NEW DELHI: The proposed new Medical Termination of Pregnancy (MTP) Amendment Draft Bill to allow ayurvedacharyas, homoeopaths and nurses to conduct MTP has triggered a debate on patient safety versus access to healthcare.The government’s proposal was apparently formulated taking a cue from a study conducted by Population Council . The NGO had suggested that expansion of healthcare providers to legally perform abortion services will result in increasing access to safe abortion. But most allopathic practitioners are concerned that abortion by untrained professional may put patients at risk and encourage unethical practices.“Expanding the number and type of providers able to legally perform abortion services, including manual vacuum aspiration (MVA) and medical abortion (MA), could greatly expand women’s access to safe abortion and save many lives each year,” Population Council opines in a note on the issue.However, Indian Medical Association (IMA), a pan India voluntary organization with a membership of 2.5 lakh allopathic practitioners, has strongly opposed the government’s proposal. IMA argues the proposal to permit non MBBS doctors and paramedical staff to conduct MTPs is against the provisions of the Clinical Establishments Act, which does not recognize even paramedical personnel trained by the doctors for conducting medical procedures.“MTP is a procedure meant to be conducted by an allopathic doctor only and cannot be conducted by the paramedical staff on their own or by any other pathies as they are not at all well equipped to handle critical medical conditions arising out of excessive bleeding in some cases specially during incomplete abortions as a result of procedures and prescriptions provided by untrained and unauthorized medical or paramedical professionals during and after MTPs,” said Dr Narendra Saini of IMA.However, World Health Organisation (WHO) also seems to endorse the government’s proposal. A technical and policy guidance for health systems by WHO released in 2012 states, “Abortion care can be safely provided by any properly trained health-care provider, including midlevel providers....(e.g. midwives, nurse practitioners, clinical officers, physician assistants, family welfare visitors, and others) who are trained to provide basic clinical procedures related to reproductive health…”Traditionally, mid-wives or dai have played a key role in catering to urgent medical needs, especially attending to pregnant women for child delivery or even for abortion, in rural areas and villages that lacked medical facilities. Though with time government health centres and private players have reached many such villages, mid-wives continue to exist and attend to many emergencies even today.Estimates show, in India around seven million abortions are conducted every year. Out of this 50 per cent of the abortions are conducted illegally. The rates of maternal death attributed to complications from unsafe abortions are estimated at eight per cent.Public health experts say while there is a dearth of doctors and skilled providers, mainly in distant villages, legal restrictions are holding many non-MBBS but trained paramedics or healthcare providers from performing abortion. “Because of legal restrictions, many trained professions opt for the illegal route to perform abortions. By introducing provisions in the law to make it legal, government can ensure proper training of such professionals while also enabling regulation and monitoring,” says Vinoj Manning, Country Director, IPAS, a non-profit organization that works to increase women's ability to exercise their sexual and reproductive rights, and to reduce maternal mortality.However, the deficiency cannot be filled by substandard solutions, says Dr Anoop Misra, former professor of medicines at AIIMS and chairman Fortis CDOC hospital. Ágrees, Dr Mala Srivastava, senior consultant-gynaecology at Ganga Ram Hospital . “Without proper training and qualification, MTP procedures can result in incomplete abortions and infections which can be hazardous for patients,” says Dr Srivastava.