Expanding Access to Safe Abortion Services to the Fullest Extent Possible by Law

Abortion access pathways are complex and multi-dimensional, shaped by both systemic constraints and individual choices.

In India, conditional access to safe and legal abortion services is possible for a wide category of pregnant persons, under the purview of the MTP Act (Amendment) 2021. However an interplay of societal and structural barriers reinforce each other, leading to delays or denials faced by abortion seekers in timely and safe abortion care.

Societal Barriers:

  • Stigma and cultural taboos around abortion, along with deep-rooted gender and socioeconomic inequalities.
  • Limited awareness about legal rights available services further restricts access.
  • These barriers often lead to delays, unsafe practices, and poor health outcomes, reducing individuals' ability to make informed choices.

Structural Barriers

Structural challenges exist at legal, provider, and system levels. These include

  • Inconsistent implementation of the MTP Act,
  • Delays in medical board processes, and
  • The impact of other laws and regulations on the implementation of the MTP Act. For example, overlaps with laws such as the Protection of Children from Sexual Offences (POCSO) Act can create confusion among providers, particularly around mandatory reporting requirements, which may delay or restrict access to abortion services. Similarly, provisions of the PCPNDT Act or the Drugs & Cosmetics Act are sometimes misapplied, resulting in denial or postponement of abortions.
  • Providers also face operational and registration hurdles, while access remains limited in remote areas. In addition, there is inadequate availability of medication abortion services and a lack of clear clinical protocols, especially for later-term abortions. Private providers are often constrained in offering abortion services due to complex and overlapping regulatory requirements, a pervasive fear of legal repercussions, and gaps in clinical guidance — particularly around second trimester procedures and foetal demise protocols.

Priority actions identified by ARISE to mitigate barriers to access include

  1. Influencing State level directives for effective implementation of the Abortion law to ensure access of the most vulnerable groups such as adolescents under 18 years of age, those needing late-term termination of pregnancy, or those who are unmarried) to MTP services, without stigma or discrimination.
  2. Systematically map and document the functioning of Medical Boards as a necessary first step, with recommendations to strengthen their functioning.
  3. Engage with and involve subject matter experts to support qualified abortion providers with clear updated, evidence-based technical guidelines on late-term abortion protocols.