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Gynecologist proposes MTP Act overhaul to Bombay HC

In order to improve the implementation of the Medical Termination of Pregnancy (MTP) Act, 2021, city-based gynaecologist Dr Nikhil Datar has submitted crucial suggestions to the Bombay high court (HC) on Friday. These recommendations come in response to concerns about the practical application of the amended act, particularly regarding the termination of pregnancies beyond 24 weeks, and its alignment with existing guidelines.

Dr Datar’s suggestions address various gaps in the current framework, including limitations in the form used by Medical Boards to provide opinions on termination. This oversight, according to him, adds complexity for pregnant individuals seeking to terminate their pregnancies.

HC on April 25 allowed Dr Datar’s patient, a 37-year-old Thane resident to terminate a 27-week pregnancy at a private hospital due to foetal abnormalities, setting a unique precedent.

“While the court permitted my patient to get the MTP done in a private hospital, I submitted the affidavit to highlight the ‘system error’,” said Dr Datar.

The Goregaon-based judicial activist has by now helped more than 324 women above 20 weeks of pregnancy get court approvals and fight for their rights to get MTP. Dr Datar said even after the amendment, the Act does not give clarity on the intention with regards to the foetus while terminating the woman’s status of being pregnant.

“There is an ambiguity in terms of the outcome of the termination of pregnancy. We are only saying that we are terminating the pregnancy, which means we are inducing separation of the foetus from the mother’s body. but it is unclear what next? Should the foetus be born as a “ live child”? Will it not be an absurdity to have a severely abnormal “child” that too now born prematurely, lead to a lot of anguish and pain?” he questioned.

The suggestions were presented in an affidavit filed in connection with a petition by a woman from Thane seeking to terminate her 27-week pregnancy at a private hospital, challenging the restriction that prevents terminations beyond 24 weeks at private institutions. On Thursday a bench comprising Justice AS Chandurkar and Justice Jitendra Jain allowed the plea, leaving open the question of whether such procedures could be routinely performed at private hospitals.

Dr Datar emphasised that he noticed the need for clarity subsequent to a meeting with the Medical Board at JJ Hospital, identifying key issues that require urgent attention for the effective functioning of the MTP Act. These issues include the ambiguity surrounding the applicability of the Guidance Note issued by the Ministry of Health & Family Welfare and the absence of a designated column in Form “D” for the Medical Board to specify the method of termination. While the note requires foeticide to be performed before the actual act of abortion, Datar says that this is not often followed in government hospitals and most often is unknown to many of them.

Additionally, he highlighted concerns about the ambiguous definition of “medical termination of pregnancy” in the MTP Act, which does not distinguish between premature delivery and abortion. He suggested specific directions by the Medical Board to prevent potential complications.

Moreover, he also pointed out potential inadequacies in infrastructure and manpower in hospitals with permanent Medical Boards, emphasising the need for sufficient resources to carry out specialised procedures outlined in the guidance note.

“In this case, the medical board permitted MTP due to severe foetal abnormality and also allowed the procedure to stop the heart beforehand. At the same time, government hospitals said that they don’t have the required facilities. On top of it, the government is not willing to allow termination in private hospitals even after a woman’s request. This means that we are ultimately making the woman and the foetus suffer,” said Dr Datar.

He also stressed the importance of addressing these issues to uphold the objectives of the MTP Act, particularly in improving access to safe and legal abortions for women. His proposals aim to streamline implementation processes and address challenges faced by medical practitioners and institutions.

Case history
The 37-year-old woman had obtained the approval of the civic-run JJ Hospital’s medical board to terminate her pregnancy due to a congenital heart abnormality in the foetus. However, she wanted Dr Nikhil Datar, an obstetrician and gynaecologist at private hospital Cloudnine, to do the procedure.

That’s when she learnt that the Medical Termination of Pregnancy (MTP) Act mandates terminations beyond 24 weeks to occur solely at government hospitals or government-approved institutions. Private hospitals are also not permitted to seek approval to perform such procedures.

Adding to her concerns, the JJ Hospital medical board’s report indicated that if the baby were born alive during the procedure, it would require admission to the neonatal intensive care unit. Fearing the birth of a live baby, she sought selected foetal reduction. In response, she challenged this restriction as a violation of her constitutional right to life, highlighting the emotional distress of being forced to deliver a foetus with severe abnormalities. The woman and Dr Datar then approached Bombay High Court. Hindustan Times

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