Mcb777 Live Why 'counselling' a woman against abortion is a rights violation

When the Supreme Court recently turned down a woman’s plea seeking an abortion after being pregnant for 26 weeks, it put the spotlight on India’s supposedly progressive abortion law that presumes to give women the right to choose to abort a pregnancy. In this case, the Supreme Court initially granted the mother of two permission to abort the pregnancy, but overturned its verdict after a doctor on the All India Institute of Medical Sciences (AIIMS) medical board sought clarifications on the abortion. The woman had sought – and was initially granted permission – for an abortion on account of mental illness and economic constraints.During the hearing, the judges and central government’s lawyer also spoke to the woman multiple times on the grounds that they were 'counselling' her. In the end, the court asked AIIMS to provide all medical help and assistance to the woman to continue with her pregnancy to full-term.Legal experts have pointed out the issue with the Supreme Court dealing with terms like 'foetal viability', which are alien to Indian jurisprudence. In this episode of The Times of India podcast, Dr Subha Sri Balakrishnan from CommonHealth, which works on providing safe abortion services and reproductive health services, spoke about why it is difficult for women to access an abortion despite the Medical Termination of Pregnancy (MTP) Act permitting it. Edited excerpts: How easy is it for a woman in India to access an abortion?If you look at access to services, there are studies that show abortion services are scarcely available, especially in the public hospitals. They are usually available only in the private sector, and that too only in bigger centres like district headquarters, towns or cities. So for a person to actually access the services, they have to first ensure they are allowed to make the decision, then get their partner or family’s support, and have adequate money for the procedure. Studies have shown the more desperate the person is to terminate a pregnancy, the higher the cost. So if it's a socially unsanctioned pregnancy, like if the person is not married and there is a lot of stigma around it, then the costs actually go up tremendously. If the gestational age is higher, the costs go up. So it's actually a very exploitative service. !function(){"use strict";window.addEventListener("message",(function(a){if(void 0!==a.data["datawrapper-height"]){var e=document.querySelectorAll("iframe");for(var t in a.data["datawrapper-height"])for(var r=0;r<e.length;r++)if(e[r].contentWindow===a.source){var i=a.data["datawrapper-height"][t]+"px";e[r].style.height=i}}}))}();Even within a marriage, terminating a pregnancy carries a lot of stigma. That’s because society views this with religious and moral overtones. A good woman is supposed to be somebody who's the sacrificial mother. Any person who seeks an abortion has to navigate all these social barriers before they are able to reach the health system, and then they have to navigate the barriers there. That’s why a lot of women still end up with unsafe abortions and it’s one of the top causes of maternal deaths in this country. This is why abortions should be legally and safely available.Untitled Carousel 104733359 How do you view the language used in the SC while deciding on permitting the abortion? I think it is quite concerning, because it's a slippery slope, and could impinge on any woman’s right to choose even at other gestational periods of pregnancy. To personify a foetus, this whips up a lot of negativity around abortion itself. Abortion is already a highly stigmatised issue socially, and this further adds to the stigma. This actually places the person who's seeking the abortion in a very difficult situation. What explains the inconsistencies in how medical boards consider late-stage abortions? Why do they rule differently in similar cases? There are several studies on healthcare providers’ attitudes towards abortion, and they show that healthcare providers come with their own prejudices and biases. These could come from religious, moral or ethical beliefs. There are enough studies to show that these attitudes of providers actually affect access to abortion. That is something that actually gets highlighted in this case as well, where an individual provider’s personal beliefs, or prejudices, have influenced how the case was handled. Internationally, the European Human Rights Commission's judgments talk about what they call conscientious objection. If a provider feels that they're not able to provide a particular procedure, they still have a duty to ensure the patient gets the procedure. We do need a lot more sensitisation for healthcare providers. Also, the MTP Act does not penalise refusal of services. I think we need a regulatory framework that actually ensures that a person eligible is able to receive the service without being refused by a healthcare provider.In this case the SC kept counselling the woman to not undergo the abortion. This has happened in other courts as well. Are women typically counselled before an abortion?Ideally, counselling is an essential feature of an interaction with the person who's seeking an abortion service. There, counselling would entail confirming with the person that they are not being coerced. After that, the counselling process informs them of the various medical methods available and what would be suitable. They would be informed of the risks, post-procedure care and follow up. They would be spoken to about contraception because this is a person who's come with an unwanted pregnancy. !function(){"use strict";window.addEventListener("message",(function(a){if(void 0!==a.data["datawrapper-height"]){var e=document.querySelectorAll("iframe");for(var t in a.data["datawrapper-height"])for(var r=0;r<e.length;r++)if(e[r].contentWindow===a.source){var i=a.data["datawrapper-height"][t]+"px";e[r].style.height=i}}}))}();However, counselling has transformed into something where you're actually trying to thrust your views on that person. The latest World Health Organisation (WHO) guidelines on abortion services point out that in many places women undergo something called mandatory counselling. Many times this is used to convince the person not to go ahead with the abortion. The WHO actually calls it a human rights violation. The AIIMS report argued that the foetus was a viable one and that’s what the Supreme Court accepted. How do you view the discussion of ‘foetal viability’? Nowhere in the MTP Act is foetal viability talked about. If you look at international human rights law, a person becomes a person only at the moment of birth. It is quite unfortunate this term was used. If you look at the gestational ages that are given as limits in the law, the whole rationale is based on the advances in medical technology and the safety of the procedure for the pregnant individual. It doesn’t have anything to do with the foetus. ShowQuotesSome medical practitioners say that freely providing abortions could prevent use of contraceptives and increase female foeticide. How do you view these claims? If you look at the reasons behind second trimester abortions, studies have shown sex-selective abortions are a small proportion. Why most women actually have second trimester abortions is because they're not able to get first trimester abortions.These are women who are already in difficult circumstances. They may be young women who may not be married, or do not discover the pregnancy early enough. Some face a lot of social stigma, are not able to disclose the pregnancy and get enough support from their family, or partner, to access abortion services. They are women who are poor, who do not have enough resources to access the abortion services. To say that liberalising abortions will cause sex-selective abortions to rise, is not backed by data. !function(){"use strict";window.addEventListener("message",(function(a){if(void 0!==a.data["datawrapper-height"]){var e=document.querySelectorAll("iframe");for(var t in a.data["datawrapper-height"])for(var r=0;r<e.length;r++)if(e[r].contentWindow===a.source){var i=a.data["datawrapper-height"][t]+"px";e[r].style.height=i}}}))}();I’ve been an abortion service provider for over a decade now. Having an abortion is not a frivolous decision that any woman makes, it's actually a very difficult – and often traumatising – decision that a person has to take. I don't think any woman wants to go through multiple abortions. The perception that women will suddenly start coming for multiple abortions is not rooted in reality. I don't think any woman willfully will not use contraception if it is available and she has adequate information about it. Liberalising abortion will only esure that those who need an abortion actually end up getting a safe abortion.How can abortion services in India be improved? The person who needs an abortion should be at the centre of the decision. The MTP law should validate the right to bodily autonomy and the right to choose. The law is presently still controlled by the healthcare providers. I think access and availability of abortion services definitely has to increase. They should be available in the public sector, at the primary health-centre level. There are now abortion pills and healthcare providers can easily be trained to provide them safely.