THIRUVANANTHAPURAM: The Union Ministry of Health and Family Welfare’s proposal to amend the Medical Termination of Pregnancy Act, 1971 has triggered a nationwide debate with allopathic doctors associations and Indian Medical Association coming out strongly against the move. They believe that allowing midwives, practitioners of ayurveda, siddha and homeopathy to carry out abortions could have serious ramifications on the health of pregnant women, even putting their lives in danger.
Many organisations of gynaecologists have already appraised the Union Health Ministry about their reservations and concerns on the issue. According to gynaecologists, abortions carried out in the first trimester of pregnancy involve a huge risk. Puncturing of the uterus, management of massive bleeding and sepsis are complications that need advanced medical care which Ayush doctors may not be able to provide.
“How can non MBBS doctors or midwives perform MTPs?,” asked Dr C Nirmala, head of the department of obstetrics and gynaecology, medical college Thiruvananthapuram. Such proposals, if adopted, could be misused widely in areas where medical facilities are scarce. “Just because women are poor and illiterate in many parts of the country does not mean that they don’t have the right to life or right to quality care. MTP was legalised to reduce mortality due to illegal abortions. But the changes proposed can bring things back to square one. And this is being done at a time when the world was going for wider research to make MTP’s more safe,” she added.
She said the focus should be on creating awareness about contraception. However, Ayurveda Medical Association of India (AMAI) which represents 7000 ayurveda practitioners in the state has supported the move. “With proper training and facilities even ayurveda doctors can handle abortions. Ayurveda surgery also includes modern surgery. We are using para surgical procedures to cure many problems. Ksharasutra procedure especially in the management of anal fistula is now widely recognised. It is a difficult disease to cure by conventional surgery,” said Dr Rejith Anand, AMAI general secretary.
On the charge that Ayush doctors will not be able to handle complications, he said; “Even MBBS doctors refer complicated cases to super speciality hospitals. Bad politics is responsible for the present controversy.” But gynaecologists reject the claims of ayurveda doctors in handling abortion cases. “Non MBBS doctors are not trained to handle complications. About 20 years ago we used to get criminal abortions. These were completely botched up cases coming from the periphery. Most patients used to come with near fatal complications. But with advanced medical facilities such cases have come down drastically. Allowing untrained people to handle MTPs will push us back to those days,” said Dr K P Vasanthakumari, Trivandrum Obstetrics and Gynaecology Society.
Interestingly, a section of the Federation of Obstetric and Gynaecological Societies of India (FOGSI) an umbrella organisation of gynaecologists has favoured the health ministry’s proposal to allow non-MBBS practitioners to carry out abortions. However, a large number of members of the association are against the proposal.
Many societies affiliated to FOGSI have also expressed their reservations. Inclusion of non-allopathic health care practitioners, nurses, auxiliary nurses and midwives will encourage quackery and put the health of women at risk. Objection to the proposal is coming even from Ayurveda doctors. Dr P K Soman, president of Government Ayurveda Medical Officers Association, said even if Ayush doctors were trained, not many would come for MTPs to them. “You need all state of the art medical facilities to treat complications. I do not think people will take the risk ,” he said.
However, those supporting the proposal say non MBBS, midwives and nurses can be trained to handle abortions. Expanding the base of health care providers by including mid level and non allopathic health care providers is also seen as a positive development considering the high rates of unsafe abortions especially in rural areas across the country.
The supporters of the move believe that the proposal is more inclusive. One of the highlights of the proposal is that the first trimester abortion will be considered a matter of the woman’s choice and physicians’ opinion will no longer be required. In the second trimester, a woman will require only one physician’s opinion.
But the opponents also point to the long term complications like pelvic inflammatory disease (PID) which can damage reproductive organs and cause infertility. Other apprehensions include possible increase in sex selective abortions and dip in child sex ratio. Clearly the government will have to carry out a comprehensive exercise to ensure that all these concerns are addressed well before the proposals become law.
