The proposed new Medical Termination of Pregnancy (MTP) Amendment Draft Bill to allow nurses and non allopathic practitioners such as ayurveds and homeopaths to conduct MTP has triggered a huge debate on patient safety versus access to healthcare. This story in the Times of India says the the government’s proposal was formulated after a study conducted by the Population Council, which had suggested that expansion of healthcare providers to legally perform abortion services will result in increasing access to safe abortion. However, many are concerned that abortion by untrained professional may put patients at risk and encourage unethical practices.
The Indian Medical Association (IMA) has strongly opposed the government’s proposal. IMA is a pan India voluntary organisation with a membership of 2.5 lakh medical practitioners. It argues that the proposal to permit non MBBS doctors and paramedical staff to conduct MTPs is against the provisions of the Clinical Establishments Act, which does not recognise even paramedical personnel trained by the doctors for conducting medical procedures. The IMA pointed that the amendment draft made by the union Health Ministry was incorrectly based on an unscientific study done by Population Council in 2012 which showed that trained nurses and ayurved physicians provide medical abortions as safely as MBBS doctors
Dr. Anoop Misra, former professor of medicines at AIIMS and chairman -Fortis hospital and Dr. Mala Srivastava, senior consultant-gynaecology at Ganga Ram Hospital agree with the IMA view point . “Without proper training and qualification, MTP procedures can result in incomplete abortions and infections which can be hazardous for patients,” says Dr Srivastava.
According to the TOI article , seven million abortions in India are conducted every year. Out of this 50 per cent of the abortions are conducted illegally. The rates of maternal death attributed to complications from unsafe abortions are estimated at eight per cent.
In contrast, World Health Organisation (WHO) and other organisations seem to endorse the government’s proposal. One of the reasons for this as suggested in the news is that in remote areas, legal restrictions are holding many non- certified but trained paramedics or health care providers from performing abortions.
“Because of legal restrictions, many trained professionals opt for the illegal route to perform abortions. By introducing provisions in the law to make it legal, government can ensure proper training of such professionals while also enabling regulation and monitoring,” says Vinoj Manning. He is the Country Director of IPAS, a non-profit organisation that works to increase women’s ability to exercise their sexual and reproductive rights and reduce maternal mortality.
This is an important issue and HII will be monitoring this story closely.
We would like to leave you with one last view point for today . Shiv Sena MP, Dr. Shrikat Shinde doesn’t agree with the proposed amendment. He decided to educate his colleagues in the parliamentary standing committee on the health and family welfare about the proposed change in the MTP Law. As he said, “we are opening the floodgates by allowing anyone and everyone to conduct abortions. The surgery involves use of sharp instruments such as the curette. Any doctor, nurse or midwife not trained to use these instruments or who has not studied the female anatomy just cannot conduct this procedure”. He will bringing up the issue at the meeting of the parliamentary standing committee scheduled this Wednesday.