Despite four months of protests by doctors across India, the union health ministry has cleared a proposal that will allow homeopaths, ayurveda doctors and even registered midwives to perform non-invasive abortions.

In October 2014, the ministry had proposed a draft bill of amendments to the Medical Termination of Pregnancy Act, which has so far allowed only registered medical practitioners – MBBS doctors – to perform abortions. The new amendment, which will now be sent to the Union cabinet for approval, wants to extend that qualification to registered healthcare providers in general, which would include auxiliary nurse midwives and doctors of homoeopathy, ayurveda, unani and siddha medicine. The government’s aim is to increase access to safe abortions for women.

Traditional allopathic doctors view this as an appalling move that could compromise the health and safety of women seeking a termination of pregnancy. The Indian Medical Association, a national body representing 2.5 lakh allopathic doctors, has formally opposed the amendment in a letter to the prime minister and health minister Dr Harsh Vardhan.

Allopathic doctors believe that healthcare providers and practitioners of alternative medicine can never be adequately trained to deal with complex abortion procedures or emergency situations.

“Conducting abortions requires specific training and expertise because the doctor should be able to detect complications and know how to solve them,” said Dr Neena Bahl, a gynaecologist who performs abortions at her Delhi clinic. Bahl is also a member of the Indian Medical Association. “As an allopath, I would never dispense homoeopathic or ayurvedic medicines to patients because those are not my branches of study.”

Doctors at the IMA also fear that the modified law, if passed, could encourage quacks and promote female foeticide.

Shared discontent

Allopathic doctors are not alone in their opposition to this particular amendment proposed in the draft abortion bill. Many prominent homoeopathy and ayurveda doctors themselves object to the idea of being given a free rein to terminate pregnancies for women.

Prominent among them is the Indian Homoeopathic Medical Association, an organisation representing homoeopaths across the country. “As an association, we are strongly against this proposition, because we simply don’t have the practical experience or training to deal with the complications of abortions,” said Dr VK Ajithkumar, the national vice president of the Association.

Even with training, Ajithkumar believes it would not be a good decision to permit homoeopaths, ayurvedic doctors and particularly midwives to perform abortions.

“An abortion is largely a surgical procedure for which you need gynaecologists,” he said. “If this amendment is approved, it would compromise the credibility of homoeopathy.”

Among ayurvedic doctors too, there are significant voices of protest. Doctors at Jiva Ayurveda, a healthcare company offering ayurveda services across most of India, believe the proposed amendment could lead to many medical practitioners taking advantage of the situation at the risk of women’s health.

“Ayurveda does have oral medicines for terminating pregnancies, but they almost always lead to incomplete abortions,” said Dr. Pankaj Patil, a Faridabad-based consultant at Jiva Ayurveda. “As such, ayurvedic doctors cannot be trained to perform abortions but if they are allowed to, they could take advantage of it.”

Contrary views

There are, of course, some doctors who believe there is a degree of merit to the government’s proposal to grant more kinds of healthcare providers the right to conduct abortions, particularly pill-based abortions that don’t require surgery.

“Even allopathic doctors need specialised training to be able to carry out an abortion,” said Dr Praveen Raj, managing director of the IHMA School of Homoeopathy in Mangalore. “Expertise is based on the number of hours of training one receives, so the law should specify a measurable amount of time for training all kinds of doctors.”

Predominantly, pro-amendment doctors view the situation from the perspective of rural populations in remote areas of the country, who have very little access to basic healthcare. “Trained midwives often do a good job of handling deliveries in such areas, so why not train them for abortions too?” he said.

In cases of complications such as an internal rupture or excessive bleeding, however, Raj and other doctors unanimously acknowledge the need for a qualified, allopathic gynaecologist.

“Ayurvedic doctors do study some amount of modern medicine as part of their courses, so with preliminary training, they can help people with abortions in remote areas,” said Dr G Vinod Kumar, president of the Ayurveda Medical Association of India.  “But if there is a very serious problem during an abortion, one would obviously need to go to a gynaecologist in a hospital.”