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Subject: Health

Need for integrated approach to power sector
Context

Electricity and development sectors need a more integrated approach to achieve the vision set forth in instruments such as the Union Budget that guide policy implementation at other administrative levels.

Reduction in allocation
- While the health sector witnessed a 16% increase in estimated Budget allocations from last year, medical and public health spending was reduced by 45% for 2022-23.
- Budget estimates demonstrate intent, but the proof of the pudding lies in the actual expenditure which reiterates the need for greater attention to be paid to our health and education sectors.
- While the health sector was allocated ₹74,602 crore in 2021-22, the Government exceeded its spending by over ₹5,000 crore more (₹80,026 crore) on health, signalling a spike in demand, likely propelled by the ongoing COVID-19 pandemic.
- Given this scenario, a less than ₹1,000 crore increase in the Budget Estimate (₹86,606 crore) in 2022-23 when compared with last year’s Revised Estimates (₹85,915 crore) appears incongruent with the Government’s aim of providing quality public health care at scale.
Role of reliable energy
- It is widely recognised that the availability of reliable electricity supply can improve the delivery of health and education services.
- 74% of the targets of the Sustainable Development Goals are interlinked with universal access to reliable energy.
- Its reliability in terms of the number of hours that electricity is available steadily without any voltage fluctuations also plays a significant role in delivering services.
- Sometimes, multiple policies can complement each other to achieve the larger sectoral objectives.
- For example, in Assam, the Energy Vision document that lays out the electricity and development outcomes is to be applied in tandem with the Solar Energy Policy 2017 that operationalises this vision via an action plan.
Reasons for lack of integration of electrification in the development sector
- The lack of integration of electrification requirements in development sector policy documents may be partly due to lack of information about electricity and development linkages, poor coordination mechanisms between the sectors and departments, and poor access to appropriate finance.
- Even while electricity is considered, it is to the limited extent of being a one-time civil infrastructure activity rather than a continuous feature necessary for the day-to-day operations of these services.
Way forward
- To successfully integrate electricity provisioning and maintenance, policy frameworks should include innovative coordination and financing mechanisms.
- These mechanisms, while developing clear compliance mandates, must also allow sufficient room for flexibility to respond to local contexts.
- Providing reliable electricity for health centres and schools should be the responsibility of centralised decision-making entities at the State or national level.
- As India has witnessed with other cross-sectoral and centralised statistical, planning, and implementation data governance, diverse contexts must support oversight mechanisms that ensure data credibility.
- Finance is largely unavailable to ensure reliable electricity supply to schools and health facilities.
- Some directives, such as those governing the use of untied funds, need to be more flexible in allowing these facilities to prioritise providing reliable and sustainable electricity.
Conclusion

A successful policy outcome might be dependent on several invisible aspects that do not get the attention and funding necessary to aid in successful policy delivery. Electricity is one of them.

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February 28, 2022
What are Eat Right Campuses?
Four police stations of New Delhi district have been certified as ‘Eat Right Campus’ by the Food Safety and Standards Authority of India (FSSAI).

Eat Right Campus
- Eat Right India is a flagship mission of FSSAI, which aims at ensuring that the citizens of the country get safe and nutritious food.
- The ‘Eat Right Campus’ initiative led by FSSAI aims to promote safe, healthy and sustainable food in campuses such as schools, universities, colleges, workplaces, hospitals, tea estates etc. across the country.
- The objective is to improve the health of people and the planet and promote social and economic development of the nation.
- The initiative is not mandatory to adopt.
Evaluation Criteria
- Benchmarks have been created on four different parameters based on which campuses are evaluated and certified as ‘Eat Right Campus’.
- These parameters include
1. Food safety measures, steps to ensure the provision of healthy, Environmentally sustainable food, and Building awareness to make the right food choices.
2. These practices include mandatory steps such as licensing and registration of food service providers in the campus and compliance to food safety and hygiene standards as per Schedule 4 of the Food Safety and Standards (FSS) Act, 2006.
Benefits of Eat Right Campus
- It can provide immense benefits to the campus and the individuals on the campus not only in terms of health but also economics.
- Safe, healthy, and sustainable food on the campus would reduce the incidence of food-borne illnesses, deficiency diseases, and non-communicable diseases among the people on the campus.
- This means less absenteeism and loss of working hours and greater wellbeing, motivation, and productivity of people.
- This would also reduce the burden of healthcare costs for the workplace, institution, hospital, jail, or tea estate.
Back2Basics: Food Safety and Standards Authority of India (FSSAI)
- The FSSAI is an autonomous body established under the Ministry of Health & Family Welfare, Government of India.
- It has been established under the Food Safety and Standards Act, 2006 which is a consolidating statute related to food safety and regulation in India.
- It is responsible for protecting and promoting public health through the regulation and supervision of food safety.
- It is headed by a non-executive Chairperson, appointed by the Central Government, either holding or has held the position of not below the rank of Secretary to the Government of India.
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February 17, 2022
Intensified Mission Indradhanush (IMI) 4.0 launched
The Union Health Minister has launched the Intensified Mission Indradhanush (IMI) 4.0.

About IMI 4.0
- The IMI 4.0 will have three rounds and will be conducted in 416 districts (including 75 districts identified for Azadi ka Amrit Mahotsav) across 33 States and UTs, a Health Ministry statement said.
- It will immensely contribute in filling the gaps and make lasting gains towards universal immunisation.
- It will ensure that Routine Immunisation (RI) services reach the unvaccinated and partially vaccinated children and pregnant women” he said.
What is Mission Indradhanush ?
- With the aim to increase the full immunisation coverage, the PM launched Mission Indradhanush in December 2014.
- It aimed to cover the partially and unvaccinated pregnant women and children in pockets of low immunisation coverage, high-risk and hard-to-reach areas and protect them from vaccine preventable diseases.
- The first two phases of the Mission resulted in 6.7% increase in full immunisation coverage in a year.
Aims and objectives
- It aims to immunize all children under the age of 2 years, as well as all pregnant women, against eight vaccine-preventable diseases.
- The diseases being targeted are diphtheria, whooping cough, tetanus, poliomyelitis, tuberculosis, measles, meningitis and Hepatitis B.
- In 2016, four new additions have been made namely Rubella, Japanese Encephalitis, Injectable Polio Vaccine Bivalent and Rotavirus.
- In 2017, Pneumonia was added to the Mission by incorporating the Pneumococcal conjugate vaccine under Universal Immunisation Programme
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February 10, 2022
Pradhan Mantri Matru Vandana Yojana (PMMVY)
The government’s recent announcement that the maternity benefits program which provides ₹5,000 for the first child will be extended to cover the second child only if it is a girl has met with sharp criticism from activists who have demanded that it be universalized.

What is PMMVY?
- Launched in 2017, this scheme provides ₹5,000 for the birth of the first child to partially compensate a woman for the loss of wages.
- It also aims to improve the nutritional well-being of the mother and the child.
- The amount is given in three installments upon meeting certain conditions.
- It is combined with another scheme, Janani Suraksha Yojana, under which nearly ₹1,000 is given for an institutional birth so that a woman gets a total of ₹6,000.
Eligibility Conditions

The first transfer (at pregnancy trimester) of ₹1,000 requires the mother to:
- Register pregnancy at the Anganwadi Centre (AWC) whenever she comes to know about her conception
- Attend at least one prenatal care session and take Iron-folic acid tablets and TT1 (tetanus toxoid injection)
- Attend at least one counseling session at the AWC or healthcare centre.
The second transfer (six months of conception) of ₹2,000 requires the mother to:
- Attend at least one prenatal care session and TT2
The third transfer (three and a half months after delivery) of ₹2,000 requires the mother to:
- Register the birth
- Immunize the child with OPV and BCG at birth, at six weeks, and at 10 weeks
- Attend at least two growth monitoring sessions within three months of delivery
Additionally, the scheme requires the mother to:
- Exclusively breastfeed for six months and introduce complementary feeding as certified by the mother
- Immunize the child with OPV and DPT
- Attend at least two counselling sessions on growth monitoring and infant and child nutrition and feeding between the third and sixth months after delivery
Why in news?
- Under the revamped PMMVY under Mission Shakti, the maternity benefit amounting to ₹6000 is also to be provided for the second child.
- However, this is only in case the second is a girl child, to discourage pre-birth sex selection and promote the girl child.
Issues with this provision
- To provide maternity benefit only to the mother of the firstborn is illegal as the National Food Security Act, 2013 lays down that every pregnant woman and lactating mother are entitled to it.
- For second child as a girl, it is to promote the birth of a girl child is nothing but posturing since it penalizes the mother for not giving birth to a girl child.
- Subsequent adding of more conditions to the scheme will prove to be a bureaucratic nightmare, which can be overcome if the scheme is universalized.
- Women will be able to access the scheme only after the delivery, which will not have any impact on their nutritional uptake during the course of their pregnancy.
Before judging this factual information, take this PYQ form 2019:

Q.Which of the following statements is/are correct regarding the Maternity Benefit (Amendment) Act, 2017?
1. Pregnant women are entitled to three months pre-delivery and three months post-delivery paid leave.
2. Enterprises with creches must allow the mother a minimum of six crèche visits daily.
3. Women with two children get reduced entitlements.
Select the correct answer using the code given below.

(a) 1 and 2 only

(b) 2 only

(c) 3 only

(d) 1, 2 and 3

[wpdiscuz-feedback id=”6pftvi12o6″ question=”Please leave a feedback on this” opened=”1″]Post your answers here.[/wpdiscuz-feedback]
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February 8, 2022
Weighing in on a health data retention plan
Context

The National Health Authority (NHA) — the body responsible for administering the Ayushman Bharat Digital Mission (ABDM) — has initiated a consultation process on the retention of health data by healthcare providers in India. The consultation paper asks for feedback on what data is to be retained, and for how long.

Issues with the policy for healthcare data retention
- Risk of over-collection: A simple classification system, as suggested in the consultation paper, exposes individuals to harms arising from over-collection and retention of unnecessary data.
- At the same time, this kind of one-size-fits-all system can also lead to the under-retention of data that is genuinely required for research or public policy needs.
- Instead, we should seek to classify data based on its use.
Do we need a policy for the mandatory retention of health data?
- Currently, service providers can compete on how they handle the data of individuals or health records, in theory, each of us can choose a provider whose data policies we are comfortable with.
- Whether the state should mandate a retention period at all is an open question.
- Given the landscape of healthcare access in India, including through informal providers, many patients may not think about this factor in practice.
- Nonetheless, the decision to take the choice out of the individual’s hands should not be taken lightly.
Balancing the policy for public health data retention with the right to privacy
- Four-part test for privacy: The Supreme Court of India has clarified that privacy is a fundamental right, and any interference into the right must pass a four-part test: legality; legitimate aim; proportionality, and appropriate safeguards.
- Health data and privacy: The mandatory retention of health data is one such form of interference with the right to privacy.
- 1] Legality: In this context, the question of legality becomes a question about the legal standing and authority of the NHA.
- Since the NHA is not a sector-wide regulator, it has no legal basis for formulating guidelines for healthcare providers in general.
- 2]Legitimate aim: The aim of data retention is described in terms of benefits to the individual and the public at large.
- Benefits to the individuals: Individuals benefit through greater convenience and choice, created through portability of health records.
- The broader public benefits through research and innovation, driven by the availability of more and better data to analyse.
- Risk involved: Globally, legal systems consider health data particularly sensitive, and recognise that improper disclosure of this data can expose a person to a range of significant harms.
- Benefits must be clearly defined: As per Indian law, if an individual’s rights are to be curtailed due to anticipated benefits, such benefits cannot be potential or speculatory: they must be clearly defined and identifiable.
- 3] Proportionality: This is the difference between saying that data on patients with heart conditions will help us better understand cardiac health — a vague explanation — and being able to identify a specific study that will include data from that patient.
- It would further mean demonstrating that the study requires personally identifiable information, rather than just an anonymous record — the latter flowing from the principle of proportionality, which requires choosing the least intrusive option available.
- 4] Safeguard: Standards for anonymisation are still developing.
- We are not yet able to rule out the possibility of anonymised data still being linked back to specific individuals.
- In other words, even anonymisation may not be the least intrusive solution to safeguarding patients’ rights in all scenarios.
Way forward
- Clear and specific case for retention: The test for retaining data should be that a clear and specific case has been identified for such retention, following a rigorous process run by suitable authorities.
- Anonymise data: A second safeguard would be to anonymise data that is being retained for research purposes — again, unless a specific case is made for keeping personally identifiable information.
- If neither of these is true, the data should be deleted.
- Express and informed consent: An alternate basis for retaining data can be the express and informed consent of the individual in question.
- User-based classification process: Health-care service providers — and everyone else — will have to comply with the data protection law, once it is adopted by Parliament.
- The current Bill already requires purpose limitation for collecting, processing, sharing, or retaining data; a use-based classification process would thus bring the ABDM ecosystem actors in compliance with this law as well.
Consider the question “What are the advantages and concerns with the retention of public health data? Suggest the ways to ensure the privacy-centric public health data retention policy.”

Conclusion

A privacy-centric process is needed to determine what data to retain and for how long.

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February 7, 2022
Missed opportunity to opportunity of employment-centred and inclusive growth
Context

India continues to rank poorly in various global indices that reflect the quality of life, human capital or human development in the country. In this context, it was expected that the current Budget would see an expansion in government spending on the social sector.

Need for greater spending on social sector
- In Human Development Index, India ranks 131 out of 189 countries and on the Global Hunger Index, it ranks 101 out of 116 countries.
- The pandemic over the last two years has had a severe impact on the health, education and food security of the poor and informal sector workers.
- The country has been experiencing increasing inequality over the last couple of decades.
Marginal increase in allocation for school education
- In the budget, the government announced that it will expand its ‘one class, oneTVchannel’ scheme instead of announcing enhanced allocations for schools the government announced that it will expand its ‘one class, oneTVchannel’ scheme instead of announcing enhanced allocations for schools so that they can reopen with vigour.
- The budget for school education at ₹63,449 crore is a slight improvement over last year’s ₹54,873 crore (2021-22 budget estimates, BE) and a mere increase of 6% in nominal terms compared to 2020-21 BE of ₹59,845 crore.
- After rechristening the school mid-day meal scheme as Pradhan Mantri Poshan Shakti Nirman, simply called PM Poshan, the allocation for the scheme has reduced from ₹11,500 crore last year to ₹10,233 crore this year.
Low allocation for health
- Despite repeated statements about strengthening the public health system, the overall budget for the Department of Health and Family Welfare at ₹83,000 crore has gone up by only 16% over the BE for 2021-22 and by less than ₹1,000 crore compared to the RE for 2021-22, which is ₹82,921 crore.
- However, by including water and sanitation in the budget for health, there is an increase being shown in health spending as a proportion of GDP.
- Also, even though the budget for the Jal Jeevan Mission has increased from ₹50,000 crore to ₹60,000 crore, only 44% of the allocated funds to the Department of Water and Sanitation for 2021-22 has been spent as on end December 2021.
No indication of plan to extend the PMGKAY
- 60% of the population are covered by ration cards currently under the National Food Security Act.
- Those who were eligible benefited from the additional free foodgrains that they have been given under the Pradhan Mantri Garib Kalyan Anna Yojana (PMGKAY).
- However, the food subsidy (BE) for 2022-23 at ₹2.06 lakh crore is only enough to cover the regular NFSA entitlements.
- The indication is that there is no plan to extend the PMGKAY.
- The food subsidy RE for 2021-22 is ₹2.86 lakh crore.
Other schemes
- Budgets for important schemes such as Saksham Anganwadi, maternity entitlements and social security pensions are around the same as the allocations for last year.
- The allocation for MGNREGA at ₹73,000 crore also does not reflect the increased demand for work or thethe pending wages of ₹21,000 crore.
Continued negligence
- The resources allocated for crucial government schemes in the fields of health, education, nutrition, and social protection have remained stagnant or show negligent increase.
- In fact, the budgets for these schemes have been declining in real terms since 2015.
- The World Social Protection Report 2020-22, brought out by the International Labour Organization, shows that the spending on social protection (excluding health) in India is 1.4% of the GDP, while the average for low-middle income countries is 2.5%.
Conclusion

This continued negligence does not bode well for inclusive development in India.

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February 2, 2022
How the Budget can push India’s health system transformation
Context

After decades of low government expenditure on health, the Covid pandemic created a societal consensus on the need to strengthen our health system.

Steps to strengthen our health system
- The Fifteenth Finance Commission recommended greater investment in rural and urban primary care, a nationwide disease surveillance system extending from the block-level to national institutes, a larger health workforce and the augmentation of critical care capacity of hospitals.
- The Union budget of 2021 reflected these priorities in a proposed Pradhan Mantri Aatmanirbhar Swasth Bharat Yojana (PMASBY) to be made operational over six years, with a budget of Rs 64,180 crore.
- Broader vision of health: The Finance Minister also projected a broader vision of health beyond healthcare by merging allocations to water, sanitation, nutrition and air pollution control with the health budget.
- Under the Ayushman Bharat umbrella the Digital Health Mission was launched in September 2021.
- The Health Infrastructure Mission, launched in October 2021, was a renamed and augmented version of the PMASBY.
- These missions join the two other components of Ayushman Bharat launched in 2018.
- The Comprehensive Primary Health Care (CPHC) component is nested in the National Health Mission (NHM) while the Pradhan Mantri Jan Arogya Yojana (PMJAY) is steered by the National Health Authority (NHA).
Way forward
- While much of the following needs to be done by the states, the Centre should incentivise and support such efforts by the states.
- Link synergically: Primary healthcare services under the CPHC and linkage with water, sanitation, nutrition and pollution control programmes will strengthen the capacity of the health system for health promotion and disease prevention.
- The budget of 2022 must not only fund these missions adequately but indicate how they will link synergically while functioning under different administrative agencies.
- Allocate more funds: The NHM received only a 9.6 per cent increase in the 2021 budget.
- PMJAY did not see an increase in allocation last year, because its utilisation for non-Covid care declined sharply in the previous year.
- More importantly, limiting cost coverage to hospitalised care reduces the PMJAY’s capacity to significantly lower out-of-pocket expenditure (OOPE) on health, which is driven mostly by outpatient care and expenditure on medicines.
- Focus on Digital Heath Mission: The Digital Health Mission can enhance efficiency of the health systems in a variety of ways.
- These include better data collection and analysis, improved medical and health records, efficient supply chain management, tele-health services, support for health workforce training, implementation of health insurance programmes, real time monitoring and sharper evaluation of health programme performance along with effective multi-sectoral coordination.
- Improve the skill and number of healthcare workers: We need to increase the numbers and improve the skills of all categories of healthcare providers.
- While training specialist doctors could take time, the training of frontline workers like Accredited Social Health Activists (ASHAs) and Auxiliary Nurse Midwives (ANMs) can be done in a shorter time.
- Upgrade district hospitals: District hospitals need to be upgraded, with greater investment in infrastructure, equipment and staffing.
- In underserved regions, such district hospitals should be upgraded to become training centres for students of medical, nursing and allied health professional courses.
Conclusion

The expanded ambit of health, as defined in last year’s budget, must continue for aligning other sectors to public health objectives. The Union budget of 2022 can add further momentum to our health system transformation.

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January 31, 2022
Extinguishing the tobacco industry’s main narrative
Context

There is no doubt that tobacco use is highly detrimental to public health. We have to find the ways and the means to reduce the demand for tobacco among existing as well as aspiring users.

Impact of tobacco
- Tobacco is a product that kills more than 13 lakh Indians every year.
- Annual burden: The annual economic burden from tobacco use is estimated to be ₹177,340 crore which is more than 1% of India’s GDP.
- About 27 crore people above the age of 15 years and 8.5% of school-going children in the age group 13-15 years use tobacco in some form in India.
Are price and tax measures effective against tobacco use?
- When tobacco products become more expensive, people either quit using them or use them less, and it incentivises many to not initiate the habit.
- Because it hurts both revenue and profits, the tobacco industry, globally, is always devising tactics and narratives that will pre-empt any kind of tax increases on tobacco products.
- The narrative of “increasing illicit trade” is something the tobacco industry has historically used to pre-empt potential tax increases on tobacco products in most countries around the world.
- The story is no different in India.
- In a recent report by the Tobacco Institute of India, it was said that the illicit cigarette volume in India has grown by 44% from 2011 to 2019 while adding that high and increasing tax rates provide a profitable opportunity for tax evasion and encourage growth in illegal trade.
- A study published in 2018 which used a survey of empty cigarette packs collected from retail outlets across different cities in India estimated that illicit cigarettes constitute 2.7% of the market.
- The second study published in 2020 used tax-gap analysis to estimate that the percentage of illicit cigarettes was 5.1% in 2009-10 and 6.6% in 2016-17.
Are taxes and prices key determinants of illicit trade?
- It is to be noted that taxes and prices are not the key determinants of illicit trade.
- There is sufficient evidence in the literature on illicit trade in cigarettes that shows tax increases only have a minimal impact, if at all, on illicit trade.
- There are several countries where tobacco taxes are quite high and yet have low levels of illicit trade, while there are also countries with high levels of illicit trade despite having relatively low tax rates.
- Several factors such as the quality of tax administration, the strength of the regulatory framework, government commitment to control illicit trade, the strength of governance, social acceptance, and the presence of informal distribution networks are known to play a larger role in determining the scale and the extent of an illicit market.
Way forward
- WHO protocol: Eliminating all forms of illicit trade in tobacco products through a package of measures is one of the major objectives of the Protocol to Eliminate Illicit Trade in Tobacco Products under the World Health Organization’s Framework Convention on Tobacco Control.
- The Protocol provides the tools and the measures to eliminate or minimise illicit trade which includes strong governance, establishing an international track and trace system, and securing supply chains.
- India has already ratified the World Health Organization Protocol and it should now show leadership in implementing these measures to effectively address even the relatively lower levels of illicit trade.
Conclusion

There is no scientific or public health rationale not to increase tax on tobacco products for unfounded fear of increasing illicit trade.

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January 7, 2022
Worrying trends in nutrition indicators in NFHS-5 data
Context

The NFHS-5 factsheets for India and all states and Union territories are now out. At first glance, it appears to be a mixed bag — much to cheer about, but concern areas remain.

Positives from the NFHS-5 survey
- Change in demographic trends: For the first time since the NFHS 1992-93 survey, the sex ratio is slightly higher among the adult population.
- Improvement in sex ratio at birth: For the first time in 15 years that the sex ratio at birth has reached 929 (it was 919 for 1,000 males in 2015-16).
- The total fertility rate has also dropped from 2.2 per cent to a replacement rate of 2 per cent, albeit with not much change in the huge fertility divide between the high and low fertility states.
- Improvement in literacy level of women: There has been an appreciable improvement in general literacy levels and in the percentage of women and men who have completed 10 years or more of schooling, which has reached 41 per cent and 50.2 per cent respectively.
- Improvements in health indicators: The health sector deserves credit for achieving a significant improvement in the percentage of institutional births, antenatal care, and children’s immunisation rates.
- There has also been a consistent drop in neonatal, infant and child mortality rates — a decrease of around 1 per cent per year for neonatal and infant mortality and a 1.6 per cent decrease per year for under five mortality rate.
Nutrition: Area of concern
- Increase in anaemic people: India has become a country with more anaemic people since NFHS-4 (2015-16), with anaemia rates rising significantly across age groups, ranging from children below six years, adolescent girls and boys, pregnant women, and women between 15 to 49 years.
- Why anaemia is a concern? Adverse effects of anaemia affect all age groups — lower physical and cognitive growth and alertness among children and adolescents, and lesser capacity to learn and play, directly impacting their future potential as productive citizens.
- Further, anaemia among adolescent girls (59.1 per cent) advances to maternal anaemia and is a major cause of maternal and infant mortality and general morbidity and ill health in a community.
- The detailed report will explain why a dedicated programme like Anaemia Mukt Bharat which focused on IFA consumption failed to gain impetus.
- Slow pace of improvement in nutritional indicators: Between NFHS 4 and NFHS 5, the percentage of children below five years who are moderately underweight has reduced from 35.8 per cent to 32.1 per cent.
- Moderately stunted children have fallen from 38.4 per cent to 35.5 per cent, moderately wasted from 21 per cent to 19.3 per cent and severely wasted have increased slightly from 7.5 per cent to 7.7 per cent.
- Inadequate diet: The root cause for this is that the percentage of children below two years receiving an adequate diet is a mere 11.3 per cent, increasing marginally from 9.6 per cent in NFHS-4.
Way forward
- India’s nutrition programmes must undergo a periodic review.
- The Integrated Child Development Services (ICDS), which is perceived as the guardian of the nation’s nutritional well-being must reassess itself and address critical intervention gaps, both conceptually and programmatically, and produce rapid outcomes.
Conclusion

The nutritional deficit which ought to be considered an indicator of great concern is generally ignored by policymakers and experts. Unless this is addressed, rapid improvement in nutritional indicators cannot happen.

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January 7, 2022
HC allows woman to terminate 28-week pregnancy
The Delhi High Court has permitted a 28-week pregnant woman to undergo medical termination of pregnancy on account of substantial foetal abnormality.

What did the HC rule?

Ans. Termination of Pregnancy is a matter of Right
- The High Court said the woman cannot be deprived of the freedom to take a decision to continue or not to continue with the pregnancy, due to foetal abnormalities.
- HC ruled that reproductive choice is a dimension of personal liberty that is enshrined in Article 21 of the Constitution.
- It stated that allowing the pregnancy to continue would have a deleterious impact on the petitioner’s mental health.
- The petitioner cannot be deprived of the freedom to take a decision to continue or not to continue with the pregnancy in view the medical board’s opinion.
What is the Medical Termination of Pregnancy (MTP) Act?
- Abortion in India has been legal under various circumstances for the last 50 years with the introduction of MTP Act in 1971.
- The Act was amended in 2003 to enable women’s accessibility to safe and legal abortion services.
Termination of pregnancy is permitted for a broad range of conditions up to 20 weeks of gestation as detailed below:
1. Threat to mother: When the continuation of pregnancy is a risk to the life of a pregnant woman or could cause grave injury to her physical or mental health;
2. Child abnormalities: When there is substantial risk that the child, if born or dead would be seriously handicapped due to physical or mental abnormalities;
3. Rape survivors: When pregnancy is caused due to rape (presumed to cause grave injury to the mental health of the woman);
4. Failure of contraception: When pregnancy is caused due to failure of contraceptives used by a married woman or her husband (presumed to constitute grave injury to mental health of the woman).
Conditions for abortion
- The MTP Act specifies – (i) who can terminate a pregnancy; (ii) till when a pregnancy can be terminated; and (iii) where can a pregnancy be terminated.
- There must be an opinion formed of a doctor, that the pregnancy would cause a risk to the life of the pregnant woman or grave injury to her physical or mental health.
- When a pregnancy exceeds 20 weeks but not 24 weeks, termination is permissible on the opinion formed of two registered medical practitioners.
What was the recent case?
- In the present case, the woman has completed 28 weeks of pregnancy.
- As the MTP Act does not permit pregnancy termination beyond 24 weeks, she approached the court.
- Various anomalies were found in the heart of the foetus in the foetal ECG.
Key issues

There are differing opinions with regard to allowing abortions.
- One opinion is that terminating a pregnancy is the choice of the pregnant woman and a part of her reproductive rights.
- The other is that the state has an obligation to protect life, and hence should provide for the protection of the foetus.
- Across the world, countries set varying conditions and time limits for allowing abortions, based on foetal health, and risk to the pregnant woman.
Conclusion
- Access to abortion facilities is limited not just by legislative barriers but also the fear of judgment from medical practitioners.
- It is imperative that healthcare providers be sensitized towards being scientific, objective and compassionate in their approach to abortions.
Also read

Termination of Pregnancy (MTP) Amendment Bill, 2020

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January 3, 2022