. Hence, any consensual sexual activity between adolescents is effectively a crime and needs to be mandatorily reported to the police. This means that if an adolescent girl wishes to terminate her pregnancy, she would have to divulge such information to the police which violates her right to privacy, which the MTP amendment seeks to protect.

Almost 50 years have passed since the principal Act came into force and yet the legislation lacks a rights based approach. It is high time that the law recognises a woman’s right to her body and her choice to terminate her pregnancy without any conditions or requiring approval of a doctor.  By ensuring that the amended law transforms into a rights based legislation, not only will cases of unsafe abortions decline but it will also give women the volition that is a matter of a natural right.

The MTP Bill is yet to be passed in the Rajya Sabha and is likely to l come up for consideration in the next session of Parliament. The amendments proposed by Campaigners and the Coalition are crucial and need to be discussed in the public domain. So that, when the matter is ‘debated’ an informed view, that factors in Women’s Voices, influences the debate, and the law.

The document prepared by the Coalition of civil rights and feminist organisations may be read here.  

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The cabinet has cleared some key reforms related to medical termination of pregnancy recognising women’s agency over their reproductive choices. This is however a marked departure from the government’s own stand on the subject as recently as September 2019.  

Four months ago, responding to a petition filed in the Supreme Court demanding an extension on the deadline for abortions to 26 weeks the government had submitted that it was duty bound to protect all citizens including fetuses that are considered viable from the point they become five months old. The government had therefore stated its position as believing that reproductive autonomy did not trump the State’s interest in protecting the live of a foetus. The government was therefore reluctant to extend the deadline beyond the existing 20-week period.

Current unamended provisions of the MT Act

At present, section 3 of the Medical Termination of Pregnancy Act, 1071 reads as follows:

When pregnancies may be terminated by registered medical practitioners

(1) Notwithstanding anything contained in the Indian Penal Code (45 of 1860), a registered medical practitioner shall not be guilty of any offence under that Code or under any other law for the time being in force, if any pregnancy is terminated by him in accordance with the provisions of this Act.

(2) Subject to the provisions of sub-section(4),a pregnancy may be terminated by a registered medical practitioner, –

(a) Where the length of the pregnancy does not exceed twelve weeks if such medical practitioner is, or

(b) Where the length of the pregnancy exceeds twelve weeks but does not exceed twenty weeks, if not less than two registered medical practitioner are,of opinion, formed in good faith, that –

(i) The continuance of the pregnancy would involve a risk to the life of the pregnant woman or of grave injury to her physical or mental health; or

(ii) There is a substantial risk that if the child were born, it would suffer from such physical or mental abnormalities to be seriously handicapped.

Explanation 1- Where any pregnancy is alleged by the pregnant woman to have been caused by rape, the anguish caused by such pregnancy shall be presumed to constitute a grave injury to the mental health of the pregnant woman.

Explanation 2- Where any pregnancy occurs as a result of failure of any device or method used by any married woman or her husband for the purpose of limiting the number of children, the anguish caused by such unwanted pregnancy may be resumed to constitute a grave injury to the mental health of the pregnant woman.

(3) In determining whether the continuance of a pregnancy would involve such risk of injury to the health as is mentioned in sub-section(2)account may be taken of the pregnant womens actual or reasonable foreseeable environment.

(4) (a) No pregnancy of a woman, who has not attained the age of eighteen years, or, who, having attained the age of eighteen years, is a lunatic, shall be terminated except with the consent in writing of her guardian.
(b) Save as otherwise provided in clause (a), No pregnancy shall be terminated except with the consent of the pregnant woman.

What the new reforms hope to achieve

However, on Wednesday, speaking to media persons at a Cabinet briefing Union Minister Prakash Javadekar said, “In a progressive reform and giving reproductive rights to women, the limit of 20 weeks of medical termination of pregnancy has been increased to 24 weeks.” He explained the rationale behind this saying “This is important because in first five months there are cases where the girl concerned doesn’t realise and has to go to court.”

Another, issue faced by many women seeking abortions is that of marital status. Many unmarried women are routinely shamed for exercising their sexual agency and made to feel guilty about not only becoming pregnant but also choosing to terminate the pregnancy. This forces many women to seek unsafe abortions from untrained or poorly trained practitioners in back-alley clinics under unhygienic conditions.

The Medical Termination of Pregnancy (Amendment) Bill (2020) to amend the Medical Termination of Pregnancy Act (1971) that is likely to be introduced in the next session of the Parliament attempts to rectify this. According to the Indian Express, the bill seeks to aid unmarried women seeking abortions by relaxing the contraceptive-failure condition for “any woman or her partner” from the present provision for “only married woman or her husband”, allowing them to medically terminate the pregnancy.

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Uttar Pradesh reported better availability–66% of the pharmacists interviewed said they stock the drugs–as did Bihar at 37.8%.

These prescription drugs, mifespristone and misoprostol, commonly referred to as medical methods of abortion (MMA), account for four out of five abortions in India undertaken by 10 million women every year, as reported by IndiaSpend in 2016. This implies a clandestine market in MMA, activists working in the field of women’s reproductive health alleged.

When asked why they did not stock MMA, 69.4% pharmacists cited “legal barriers”, said the study conducted by Pratigya, a network dedicated to women’s rights and their access to safe abortion care. This reason was quoted by 90.4% of those surveyed in Maharashtra and 75.6% in Rajasthan.

These “legal barriers” refer to concerns about sex-selective abortions that ensure the birth of only a male child, a practice common in countries such as India and China with a marked son preference in families. But, as we explain later, these fears about MMA’s misuse are misplaced–it cannot be used for sex selection because it is effective only in early pregnancy when the foetus’ gender cannot be determined.

“For women in India, access to abortion has been marred by extreme stigma, lack of awareness about its legality, unavailability of safe services near the community, and high costs charged by providers,” said Vinoj Manning, CEO Ipas Development Foundation, a not-for-profit organisation that works for safe abortion and contraception.

Abortion was legalised in India almost half a century ago, yet unsafe abortions–performed in unhygienic conditions by untrained providers–are the third largest cause of maternal death. An estimated 56% of abortions in India are unsafe, IndiaSpend reported in 2017.

MMA has a success rate of 95%-98% if administered properly, but the lack of medical supervision has resulted in a significant number of botched abortions in India.

The study surveyed 1,008 retail chemists across four states, interviewing at least 250 in each. The cities included were Bhagalpur, Darbhanga, Gaya, Muzaffarpur, and Patna in Bihar; Aurangabad, Mumbai, Nagpur, Pune, and Solapur in Maharashtra; Ajmer, Bikaner, Jaipur, Jodhpur, and Kota in Rajasthan and Agra, Ghaziabad, Kanpur, Lucknow, and Varanasi in Uttar Pradesh.

Rajasthan and Maharashtra were chosen for the study because there were reports of shortage of MMA in the market, VS Chandrashekar, CEO of Foundation for Reproductive Health Services, and Pratigya Campaign for Gender Equality and Safe Abortion, and writer of the study. Bihar and UP were chosen because they are highly populated and have poor socio-economic and health indicators, he added.

Most sales without prescription, study

Medical abortion pills are currently classified as Schedule H drugs, and therefore are legally available at pharamacists with prescription. But most clients come to ask for medical abortion drugs without a prescription, the study found, and therefore without information about the drugs.
“In this case, the obligation to give clients the right information about dosage and side-effects lies with the doctor and the chemists,” said Chandrashekar. “Many chemists also sell the medicine out of packs, in that case it is difficult for women or men to read the inserts.”

This form of abortion has prompted a new classification of “less safe” abortion by the World Health Organization. It is seen as better than “least safe” abortion, because it uses prescribed medication, rather than the introduction of foreign objects and use of herbal concoctions. But it is still not safe due to the absence of a trained provider.

‘Secret sales because of overregulation’

Why do authorities warn pharmacists against supplying MMA? The answer lies in the practice of sex-selective abortions in India.

From 2001 to 2011, India’s child sex ratio declined from 927 to 919 females per 1,000 males. In Rajasthan, it fell to 888 per 1,000, spurring the state into setting a target sex ratio of 940 by 2021, as reported by The Times of India in 2018. The Pre Conception and Pre Natal Diagnostics Techniques Act (PCPNDT), 1994, was brought in to tackle gender-biased sex selection in India, and raids and crackdowns were conducted on retail pharmacists and provider sites stocking MMA.

This conflict between providing abortions and fighting the declining sex ratio in Rajasthan and Maharshtra has “created barriers and roadblocks to women’s access to abortion care”, the study said.

Whilst 31.8% of pharmacists were told by drug authorities to sell them on prescription, 45% (and as much as 73.3% in Rajasthan) were told to not sell or keep the drug, the study found.  Most (56%) retail pharmacists interviewed for the study considered MMA to be overregulated compared to other Schedule H drugs. In Maharashtra, this response came from nearly all pharmacists (91.7%).

“As a result, medical abortion drugs are often secretely sold at chemists in Rajasthan off-record, for five or six times the price,” said Rajan Chowdhury, a Jaipur-based social activist who works in the field of women’s rights.

But the regulatory pressure on pharmacists stocking MMA is misplaced, said Chandrashekar. MMA cannot be used to facilitate sex selection because foetus’ sex can only be determined after the 13th-14th week of pregnancy while MMA has to be used within nine weeks.

Sex selection makes up 9% of abortions in India, it was found in 2015.

Ill-informed pharmacists

The overregulation of MMA not only prevents access to abortions, but also results in low knowledge about the pills as well as the legality of abortions among pharmacists. “The Pratigya Campaign is very concerned about this,” said Chandrashekhar.

The number of retail druggists who reported being trained on MMA was low–15% in Bihar and 9% in Uttar Pradesh, for example. Upto 64.5% reported getting information on the drugs from brochures and booklets. When asked, 35% of pharmacists could not recall the name of the drugs used for medical abortion. More than half of retail chemists thought that abortion medication is not useful for women.

There were signifacant gaps in awareness about abortion among pharmacists–43% thought that they are illegal in India despite its legalisation through The Medical Termination Of Preganancy Act in 1971. In Rajasthan, upto 60.7% thought abortion is illegal.

Three of four who stocked MMA were not aware that abortion is legal up to 20 weeks of gestation. A higher proportion of them (40%) considered abortion to be legal only upto 12 weeks of gestation. Awareness of this detail was the least in Uttar Pradesh at 9.5% though the state had the highest number of pharmacists stocking MMA (66%).

Less than a third (30%) of pharmacists were aware that the MMA drugs have to be taken within the nine-week limit. Just as many retail chemists misunderstood this period to be seven weeks.

No awareness among users

Since the providers are untrained, few women who buy MMA without a prescription get necessary counselling about the drug, its usage and side-effects. This is the “biggest problem women are facing”, said Kalpana Apte, secretary general, Family Planning Association of India and a member of the technical advisory group at the Pratigya Campaign.

Less than half the respondents (45.7%) were able to recommend the correct dosage of MMA to clients, 29.8% knew nothing of how it was to be taken, and 43.4% when. Upto 80.8% reported that they gave no information about the side-effects associated with the drug and this was despite the fact that 29.5% of clients returned to complain about side-effects. To those who complained, nine out of 10 druggists suggested that they consult a doctor.

“Currently, there is no training for Rajasthan chemists and when they give the pills it is without any guidance or instructions,” social activist Chowdhury said. “Going forward chemists must become more responsible for the sale of MMA, and give adequate warnings about its use.”

Upon purchase, 63.8% of pharmacists did not ask clients about their last menstrual period–necessary for calculating the term of the pregnancy–43% did not ask about the duration of the pregnancy, 54.2% did not ask for a doctor’s prescription. On average, 60% of clients who came to purchase the pills were men.

Apte and Chandrashekar both recommended increasing the base of doctors and nurses who can prescribe medical abortions, in line with recomendations from the World Health Organization.

“At present, only 60,000/70,000 doctors can prescribe MMA drug in the whole of India,” said Chandrashekar. “Widening the pool of providers to all doctors can increase doctors in India able to prescribe this drug to 800,000-1 million.”

This story was first published here on Healthcheck.

(Habershon, a graduate from the University of Manchester, is an intern with IndiaSpend.)
 

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While this medical method of abortion (MMA) has a success rate of 95%-98% if administered properly and before nine weeks of gestation, the study found that the lack of medical supervision has resulted in a significant number of botched abortions in India.

Incomplete abortions after the use of pills caused 65% of complications in women seeking post- abortion care in Assam, 59% in UP and 51% in Bihar, stated the report. The method was legalised in India by amending MTP act in 2002 to strengthen access to safe abortions up to seven weeks and it is still considered one of the safest and most effective measures.

The report ‘The Incidence of Abortion and Unintended Pregnancies in Six Indian States’, published on November 13, 2018, provides data for Assam, Gujarat, Bihar, Madhya Pradesh Tamil Nadu and Uttar Pradesh, which together account for 45% of women of reproductive age in India. The study was conducted jointly by Indian Institute for Population Sciences, Mumbai, Population Council, New Delhi and New York-based Guttmacher Institute, a research organization that promotes reproductive health and rights globally.

The prime reason for the abortion complications, the study found, was that women did not undergo the stipulated 15-day procedure for termination of pregnancy which requires at least two visits to a health facility.

Of the 7.6 million abortions that took place in 2015 in the six study states, 77% or 5.8 million were carried out through non-facility MMA and Uttar Pradesh alone accounted for 2.6 million.

The guidelines in the Handbook for MMA, issued by the ministry of health and family welfare, require that Mifepristone and Misoprostol, the two-drug regimen used to induce abortion, can only be provided only by a registered medical practitioner or a government hospital. But, the UPAI study found that most women obtained it from informal vendors and chemists. This means that they are not counselled and lack adequate information about the usage and side-effects of these drugs.

More than half of all abortions in India continue to be unsafe, and incomplete abortions have increased from around 30% to over 50% in the last five years, which shows the increase in unsuccessful home medical abortion attempts, IndiaSpend had reported on November 5, 2016.
The new study underlines the importance of abortion as an indicator that reflects a region’s contraceptive behaviour, unintended pregnancies and the type of termination services offered.

‘Abortion numbers are underestimated in India’

While abortion has been legal in India for over five decades, maternal deaths remain an issue: As many as 56% abortions in India are unsafe; 8.5% of all maternal deaths in India are due to unsafe abortion; and 10 women die every day due to this reason, IndiaSpend had reported on November 22, 2017.

The new study is a follow-up of the report published by The Lancet Global Health in December 2017 titled The Incidence of Abortion and Unintended Pregnancy in India, 2015.

The previous report estimated 15.6 million abortions in the country in 2015, of which 73% or 11.5 million were obtained through MMA medication outside health facilities, 22% or 3.4 million occured in health facilities and 5% were done outside facilities using unsafe methods.

But the NFHS-4 survey estimated that a majority of abortions, as many as 52%, were provided in private health facilities, about 20% in public facilities and 26% were performed by women themselves.

“Statistics compiled by the Indian Government on the number of abortions provided in facilities are known to greatly underestimate abortion incidence because the coverage of facility-based services is incomplete and in addition, many abortions occur outside of a facility setting,” the report argues. Hence, the study used data from indirect sources, by conducting a large-scale sample survey of public and private facilities that provide abortion and data on sales of medication abortion drugs.
 
Public health facilities plagued by shortage of trained doctors and stigma

Of all the facility-based abortions in the six states studied, about 13% were performed in private facilities; public facilities accounted for only 5% of abortions. Only Assam registered 15% of induced abortions in public facilities while Bihar, Gujarat and UP lagged behind at 2%, 3% and 4% respectively.

“The state government of Assam had over the last four- five years made a concerted attempt to improve comprehensive abortion care in the public health facilities,” said Vinoj Manning, chief executive officer of Ipas Development Foundation India, an advocacy group that works to prevent unsafe abortions. “They allocated adequate money in their annual health budget and ensured utilisation of the budgets for training and certifying new MBBS providers to provide abortion care at primary and community health centres (PHCs and CHCs).”

Though the medical termination of pregnancy (MTP) Act, 1971 was passed 50 years ago, safe abortion is still not a reality for women in India. Manning puts this down to multiple reasons. “Lack of access to safe abortion for women owing to the paucity of services where it is needed the most – close to their homes/communities – and shortage of legal providers, is one of the core reasons,” he said. “Additionally, many women continue to be unaware about abortion being legal in India, and the knowledge about where, when and how they can access safe services.”

PHCs need to step up abortion services

Barriers to abortions were commonly observed in PHCs, which are essentially the first point of contact to a qualified medical practitioner for those living in rural areas. “PHCs typically have limited capacity to offer the service, and across the six study states, only a small proportion do so (3–14%)”, the report said. Hence the burden of performing abortions shifted to the large public facilities like the public hospital or the community health centres.

“MTP trained doctors are mostly located in the urban area,  while majority of our population live in the rural areas,” Sushanta Banerjee, head of research and evaluation team at Ipas Development Foundation, told IndiaSpend. “We still have high unmet need for safe abortion at PHCs. Even when a PHC doctor is trained on providing abortion services, the community remains unaware of this service.”

Although there is a provision for one gynaecologist in every CHC, there is a 76.3% shortfall of obstetricians and gynaecologists compared to their requirement at CHCs, IndiaSpend had reported on November 22, 2017.

Why women end up looking for informal, dangerous abortion services

Public and private health facilities denied women abortion beyond the prescribed 20-week  gestational period, as per the study. As many as 29% of public hospitals in Bihar and 63% in Assam provided second trimester abortions, the study showed. But in Gujarat and Tamil Nadu, CHCs and PHCs did not provide second trimester abortions which made women look to informal methods of termination.

The report also states that 54-87% of facilities in the six study states had turned away at least one woman seeking termination of pregnancy. The reasons cited by facilities included shortage of staff, lack of supplies or for not having consent from their husbands or a family member which are not legal grounds for denying abortions.

To ensure that women do not buy MMA pills from informal vendors, Banerjee recommended improved abortion services at all levels of public health facilities. “There is also an urgent need to move from medical doctors to mid-level providers, including nurse and midwives,” he said. “Over reliance on medical doctors will restrict the access and will influence to women to go to informal providers.”

Courtesy: India Spend

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Choose Life Colombia camp, September 2018. Photo: Camille Mijola.Choose Life Colombia is a religious anti-abortion movement closely linked to the international 40 Days for Life network. Since 2017, they’ve run youth camps that mix extreme sports with extreme anti-choice rhetoric, training teenagers on how to campaign against women’s reproductive rights.

They represent the new face of an emboldened anti-choice movement in Colombia – and the backlash to the government’s 2006 decision to relax its restrictions on abortion. They are also part of the ola celeste, the “sky-blue wave” of anti-abortion activism that has grown across Latin America after kicking off in Argentina in August.

I attended one of their two-day camps in September, along with about 30 other young people, between 15 and 22 years old, in a mountainous region called La Mesa, two hours outside of Bogotá. First, we met the organisers – all dressed in matching blue sweaters – at a church at 6.30am, to join an early Sunday mass before setting off.

Surrounded by evergreen hills, the camp was in an extreme sports park that looked like the perfect setting for school trips or adventure days — with obstacle courses, climbing and rappelling sites. Though our schedule included hour-long talks on abortion, referred to in one of these as a symptom of the globalised “culture of death”.

The camp’s director was Melisa Castro, a cultural studies student in her twenties at the prestigious University of Los Andes. Her opening presentation, “Defending Life”, condemned “abortion culture” and accused Profamilia and Oriéntame, the two best-known Colombian reproductive rights NGOs of “profiting from death”.

Choose Life Colombia camp, September 2018. Photo: Camille Mijola.Amid a power shortage brought by a raging thunderstorm, we were asked to lie down on the floor, close our eyes and listen to an emotionally-distressing recording of a voice, which had a Mexican accent, and was supposedly that of a fetus narrating its abortion.

“Mommy”, it said, “I love you very much. I don’t understand why you are so sad and fighting with Daddy so much”. Over ten minutes, it continued. “Mommy, why are you lying down? It’s only 2pm”, before screaming: “Mommy, what are they doing to my house? They’re taking away my arms! Tell them to stop, Mommy!”

The screams ended abruptly, the abortion apparently completed. After a long silence, the unsettling voice resumed — ending the recording with haunting words: “Mommy, it has been 17 years… but I still love you, and I’m waiting for the day we meet”.

We were then handed out pieces of paper to practice writing letters to women as if we were part of a campaign involving 40 Days for Life vigils outside Oriéntame clinics.

“What are they doing to my house? They’re taking away my arms! Tell them to stop Mommy!”

Prior to 2006, abortion was illegal in Colombia without exceptions. Since then it is legal if a pregnancy poses risks to the woman’s life or health, including her mental well-being; if there are serious foetal malformations; or in cases of rape or incest. In Bogotá, there were 16,947 legal abortions between 2006 and 2013, according official figures.

This is one of the more progressive abortion regimes in Latin America, where women’s reproductive rights are severely restricted. But it’s been opposed for years by religious and ultra-conservative movements. Within this opposition, Choose Life’s niche is its focus on young people, along with its international connections.

Daniel García, a cheerful engineering graduate in his mid-twenties, was my point of contact for the Choose Life camp. He told me he’d been involved in the movement for more than four years, since he committed himself to following “the path of God”.

I was charged 230,000 Colombian pesos (£57) to attend – about a third of the monthly minimum wage. When I asked for a receipt, García couldn’t provide one. “We’re not registered as a legal entity, we’re quite informal at this point”, he told me, though our trip would be the fourth it had run since starting these youth camps in 2017.

Instead, he got a contact of his at a print shop to emit a receipt for a different purchase, leaving me with no legal proof of having paid to attend this camp. This receipt, which made it appear that I’d purchased print services instead, cost an extra 40,000 pesos.

40 Days for Life protest in London. Photo: Ian Nicholson/PA Archive/PA Images. All rights reserved.Garcia described a close relationship between Choose Life Colombia and the 40 Days for Life network, which calls itself “the largest internationally coordinated pro-life mobilization in history, helping local communities end the injustice of abortion”.

This network started in Texas in 2004 and became known for organising prayer vigils outside clinics. It now has affiliated groups in more than 20 countries. Garcia told me that meeting 40 Days for Life activists was “what I was waiting for”. Previously, he said, he’d run a blog about these issues but felt helpless and wasn’t active in protests.

It was a Colombian doctor, Danelia Cardona, who previously lived in the UK, who brought the 40 Days for Life movement here three years ago, according to Garcia. From Bogotá, it had spread to 26 cities, with regular vigils at clinics across the country. It’s also built alliances with other anti-abortion groups, like Choose Life Colombia.

García explained how 40 Days for Life volunteers “pray” for Choose Life Colombia’s mission – and have directed people to the group. In return, Choose Life Colombia has attended their vigils – and runs workshops for the network.
 

Role-playing and misinformation

Practicing how to dissuade women from having abortions was a key theme at the camp. When Castro finished her presentation she handed out the sky-blue neck-pieces worn by ola celeste activists across Latin America, and her version of the ‘We Need You’ poster. As campers began to put their neck-pieces on, we were split into groups.

For this role-playing activity, my group included three young girls, the youngest of whom was just 15-years-old. We had to act out how we’d try to convince a hypothetical, pregnant 20-year-old rape victim not to have an abortion. Other groups had their own scenarios, but the same goal: convince women not to access their reproductive rights.

Later that day, Juan Carrasquilla, another Choose Life activist, delivered a presentation in which he appeared to deliberately misuse data from the pro-choice group Oriéntame, claiming that of 241 women and girls referred to them for adoption counselling, 236 decided to terminate pregnancies, rather than carry them to term for adoption.

I later shared this example with Maria Vivas, Oriéntame’s director. “We’re used to this type of misinformation”, she told me. “They’re reading numbers incorrectly”. Just because 14 women and girls successfully completed the adoption process, she said, doesn’t mean the other 236 who considered it chose to have abortions instead.

“They’re used to these conspiracy theories”, she added, referencing another claim that also came up at the camp — that clinics providing abortions sell fetal tissue, for example “to corporations that produce makeup and other beauty products”. She added: “They’re obsessed with the fact that fetuses are not given a ‘Christian’ burial”.

Increasingly, Colombians hear such “conspiracy theories” from anti-abortion activists – but also from key public and political figures, including the country’s extremely popular, former president Alvaro Uribe Vélez.

The same week as Choose Life’s camp in September, Vélez sent an open letter to Cristina Pardo – an openly anti-choice judge of the constitutional court – opposing the “commercialisation” of “those who have lost their lives to abortion”.

One Choose Life volunteer, Edwin Danilo Sonza, is meanwhile also the youth coordinator for Marco Fidel Ramirez, who was elected in 2016 as a councillor of Bogotá, making him part of the capital’s highest administrative authority.

After two failed campaigns, Ramirez told me this victory was his “electorate was rewarding me” for positions “against abortion, in defence of the family, against gender ideology… and against the scary secularisation which is ravaging our society’s values”.

“Against the scary secularisation which is ravaging our society’s values”

The morning I met Ramirez, I also ran into Sonza, who told me that he also had ambitions to someday join local government. He was wearing the same Choose Life wristband that I’d been given at the camp, and said that he’d just been at a protest with Choose Life activists outside the capital’s constitutional court.

In a sermon-like tone, reflecting his years as a Protestant pastor, Ramirez told me: “It is precisely because of the destruction of the family that we have all of our problems in society: resentment, bitterness, violence, destruction, disaffection, drug use, etcetera”.

He is an avid promoter of ‘conscientious objection’ – enabling doctors to object to providing abortion services. Ramirez also publicly supported the arrival in Latin America of the so-called “hate bus” from the ultra-conservative Spanish group CitizenGO, which drove around cities in Colombia in 2017 bearing anti-transgender slogans.

CitizenGo’s bus. Image: HazteOir.org/Flickr (CC BY-SA 2.0) Some rights reserved. This month, Ramirez released a new book entitled “Los Que Transforman El Mundo” (Those Who Transform the World) with Panamerica, Colombia’s largest publishing company.

“My book”, he said, “explains how a Christian leader can be capable of defending his faith and decodify the message of Christian faith to reach the day-to-day life of the city and the country, in the design of laws and in the structure of norms”.

“Already, all those leaders defending life and family that have risen in several countries… We’re getting close to each other, out of need”, Ramirez continued. “The big future of this international strategic alliance is very close”.

The councillor, who also ran as a presidential pre-candidate ahead of last year’s national elections, told me he’s plans to try for the senate in 2022.

Now, more than 10 years after Colombia relaxed restrictions on abortion, the country has a new religious conservative government in power. It’s not impossible that the senate will be summoned to revise the abortion law.

Meanwhile, the opposition to reproductive rights is increasingly well-connected, ambitious – and strategically recruiting teenagers to join their fight.

Camille Mijola is a freelance journalist and 5050oD feminist investigative journalism fellow. She’s a helping hand at Novara Media & Airwars. She can be found on Twitter @cmijola.

Courtesy: https://www.opendemocracy.net/
 

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Pro-choice activists at London’s Saint Patrick’s Day parade, March 2017. Photo: Dmitry Dzhus/Flickr. CC-BY-2.0 Some rights reserved.

Nice Irish girls don’t have sex. This is what I gathered growing up as a young woman in Ireland, at school in my local convent in Longford and at university in Dublin. If you had sex, you’d better be in a long-term relationship. Even then, you’d struggle to go on the pill because that would involve admitting to a stranger you were having sex outside marriage.

It’s safe to say that the fear of becoming pregnant was always there – that, and developing an STI that would leave you infertile for life. Why? Because sex was bad. That’s what you were taught during sex-ed class at school. If you were ‘at it’ and fell pregnant, you only had yourself to blame. As for having an abortion, well, that was the greatest sin of all.

I never had an abortion but in my early twenties a very dear friend said that she needed one. We discussed her options in a clandestine meeting, down a dark lane in a Dublin suburb. At six weeks pregnant, she decided on a termination. She booked flights to the UK, took a couple of days off of work and we didn’t speak about it again for 12 years.

Looking back, that was the moment when I became unreservedly and unapologetically pro-choice. I might not have realised which amendment to the Irish constitution forced my friend on a plane that day, but I knew something was very wrong with how our country was treating this ‘nice girl,’ my friend, who made a very difficult choice.

“That was the moment when I became unreservedly and unapologetically pro-choice.”

She hadn’t been raped; she hadn’t learned that the foetus wouldn’t survive outside the womb. She wasn’t ready to be a mother. As proprietor of her body, and governor of her life, that decision was rightfully hers. But she was left alone, ostracised, and feeling that she had become one of Ireland’s shameful exports.

Activists use chalk on pavement to show the number of Irish women who have travelled to England for safe and legal abortions since 1983. London-Irish Abortion Rights Campaign protest, September 2017. Photo: Steve Eason/Flickr. CC-BY-2.0 Some rights reserved.

Ireland will go to the polls on 25 May to vote on whether it should repeal the 8th amendment, which prohibits a woman from having an abortion in Ireland unless her life is in direct danger. A woman who terminates a pregnancy faces 14 years in jail, even in cases of rape or when the foetus isn’t viable.

These are some of the most draconian abortion laws in the world. Repealing the 8th amendment is a subject that I speak about regularly to Irish family members and friends. Not many people that I’m close to would dare say that abortion shouldn’t be allowed in ‘extreme’ cases but some are hesitant when it comes to ‘regular’ abortions.

Why is this? I’m afraid it’s that dirty word again: sex.

Ireland has an uncomfortable relationship with sex – in particular women having sex outside of marriage. International readers might be forgiven for thinking that we’re a progressive little country; we were the first country to legalise same-sex marriage by popular vote, after all. But we still have a long way to go.

“I’m afraid it’s that dirty word again: sex. Ireland has an uncomfortable relationship with sex.”

I distinctly recall the double standards between men and women at university. Many young guys would happily engage in casual sex yet they’d be fiercely opposed to bringing home the same women to their Irish mothers. It would be much more palatable to take home a ‘nice girl’, wife-material that you could proudly take to mass on a Sunday.

Sexual promiscuity amongst Irish women, meanwhile, was shunned. Dare I say it, these ‘fallen women’ were even subject to slut-shaming from some of the more obnoxious young men at university. This was our normal.

The upcoming referendum is also about the way in which Ireland views women, sex and reproduction. Historically, Ireland has an appalling track record in these areas. Here we are again, in the 21st century, debating how we legislate over Irish women’s bodies.

And even if the 8th amendment is repealed, this ‘nice Irish girls don’t have sex’ mindset must be tackled if women are to fully access their reproductive rights. There are examples, including from Italy, where abortion has been legalised for years but can still be difficult to access because of widespread ‘conscientious objection’ by medical staff.

My covert whisperings, in that dark alley in Dublin many years ago, taught me that sex, pregnancy and abortion should not be our shameful secrets. We are not as conservative as we once were; many of us are certainly not as religious. If the women of Ireland are to be treated as equal humans, the 8th amendment must be unequivocally repealed.

I will not be voting in the upcoming referendum as I lost my voting privileges when I became resident in the UK. I will however be examining, scrutinising and watching our little country from afar, as it makes the greatest decision in my living memory.

Shaunagh Connaire is an Emmy nominated and duPont-Columbia award winning journalist and filmmaker. She’s worked on over 40 films for Channel 4 Unreported World and Dispatches and has produced documentaries for BBC & PBS Frontline. She’s originally from Ireland.
 

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A Youth for Life anti-abortion campaigner. Photo: Youth for Life/Facebook.

Irish politicians have been deaf to the clamour of women’s voices calling for abortion rights for decades. Despite being the first country to legalise same-sex marriage by popular vote (in 2015), the republic of Ireland still maintains an abortion regime stricter than Saudi Arabia’s.

Abortion is legal in Ireland only when the mother’s life is at risk. The country’s constitutional misogyny has baffled fellow European states and earned it the censure of international groups including the United Nations, the Council of Europe, and Amnesty International.

In northern Ireland, women carry the passports but not the entitlements of British citizens (who have had access to legal abortions for 50 years, since 1967). This island seems united in its deliberate disregard for women’s fundamental rights if nowhere else; those seeking terminations from either side of the border must travel abroad.

‘This island seems united in its deliberate disregard for women’s fundamental rights if nowhere else.’

Yesterday the Irish government announced that a referendum will be held next year, in May or June, on whether to repeal a constitutional amendment that gives equal rights to a woman and her unborn child, thus opening the door to legalising abortion.

Battle lines have been drawn between those who want the eighth amendment repealed, and those fighting to keep it. In northern Ireland, anti-abortion lobbying has so far succeeded in blocking attempts to bring reproductive rights in line with the rest of the UK.

On the frontline are two anti-abortion groups who work loosely together across the border: Precious Life in northern Ireland and Youth Defence in the south.

In the past, both groups spent their time protesting against family planning clinics holding nightmarish posters purporting to show ‘the aborted baby’ (despite the fact that abortion was already illegal) and assuring those of us trying to enter that we were going straight to hell.

Today these groups have successfully attracted articulate millennial women to their ranks, who are then placed front and centre to recruit others. Grisly images remain, but threats of eternal damnation have been replaced with “Love Life” protests and “Rally For Life” marches.

The tone has titled to mirror the language of human rights activism and growing pro-choice movements that have been propelled by a new and active, engaged and connected generation. The last five years have seen rising pro-choice mobilisation in Dublin, Belfast and elsewhere, amid ‘repeal the eighth’ campaigns.

Precious Life at the ‘Rally for Life’ in Dublin. Photo: Lucy Kelly/Youth for Life/Facebook.

In July I joined the youth brigade of Precious Life, called Youth For Life NI, as they embarked on a summer roadshow tour of northern Ireland. They visited eight towns and cities in a week, almost at the same time as a similar Youth Defence tour, which made 17 stops across the rest of Ireland over ten days.

Appointed to speak to me was the eloquent and charming 20-year-old Lucy Kelly, who joined Precious Life through an affiliate group at Queen’s University in Belfast, where she studies law. Kelly describes herself as a “pro-life feminist”. She’s a committed campaigner and, I gathered, a serial over-achiever.

“Abortion is absolutely femicide”, she told me. “Consider who is aborted now – over half of the babies are female. So many times it’s about gender selective abortions. It’s this whole thing about women’s rights, but what about a woman’s right to be born?”

“What about a woman’s right to be born?”

Kelly is a strong communicator and her talent is clearly being recognised within the organisation. At this year’s ‘Rally For Life’ in Dublin, she was tasked with introducing the entire march before it kicked off.

This march is the highlight of the Irish anti-abortion calendar, and a potent display of the immensely well-connected, church-backed and community-centred lobby. This year, organisers claim 70,000 people attended (though this figure is disputed).

When we met, Kelly and half a dozen other young activists were cheerfully handing out pamphlets, featuring improbable horror stories from US abortion clinics, to shoppers caught in Belfast’s summer rain.

They had set up a table displaying aged plastic props – a womb and vagina, and foetuses at different stages of development – and advertisements for Stanton Healthcare, founded by US Christian activist Brandi Swindell, that opened its first overseas anti-abortion clinic in Belfast in 2014, on the same central street as reproductive rights charity Marie Stopes.

Swindell, described by Cosmopolitan magazine as ‘the woman who wants to take down Planned Parenthood’, is also one of the founders of a group called ‘Generation Life’, which recruits young anti-abortion campaigners and teaches abstinence as a form of contraception. Swindell has also worked with Youth Defence in Ireland.

Lucy Kelly (left) in Dublin at the ‘Rally For Life’. Photo: Youth for Life/Facebook.

“We are not anti-women”, Kelly insists. “We want to save both the life of the mother and the life of the baby – we want better care for both.”

Youth for Life is small – “we’re about 30 really pro-active and engaged members,” Kelly says – but has a large network of supporters offline and, increasingly, online. Among other things Precious Life sends out weekly emails, which Youth For Life contributes to, with updates for supporters and requests for donations.

Their funding, Kelly insists, does not come from the US, as is widely believed to be the case, and instead is from “grassroots” activists. But there is certainly a level of collaboration across the Atlantic. “Pro-life people stick together,” she says. “The big march in Washington DC, [the] numbers get bigger every year. Some of us are actually hoping to go…this year.”

There are also links being built across Europe: for this summer’s roadshow in northern Ireland, the group was also joined by activists from a Slovakian anti-abortion group. “People all over seem to be waking up,” says Kelly.

“Pro-life people stick together.”

Kelly laments that “the media are very biased in favour of abortion,” and that “the media totally misinforms people of the facts.” To this she said: “bring on the referendum, because you will lose.”
There’s a slightly counter-culture feel to it all: Kelly’s group is small, but everyone I meet is under 30 and appears deeply invested in trying to win over the hearts and minds of those few members of the public who did stop to challenge their views.

They presented themselves as activists for truth more than God, who wasn’t mentioned as far as I could hear – at least not in the conversations I was trying to earwig.

Young anti-abortion activists on the roadshow. Photo: Youth for Life/Facebook.

“Something we don’t hear about is how women die in legal abortions,” Kelly adds. “There was a woman from Ireland who died in Marie Stopes in London. Hundreds of women have [died] from so-called safe and legal abortion – look it up online.”

The weaving together of facts, anecdote and fictions is disarming. Abortion is a safe medical procedure (in the US less than 1% of terminations results in complications), but it’s likely she was talking about the preventable death of 32-year-old Aisha Chithira who died in London hours after having an abortion at 22 weeks in January 2012.

At the time, Chithira’s husband told the The Irish Times that she had first gone to a maternity hospital in Dublin but was denied a termination. In Ireland on student visas, the couple’s journey to England was delayed as they raised travel funds. Late term abortions carry significantly higher risks; staff involved in Chithira’s care were cleared of negligence charges in 2016.

But this tragedy has been twisted by both Precious Life and Youth Defence online, and seized upon by activists in the US who leverage the immense power of social media to tell highly emotional stories peppered with truth that promote their agenda.

“The internet helps massively of course”, Kelly told me. “Social media is massive for us, and when it’s used well it can be extremely effective.”

“Social media is massive for us.”

The array of websites framed by anti-rights and anti-abortion ideology that have emerged over the past decade could be seen as a case study in the power of “fake news”.

During the roadshow, another young woman anti-abortion activist said: “I wasn’t always pro-life, I agreed with abortion under some circumstances, but then I saw something on Facebook that had a profound impact on me.” Then, she said, “the more I started looking into it and researching it on Facebook, the more pro-life I became.”

Grim online videos, including notoriously deceptive 2015 undercover films, made by the anti-abortion Centre for Medical Progress inside Planned Parenthood clinics in the US, are particularly potent currency on Facebook.

In the social media giant’s attempts to become a video-led platform, algorithms alert users to videos based on their ‘likes’. And so a particularly distressing video by a man called Dr. Anthony Levatino recently appeared on my radar.

The video, which has been viewed more than a million times on YouTube alone, purports to show a first-trimester abortion. It’s currently at the centre of a hunger strike outside Irish parliament, by a young man who says he will not eat until the prime minister watches it.

The hunger striker is also a member of Youth Defence, and has previously run as an independent candidate in the Irish general election. Being anti-abortion in Ireland brings a certain level of political capital with it that election hopefuls eagerly cash in.

This year’s Rally for Life march in Dublin. Photo: Youth for Life/Facebook.

This summer, Kelly found a number of male politicians willing to appear in a Youth for Life promotional video that is now on their Facebook page.

What’s more, she said that one of the politicians featured in the video boasted, separately, about refusing to help a constituent who came to his office asking for assistance to get to England to obtain an abortion.

“I don’t ever feel like I am on the losing side.”

“We were really lucky with the roadshow in that most of the major parties agreed to meet us,” said Kelly, naming the SDLP, UUP and DUP as among them. “Our big campaign at the moment is ‘lobby for life’…to encourage people to contact their representatives, as they will be the ones deciding on any changes to the law.”

Northern Ireland’s first minister Arlene Foster also met with Youth for Life this summer, and assured them that she would work to protect existing anti-abortion laws.

Looking ahead, Kelly seemed confident that the eighth amendment will stay in place, and that northern Ireland will continue to be a place where women’s reproductive rights are restricted.
“There will always be obstacles, but we have to stay positive,” she said. “In the pro-life movement, everyone is extremely happy. Everyone is fighting for life. I don’t ever feel like I am on the losing side.”

Lara Whyte is an investigative journalist and award-winning documentary and news producer focusing on issues of youth, extremism and women’s rights. Originally from Belfast in northern Ireland, Lara is based in London. She is currently commissioning editor (special projects) for 50.50 tracking the backlash against sexual and reproductive rights. Find her on Twitter: @larawhyte.

Courtesy: Open Democracy
 

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