Interpreting the Medical Termination of Pregnancy Act by primary care providers in rural Karnataka: implications on safe abortion services

Maya Annie Elias,Mr Raveesha,Mamata R Patil,N Devadasan,Mh Anil,Arima Mishra,Hy Vijayashree,Patrick Van Dessel

doi:10.1186/1753-6561-6-s5-p14

Maya Annie Elias, Mr Raveesha + Show 6 more

Open Access

https://doi.org/10.1186/1753-6561-6-s5-p14

Copy DOI

Abstract

Evidence shows that eight per cent of maternal mortality in India is caused by unsafe abortions. India was one of the pioneer countries to legalize its abortion services as early as 1971. The Medical Termination of Pregnancy Act (MTP) is an enabling regulation, which allows MTP on both medical and social grounds and thus facilitates access to safe abortion services. However, despite this supposedly progressive law, which has existed for more than four decades, ‘illegal’ and unsafe abortions are still a reality in India particularly in rural areas. There is a large body of research on MTP that examines barriers to access safe abortion services from the users’ perspectives. This paper turns the research gaze from the users to the providers particularly at the primary health care level to examine the persistence of illegal and unsafe abortions in rural Karnataka.

Highlights

Evidence shows that eight per cent of maternal mortality in India is caused by unsafe abortions
Results of the study showed that (a) very few of the medical officers were trained in Medical Termination of Pregnancy Act (MTP) though many of them offered the services; (b) there was a perceived disjunction between clinical and legal training; MTP training was perceived as a mere ‘legal cover’ and not necessarily equipping providers with additional skills to provide MTP services; (c) in the absence of legal training, providers justify the provision of delivery of service through a range of explanations including “being ethical catering to patients’ demands”, “we provide abortion services not MTP”, “abortions through oral pills are out-patient cases and are not reported”; (d) MTP was largely perceived as a ‘restrictive regulation’ than enabling
Such perception was influenced by several factors like the mandatory legal training, exclusion of non-allopathic primary providers, inadequate dissemination of the regulations including amendments, lack of sensitization training of providers and health workers and providers’ own cultural beliefs; and, (e) boundaries between legal and illegal were often drawn at ‘married/unmarried’, ‘less than and more than 12 weeks of pregnancy’

Summary

Introduction

Evidence shows that eight per cent of maternal mortality in India is caused by unsafe abortions. The Medical Termination of Pregnancy Act (MTP) is an enabling regulation, which allows MTP on both medical and social grounds and facilitates access to safe abortion services. Despite this supposedly progressive law, which has existed for more than four decades, ‘illegal’ and unsafe abortions are still a reality in India in rural areas. There is a large body of research on MTP that examines barriers to access safe abortion services from the users’ perspectives.

Methods

Results

Conclusion